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Tratamento da Hepatite C Crónica
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O vírus da hepatite C é o responsável pelo desenvolvimento da hepatite C crónica, que pode evoluir, ao longo dos anos, para cirrose ou carcinoma hepatocelular, tornando-se o prognóstico reservado nestas situações.
A identificação e caracterização deste vírus, em 1989, permitiu o estudo dos vários genótipos do vírus e da evolução da doença hepática, desde a infecção até à hepatite aguda ou crónica. A via de transmissão principal do vírus é através da exposição directa ao sangue contaminado.
O vírus é endémico em muitos locais do mundo, sendo que aproximadamente 3% da população mundial está infectada (170 milhões de pessoas).
O diagnóstico da infecção, aguda ou crónica, requer a determinação dos anticorpos anti-vírus da hepatite C ou do genoma viral, por meio de testes laboratoriais.
O tratamento standard da hepatite C crónica, em doentes com o genótipo 1, engloba o peginterferão alfa em associação com a ribavirina durante 48 semanas, o que resulta numa taxa de resposta virológica mantida em 40-50% dos indivíduos.
A aprovação dos novos fármacos antivirais para os indivíduos com o genótipo 1, como o boceprevir e o telaprevir, contribuiu para o aumento substancial das taxas de resposta virológica rápida e mantida, em comparação com a terapêutica dupla. No entanto, as baixas taxas de resposta em doentes não respondedores à terapêutica prévia, a emergência de resistências e os efeitos adversos associados ao tratamento, levaram à necessidade de se descobrirem novos fármacos antivirais, com mais sensibilidade, maior barreira à resitência viral e com poucos efeitos secundários associados.
Recentemente, foram aprovados o sofosbuvir e o simeprevir. As suas acções contra todos os genótipos do vírus, é uma nova oportunidade para todos os doentes com genótipos que não o 1, até aqui o único contemplado com novos antivirais para além da terapêutica dupla.
Hepatitis C virus is the responsible for the development of chronic hepatitis C, which can progress, over the years, to cirrhosis or hepatocellular carcinoma, becoming the poor prognosis in these situations. The identification and characterization of this virus in 1989, allowed the study of various genotypes of the virus and the development of liver disease, from infection to acute or chronic hepatitis. The main route of transmission of the virus is through direct exposure to contaminated blood. The virus is endemic in many parts of the world, with approximately 3% of the world population infected (170 million people with hepatitis C). The diagnosis of infection, acute or chronic, requires determination of anti-hepatitis C virus antibodies or viral genome by means of laboratory tests. The standard treatment of chronic hepatitis C in patients with genotype 1 encompasses peginterferon alfa in combination with ribavirin for 48 weeks, resulting in a rate of sustained virological response in 40-50% of the individuals. The approval of new antiviral drugs for individuals with genotype 1, Telaprevir and Boceprevir as contributed to the substantial increase in the rates of rapid and sustained virologic response when compared to double therapy. However, the low response rates in patients nonresponders to prior therapy, emergence of resistance and adverse effects associated with treatment, led to the need to discover new antiviral drugs, with greater sensitivity, higher barrier to viral resistance and few associated side effects. Recently, Sofosbuvir and Simeprevir were approved. Their activitys against all genotypes of the virus are a new opportunity for all patients with genotypes other than 1, so far the only one awarded with the new antiviral in addition to dual therapy.
Hepatitis C virus is the responsible for the development of chronic hepatitis C, which can progress, over the years, to cirrhosis or hepatocellular carcinoma, becoming the poor prognosis in these situations. The identification and characterization of this virus in 1989, allowed the study of various genotypes of the virus and the development of liver disease, from infection to acute or chronic hepatitis. The main route of transmission of the virus is through direct exposure to contaminated blood. The virus is endemic in many parts of the world, with approximately 3% of the world population infected (170 million people with hepatitis C). The diagnosis of infection, acute or chronic, requires determination of anti-hepatitis C virus antibodies or viral genome by means of laboratory tests. The standard treatment of chronic hepatitis C in patients with genotype 1 encompasses peginterferon alfa in combination with ribavirin for 48 weeks, resulting in a rate of sustained virological response in 40-50% of the individuals. The approval of new antiviral drugs for individuals with genotype 1, Telaprevir and Boceprevir as contributed to the substantial increase in the rates of rapid and sustained virologic response when compared to double therapy. However, the low response rates in patients nonresponders to prior therapy, emergence of resistance and adverse effects associated with treatment, led to the need to discover new antiviral drugs, with greater sensitivity, higher barrier to viral resistance and few associated side effects. Recently, Sofosbuvir and Simeprevir were approved. Their activitys against all genotypes of the virus are a new opportunity for all patients with genotypes other than 1, so far the only one awarded with the new antiviral in addition to dual therapy.
Descrição
Trabalho Final de Mestrado Integrado, Ciências Farmacêuticas, Universidade de Lisboa, Faculdade de Farmácia, 2014
Palavras-chave
Vírus da hepatite C Hepatite C crónica Ribavirina Peginterferão alfa Boceprevir Telaprevir Simeprevir Sofosbuvir Mestrado Integrado - 2014