Farmacoriflessioni
Cosa deve sapere oggi il pediatra del trattamento dell’epatite C nell’era dei nuovi farmaci antivirali?
What the paediatrician should know about the treatment of hepatitis C in the era of new direct-acting antivirals
Silvio Veraldi, Giuseppe Maggiore
Epatogastroenterologia, Nutrizione e Clinica del Trapianto di Fegato, IRCCS Ospedale Pediatrico “Bambino Gesù”, Roma
Maggio 2024 - pagg. 303 -307 | DOI: 10.53126/MEB43303
Abstract
The treatment of hepatitis C virus (HCV) infection with the new direct-acting antivirals (DAAs) has dramatically modified the natural history of the HCV-related disease, eradicating the virus in over 90% of treated patients, with negligible collateral effects. The high costs of treatment, however, represent a factor that limits patients’ access to therapy and burdens the countries’ healthcare systems. In Italy the estimated cost of treatment for a naïve patient (8/12 weeks) amounts to approximately €5,500 (VAT excluded). HCV liver disease especially affects adults, in Italy the average prevalence of hepatitis C ranges between 2.4% and 3.3% in the general population. The prevalence of hepatitis C in children is significantly lower (0.15%) and the liver disease is rarely progressive in the paediatric age; however, there are not tools capable of interrupting the main route of infection, namely the vertical transmission from the infected mother. The effectiveness and great manageability of these new direct antivirals have also allowed their use in paediatrics starting from three years of age.
Riassunto
Il trattamento dell’infezione da virus dell’epatite C (HCV) con i nuovi antivirali ad azione diretta (DAA) ha drammaticamente modificato la storia naturale della malattia-HCV correlata, eradicando il virus in oltre il 90% dei pazienti trattati, con effetti collaterali trascurabili. I costi elevati della cura, però, rappresentano un fattore limitante l’accesso dei pazienti alla terapia e gravano sui sistemi sanitari dei paesi, spesso a basse risorse. In Italia il costo stimato di un trattamento di un paziente naïve (8/12 settimane) è di: circa 5.500 € ( IVA esclusa). La malattia epatica da HCV riguarda specialmente l’adulto, in Italia la prevalenza media dell’epatite C, si aggira tra il 2,4% e il 3,3% della popolazione generale. Non esistono studi epidemiologici eseguiti sull’intero territorio nazionale sui soggetti potenzialmente candidati al trattamento di eradicazione, ma alcune stime sembrano indicare in un massimo di 600.000 le persone, in cui pianificare la terapia eradicante. La prevalenza dell’epatite C nel bambino è significativamente minore (0.15%) e la malattia epatica è raramente progressiva almeno limitatamente all’età pediatrica, tuttavia non abbiamo strumenti atti a interrompere la principale via di infezione che è la trasmissione verticale dalla madre infetta. L’efficacia e la grande maneggevolezza di questi nuovi farmaci antivirali diretti ha permesso il loro utilizzo anche in età pediatrica liberalizzando il loro uso, che ha pari efficacia rispetto all’adulto, a partire dai tre anni di età.
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Corrispondenza: giuseppe.maggiore@opbg.net