Was ist gesichert in der Therapie der chronischen Virushepatitis?

Abstract

In the last 10years, a dramatic change has occurred in the treatment of chronic viral hepatitis, particularly in the area of hepatitisB and hepatitisC. Which treatment options of viral hepatitis are scientifically validated and can be recommended for practical use in consideration of current studies on the treatment of viral hepatitis and the German and European guidelines, respectively. The treatment of chronic hepatitisB continues to be based either on a long-term therapy with nucleos(t)ide analogues or a finite therapy with pegylated interferon alpha (PEG-IFN). Treatment of hepatitisD is also based on PEG-IFN; however, the relapse rate is high. The treatment of hepatitis C is currently based on the combination of PEG-IFN and ribavirin (RBV). To estimate the optimal duration of therapy and dosage, knowledge of previous treatments, genotype, and presence of cirrhosis is crucial. For genotype1, the first direct acting antiviral drugs were approved in 2011. These drugs led to a significant increase in treatment success. In the upcoming years another dramatic change in the treatment of hepatitis C is anticipated, including an improved side effect profile, increased efficacy, and a greater degree of customization in difficult-to-treat patients. Acute hepatitisE is usually self-limiting, but can become chronic in immunocompromised patients, i.e., after organ transplantation. Reduction of immunosuppression may clear HEV and RBV shows antiviral efficacy. Currently available therapies have a high disease control or chance for cure in hepatitis B and C. In HepatitisC treatment, a massive change in future therapies is foreseeable. The hepatitisD co-infection remains difficult to treat. For hepatitisE, RBV is a promising off-label treatment option.