Aktueller Stand der Hepatitis-C-Therapie

The approval of two NS3/4A protease inhibitors, boceprevir and telaprevir, as the first directly acting antiviral substances in combination with pegylated (PEG) interferon alfa and ribavirin, markedly changed the treatment of chronic hepatitis C genotype 1 infections. The pivotal studies showed significantly improved rates of sustained virologic response (SVR) of triple therapy combining a protease inhibitor with PEG interferon alfa and ribavirin in the range of 63–75 % in treatment-naïve patients and 59–65 % in treatment-experienced patients compared to 38–44 % and 17–21 %, respectively in the control groups without the protease inhibitor. The standard of care for all other HCV genotypes is still dual combination therapy with PEG interferon and ribavirin. Besides this considerable progress, HCV genotype 1 infected patients with previous null response and with liver cirrhosis showed limited response rates. In addition management of triple therapy is complicated by complex treatment schedules, drug-drug interactions and supplemental side effects, such as aggravation of anemia or a rash. The second generation of direct acting antiviral substances is currently in advanced stages of clinical development and will lead to a shortening and simplification of HCV therapy in addition to further improvement of efficiency including all HCV genotypes and interferon-free therapy.