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Farmacoterapia da hepatite B
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A hepatite B é considerada um grande problema de saúde a nível mundial. É causada pelo vírus da hepatite B, que infeta o fígado conduzindo à inflamação e posterior morte dos hepatócitos. A hepatite B é transmitida através do contacto direto com sangue ou fluidos corporais infetados. O vírus é frequentemente transmitido de mãe para filho no nascimento ou por transmissão horizontal. Esta infeção pode ser aguda ou crónica, e a doença associada varia de assintomática a sintomática. Indivíduos com hepatite B crónica podem passar por diferentes fases clínicas com níveis variáveis de ALT, DNA do VHB e antigénios do VHB. Estes níveis de ALT e DNA do VHB são importantes marcadores a longo prazo que direcionam as decisões para o início do tratamento, bem como a monitorização da resposta ao tratamento.
Atualmente, não é conhecida nenhuma cura para a infeção crónica pelo VHB. Assim sendo, o tratamento visa suprimir a replicação do vírus a níveis indetetáveis, através de fármacos antivirais ou imunomoduladores. Os fármacos atualmente administrados na terapêutica da infeção pelo VHB são os análogos dos núcleos(t)idos e o interferão α peguilado. A administração a longo prazo de um análogo de nucleos(t)ido potente com elevada barreira à resistência viral representa o tratamento preferencial e reduz a incidência do carcinoma hepatocelular. No entanto, o tratamento com interferão alfa peguilado é considerado em doentes com hepatite B crónica ligeira a moderada. Terapêuticas combinadas não são recomendadas.
Crianças infetadas até aos 5 anos, principalmente durante o primeiro ano de vida, são mais propensas a desenvolver infeção crónica. A OMS recomenda a vacinação universal para o VHB, portanto, todos os recém-nascidos devem receber a primeira dose da vacina dentro de 24 horas após o nascimento. Neste sentido, os programas universais de vacinação implementados contra a hepatite B para recém-nascidos têm sido altamente eficazes na redução da incidência e prevalência da hepatite B. Ainda assim, é necessário o desenvolvimento de novas terapêuticas direcionadas às várias etapas do ciclo de vida do VHB assim como fármacos imunomoduladores.
Hepatits B is a major global health problem caused by the hepatitis B virus, which infects the liver and causes inflammation and death of hepatocytes. Hepatitis B is transmitted through direct contact with infected blood or certain bodily fluids. The virus is most commonly transmitted from mother to child at birth or through horizontal transmission. Hepatits B virus infection can be either acute or chronic, and the associated illness ranges in severity from asymptomatic to symptomatic. Individuals with chronic hepatitis B can transition through diferent clinical phases with variable levels of serum ALT activity, HBV DNA and HBV antigens. These levels of serum ALT and HBV DNA are importante predictors of long-term outcome that inform decisons for treatment initiation as well as treatment response. Currently, no cure for chronic HBV infection is available. Treatment aims to suppress virus replication to undetectable levels, either using antiviral agents or immunomodulatory drugs. Current anti-HBV drugs can be categorized into two classes: nucleoside/nucleotide analogues and pegylated interferon-α. The long-term administration of a potent nucleos(t)ide analogue with high barrier to resistance represents the treatment of choice and reduces hepatocellular carcinoma incidence. However, pegylated interferon-alfa treatment can also be considered in mild to moderate chronic hepatitis B patients. Combination therapies are not recommended. Children under 5 years of age who become infected with the virus, particularly during the first year of life, are the most likely to develop chronic infection. The WHO recommends universal vaccination for HBV, therefore all infants should receive the first dose of vaccine within 24 hours of birth. Thus, universal hepatitis B vaccination programes implemented for infants, have been highly effective in reducing the incidence and prevalence of hepatitis B. Even so, novel and more effective therapeutic drugs are needed either targeting differetn steps of HBV life cycle or modulating the host imune system.
Hepatits B is a major global health problem caused by the hepatitis B virus, which infects the liver and causes inflammation and death of hepatocytes. Hepatitis B is transmitted through direct contact with infected blood or certain bodily fluids. The virus is most commonly transmitted from mother to child at birth or through horizontal transmission. Hepatits B virus infection can be either acute or chronic, and the associated illness ranges in severity from asymptomatic to symptomatic. Individuals with chronic hepatitis B can transition through diferent clinical phases with variable levels of serum ALT activity, HBV DNA and HBV antigens. These levels of serum ALT and HBV DNA are importante predictors of long-term outcome that inform decisons for treatment initiation as well as treatment response. Currently, no cure for chronic HBV infection is available. Treatment aims to suppress virus replication to undetectable levels, either using antiviral agents or immunomodulatory drugs. Current anti-HBV drugs can be categorized into two classes: nucleoside/nucleotide analogues and pegylated interferon-α. The long-term administration of a potent nucleos(t)ide analogue with high barrier to resistance represents the treatment of choice and reduces hepatocellular carcinoma incidence. However, pegylated interferon-alfa treatment can also be considered in mild to moderate chronic hepatitis B patients. Combination therapies are not recommended. Children under 5 years of age who become infected with the virus, particularly during the first year of life, are the most likely to develop chronic infection. The WHO recommends universal vaccination for HBV, therefore all infants should receive the first dose of vaccine within 24 hours of birth. Thus, universal hepatitis B vaccination programes implemented for infants, have been highly effective in reducing the incidence and prevalence of hepatitis B. Even so, novel and more effective therapeutic drugs are needed either targeting differetn steps of HBV life cycle or modulating the host imune system.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, 2022, Universidade de Lisboa, Faculdade de Farmácia.
Palavras-chave
Hepatite B Interferão alfa peguilado Análogo núcleos(t)ideo DNA VHB AgHBs Mestrado integrado - 2022