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Therapie der Hepatitis B

Aktueller Stand und Perspektiven

Therapy for hepatitis B

Current situation and perspectives

  • Schwerpunkt: Virushepatitis
  • Published:
Der Gastroenterologe Aims and scope

Zusammenfassung

Die therapeutischen Möglichkeiten bei chronischer Hepatitis B Virus (HBV)-Infektion haben sich in den letzten Jahren erheblich verbessert. Inzwischen sind in Europa vier Medikamente zur Behandlung der chronischen Hepatitis B zugelassen (Standard-Interferon-alpha, Peg-Interferon-α-2a, Lamivudin und Adefovir Dipivoxil) und für die Nukleosid-Analoga Entecavir und Telbivudin wird die Zulassung erwartet. Für die langfristige Kontrolle der HBV-Infektion benötigt die Mehrzahl der HBV-infizierten Patienten eine antivirale Langzeittherapie über mehrere Jahre. Nur bei einem kleinen Prozentsatz der Patienten kann mit einer Kurzzeittherapie (z. B. über 6–12 Monate) eine anhaltende Remission der chronischen Hepatitis B induziert werden. Die mit der Langzeittherapie verbundene Resistenzentwicklung gegenüber Nukleos(t)id-Analoga stellt eine zunehmende Herausforderung im therapeutischen Management der HBV-Infektion dar. Dennoch kann heutzutage bei rechtzeitiger Diagnosestellung durch die etablierten antiviralen Therapiestrategien in den meisten Fällen die Progression der Erkrankung zur Zirrhose und deren Komplikationen verhindert werden. Der Frühdiagnose der chronischen Hepatitis B durch HBsAg-Screening bei Risikogruppen bzw. Patienten mit erhöhten Transaminasen kommt daher eine entscheidende Bedeutung im Management der HBV-Infektion zu.

Abstract

Many advances have been made over the past decade in the treatment of chronic hepatitis B; in particular, the availability of new drugs has opened better strategies for the control of viral replication. There are at least four licensed therapies for HBV infection: the immunomodulators interferon-alpha and peginterferon-alpha 2a as well as the nucleos(t)ide analogues lamivudine and Adefovir Dipivoxil while the nucleoside-analogues entecavir and telbivudine will be approved in the near future.

To control HBV-infection, long-term treatment for several years is needed for most of the patients. In only a small proportion of the patients can sustained remission be achieved after a short-term treatment of 6–12 months. Unfortunately, long-term treatment with the nucleos(t)ide is associated with a major risk of developing drug resistance. Strategies to achieve sustained responses and concepts to prevent progression to cirrhosis, as well as drug resistance, will be outlined in this communication.

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  1. Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Universitätsklinikum Charité Campus Virchow-Klinikum, Augustenburger Platz 1, 13553, Berlin

    T. Berg

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Berg, T. Therapie der Hepatitis B. Gastroenterologe 1, 117–125 (2006). https://doi.org/10.1007/s11377-006-0021-1

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  • DOI: https://doi.org/10.1007/s11377-006-0021-1

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