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Aktuelle Arzneimitteltherapie der Hepatitis C

Sinnvolle Therapiealgorithmen unter Berücksichtigung ökonomischer Aspekte

Current drug treatment of hepatitis C

Useful therapy algorithms taking into consideration economical aspects

  • Arzneimitteltherapie
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Zusammenfassung

Die Therapie der chronischen Hepatitis-C-Virus(HCV)-Infektion hat sich seit der Zulassung der neuen direkt antiviral wirksamen Medikamente grundlegend verändert. Die Welle der Einführung neuer Substanzen ist seit Sommer 2017 vorerst abgeschlossen. Abhängig vom HCV-Genotyp und dem Schweregrad der Lebererkrankung sind mit einer meist nur 8‑ bis 12-wöchigen antiviralen Therapie Ausheilungsraten von über 95 % bei chronisch HCV-infizierten Patienten die Regel. Die Auswahl der Substanzen bzw. deren Kombination richtet sich unter anderem nach dem Status der Vortherapie, dem Stadium der Leberfibrose, dem HCV-Genotyp bzw. -Subtyp, der Ausgangsviruslast und der Nierenfunktion. Heute kann annähernd jedem Patienten eine kurative und weitestgehend nebenwirkungsfreie Behandlungsmöglichkeit angeboten werden. Die Qualität der Behandlung unter Berücksichtigung des Gebots der Wirtschaftlichkeit ist für Deutschland eindrucksvoll im Deutschen Hepatitis C-Register bestätigt worden. Erste Daten zeigen bereits eine Reduktion klinischer Komplikationen der chronischen Lebererkrankung durch eine Ausheilung der HCV-Infektion.

Abstract

Treatment of chronic hepatitis C (HCV) has changed dramatically since the approval of the direct-acting antivirals (DAA). Depending on the HCV genotype and the stage of liver disease, sustained HCV clearance can be achieved in more than 95% of patients with a treatment duration of 8–12 weeks in most of the cases. The selection and combination of the drugs depends on previous antivirals therapies, the stage of liver fibrosis, HCV genotype and subtype, viral load at baseline, and renal function. Nowadays, potent antiviral therapy with minimal side effects can be offered to almost every patient. In the real-world setting, a high quality of HCV therapy considering economic aspects has been documented in the German Hepatitis C Registry. A reduction of clinical complications of chronic liver disease by clearance of HCV has already been documented.

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Authors and Affiliations

  1. Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    K. Deterding &  M. P. Manns

  2. Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland

    K. Deterding &  H. Wedemeyer

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  1. K. Deterding
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  3. H. Wedemeyer
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Correspondence to K. Deterding.

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Interessenkonflikt

K. Deterding: Reisekostenerstattung und Vortragshonorare von AbbVie, MSD/Merck. M.P. Manns (Stand Juli 2017): Forschungsgelder, Beratungshonorare, Vortragshonorare und Reisekostenerstattung von Roche, Bristol Myers Squibb, Gilead, Merck (MSD), Janssen, AbbVie. Forschungsgelder und Beratungshonorare von Novartis. Forschungsgelder, Beratungshonorare und Reisekostenerstattung von GlaxoSmithKline. H. Wedemeyer: Honorare für Beratungstätigkeit oder Vorträge (vergangene 5 Jahre) von Abbott, AbbVie, BMS, Boehringer Ingelheim, Gilead, JJ/Janssen-Cilag, Merck/Schering-Plough, Novartis, Roche, Roche Diagnostics, Siemens, Transgene. Forschungsgelder von Abbott, AbbVie, BMS, Gilead, Merck, Novartis, Roche, Roche Diagnostics, Siemens.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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M. Wehling, Mannheim

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Deterding, K., Manns, M.P. & Wedemeyer, H. Aktuelle Arzneimitteltherapie der Hepatitis C. Internist 59, 401–409 (2018). https://doi.org/10.1007/s00108-018-0390-9

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