Hepatitis C Treatment From “Response‐guided” to “Resource‐guided” therapy in the transition era from IFN‐containing to IFN‐free regimens

Abstract Peginterferon/ribavirin has been the standard‐of‐care for chronic hepatitis C virus (HCV) infections: 48‐week for genotype 1 or 4 (HCV‐1/4) and 24‐week for HCV‐2/3. Response‐guided therapy recommended shorter 24‐week and 16‐week regimens for HCV‐1 with lower baseline viral loads (LVL, <400,000‐800,000 IU/ml) and rapid virological response (RVR, undetectable HCV RNA at week 4) and HCV‐2/3 with RVR, respectively; and extending to 72 and 48 weeks for HCV‐1 slower responders and HCV‐2 non‐RVR patients, respectively, to improve the efficacy. The progress of directly‐acting‐antivirals (DAA), moving from interferon‐containing regimens in 2011 to interferon‐free regimens in 2013, has greatly improved the treatment success. Interferon‐containing regimens include boceprevir or telaprevir or simeprevir or daclatasvir plus peginterferon/ribavirin, 24‐48 weeks, for HCV‐1 or 4. However, adding these DAA has no benefit for HCV‐1 with LVL/RVR. Instead, 12‐week sofosbuvir plus peginterferon/ribavirin attained SVR rates of >90% for HCV‐1/3‐6. Interferon‐free regimens include two main categories: NS5B nucleotide inhibitor (sofosbuvir)‐based regimens and NS3/4A inhibitor/NS5A inhibitor‐based regimens (daclatasvir/asunaprevir, paritaprevir/r/ombitasvir/dasabuvir and grazoprevir/elbasvir). 8‐24 weeks interferon‐free regimens could achieve SVR rates of 82%‐99% for corresponding HCV genotypes. Although the newly DAA i...
Source: Journal of Gastroenterology and Hepatology - Category: Gastroenterology Authors: Tags: Review Article Source Type: research