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Therapie der Hepatitis C bei Patienten mit Zirrhose sowie vor und nach Lebertransplantation

Treatment of hepatitis C in patients with cirrhosis and pre- and post-liver transplantation

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Der Gastroenterologe Aims and scope

Zusammenfassung

Hintergrund

Seit dem Jahr 2014 stehen erstmals Interferon(IFN)-freie Therapiemöglichkeiten zur Behandlung der chronischen Hepatitis-C-Virus(HCV)-Infektion zur Verfügung. Insbesondere für Patienten mit Zirrhose sowie auf der Warteliste zur Lebertransplantation (LT) und auch nach Lebertransplantation haben diese Neuerungen wichtige Implikationen.

Fragestellung

Zusammenfassung der bisherigen Erfahrungen mit den neuen HCV-Therapien vor und nach Lebertransplantation.

Methoden

Daten aus Patientenkohorten, Compassionate-use-Programmen (CUP) und kontrollierten Studien zu den verschiedenen aktuell verfügbaren „direct-acting antivirals“ (DAA) wurden zusammengefasst.

Ergebnisse

Im vergangenen Jahr wurden mit Sofosbuvir (SOF), Simeprevir (SMV), Daclatasvir (DCV) und Ledipasvir (LDV) antivirale Substanzen zugelassen, die in der Kombination miteinander ohne Interferon weitgehend nebenwirkungsfrei und ohne relevante Interaktionen mit Immunsuppressiva hervorragende Heilungsraten erzielen. Die Optionen werden seit Januar 2015 durch die Zulassung der Kombination aus mit Ritonavir geboostertem Paritaprevir/Ombitasvir/Dasabuvir (ABT 450/r/O/D) ergänzt. Zur Anwendung bei Patienten mit fortgeschrittener Leberzirrhose sowie vor und nach Lebertransplantation fehlen zwar bislang zu allen Regimen ausführliche Auswertungen, erste Daten aus kleineren Patientenkohorten und aus CUP sind jedoch sehr vielversprechend.

Schlussfolgerungen

Eine HCV-Reinfektion nach Lebertransplantation ist inzwischen nicht nur behandelbar, sondern auch durch eine rechtzeitige Behandlung der Patienten auf der Transplantationswarteliste zunehmend vermeidbar. Es ist darüber hinaus zu erwarten, dass die chronische HCV-Infektion eine zunehmend seltenere Indikation zur Lebertransplantation wird.

Abstract

Background

In 2014, the first interferon-free regimens were approved for the treatment of patients with chronic hepatitis C virus (HCV). For patients with cirrhosis and in the liver transplant (LT) setting, these regimens are expected to have an important effect, because graft loss due to HCV recurrence is a serious problem after LT.

Objective

To summarize the experience with the new direct-acting antiviral (DAA) agents for patients pre- and post-LT.

Methods

Evidence from patient cohorts, compassionate use programs (CUP), and clinical trials for the use of the new DAAs in cirrhosis and pre- and post-LT was analyzed.

Results

With the approval of sofosbuvir (SOF), simeprevir (SMV), daclatasvir (DCV), and ledipasvir (LDV), several all-oral antiviral combinations are now available which are applicable without relevant adverse effects or drug–drug interactions with immunosuppressants (IS). The combination of ritonavir-boosted paritaprevir/ombitasvir/dasabuvir (ABT450/r/O/D) supplemented the options at the beginning of 2015 but has slight limitations for application after LT due to interactions with IS. So far, data for patients with cirrhosis and LT patients are scarce for all regimens, while reports on smaller cohorts of several interferon-free regimens for patients with cirrhosis, pre-LT or HCV recurrence after LT have achieved good preliminary results and are very promising.

Conclusion

Evaluations of current clinical trials, real-life experiences and evaluations from compassionate use programs are eagerly awaited for this year. So far, HCV reinfection after LT can not only be treated but can also be avoided in the meantime. Moreover, it can be expected that, considering current therapeutic options, HCV as the indication for LT will become even less common.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. K. H. und G. G. haben jeweils Referentenhonorare von den Firmen Bristol-Myers Squibb, Janssen-Cilag, AbbVie, Roche und Gilead erhalten.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Gastroenterologie und Hepatologie, Medizinisches Zentrum, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Deutschland

    K. Herzer & G. Gerken

  2. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland

    K. Herzer

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Correspondence to K. Herzer.

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Herzer, K., Gerken, G. Therapie der Hepatitis C bei Patienten mit Zirrhose sowie vor und nach Lebertransplantation. Gastroenterologe 10, 297–304 (2015). https://doi.org/10.1007/s11377-015-0997-5

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