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Therapie der Koinfektion mit Hepatitis-B und -D: Mono- oder Kombinationstherapien mit Peginterferon, Nukleos(t)idanaloga und/oder Myrcludex?

Treatment of hepatitis B and D coinfection: mono- or combination treatment with peginterferon, nucleos(t)ide analogs and/or myrcludex?

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Zusammenfassung

Die chronische Koinfektion mit dem Hepatitis-B- (HBV) und dem Hepatitis-Delta-Virus (HDV) stellt die schwerste Form der viralen Hepatitiden dar. Die HDV-Infektion führt oft zu einer Leberzirrhose, einer Leberdekompensation und einem hepatozellulären Karzinom (HCC). Bislang stand zur Behandlung der Hepatitis D nur pegyliertes Interferon α‑2a (PEG-IFNα-2a) zur Verfügung, mit dem jedoch Ansprechraten von lediglich 25–40 % erreicht werden konnten. Darüber hinaus ist bekannt, dass es auch noch Jahre nach Beendigung der antiviralen Therapie zu einem späten Relaps der HDV-RNA kommen kann. Erfreulicherweise sind neue Substanzen zur Behandlung der chronischen Hepatitis D in Entwicklung bzw. bereits zugelassen. Der Entry-Inhibitor Bulevirtid und der Prenylierungsinhibitor Lonafarnib werden derzeit bei Patienten mit chronischer Hepatitis D in klinischen Studien der Phase III untersucht. Zusätzlich wurde im Juli 2020 mit Bulevirtid (2 mg/Tag) erstmals ein Entry-Inhibitor zur Behandlung der chronischen Hepatitis D in Europa zugelassen. Die Daten über die Wirksamkeit und Sicherheit dieser neuen antiviralen Medikamente zur Behandlung der Hepatitis D werden hier zusammengefasst.

Abstract

Persistent coinfection with the hepatitis B (HBV) and hepatitis D virus (HDV) represents the most severe form of viral hepatitis. HDV infection often leads to liver cirrhosis, hepatic decompensation, and hepatocellular carcinoma (HCC). So far, treatment options are limited as the only antiviral treatment with proven efficacy against HDV is based on administration of type 1 interferons, in clinical practice pegylated interferon alfa-2a (PEG-IFNα-2a). However, treatment response is still unsatisfactory with 25–40% HDV-RNA suppression. In addition, late HDV RNA relapse has been described during long-term follow-up. Fortunately, new treatment options for patients with chronic hepatitis D are currently under clinical investigation or even approved already. The hepatocyte entry inhibitor bulevirtide and the prenylation inhibitor lonafarnib are currently being explored in patients with chronic hepatitis D in phase III clinical studies. In addition, in July 2020, bulevirtide (2 mg/day) was approved in the European Union for the treatment of chronic hepatitis D. We provide a summary of data regarding the efficacy of these new antiviral drugs and the existing safety data on treatment of HDV infection.

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  1. Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    Katja Deterding

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Correspondence to Katja Deterding.

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K. Deterding weist auf folgende Beziehungen hin: Vortragshonorare und Reisekostenerstattung von Gilead, MSD/Merck, Falk, Alnylam, AbbVie.

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Stefan Zeuzem, Frankfurt am Main

Heiner Wedemeyer, Hannover

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Deterding, K. Therapie der Koinfektion mit Hepatitis-B und -D: Mono- oder Kombinationstherapien mit Peginterferon, Nukleos(t)idanaloga und/oder Myrcludex?. Gastroenterologe 16, 433–441 (2021). https://doi.org/10.1007/s11377-021-00565-9

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