Top Abstracts 12/07; Ribavirin for chronic hepatitis C: And the mystery goes on.

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  • Thursday, December 9, 2010
  • Posted by New HCV Drugs
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2010 Nov 17
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Ribavirin for chronic hepatitis C: And the mystery goes on
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Brillanti S, Mazzella G, Roda E.
Divisione di Gastroenterologia, Policlinico S. Orsola - Malpighi, Bologna, Italy
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Abstract
Twenty years ago, ribavirin was first used in the treatment for chronic hepatitis C. After few years, ribavirin, in combination with interferon-alpha, showed a dramatic synergistic efficacy against hepatitis C virus infection, leading to viral clearance in about 50% of patients. Recent discovery of potent inhibitors of hepatitis C virus proteases did not replace ribavirin as the mainstay of combination therapy for chronic hepatitis C
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Despite this fundamental role of ribavirin, many aspects of the mechanism of action and of the optimal dose and duration of therapy remain to be discovered or settled. In the present review, the authors recall the milestones in the history of ribavirin and try to shed light on the more relevant features of ribavirin action and utilization, and on the clinical problems encountered in managing and optimizing treatment for chronic hepatitis C. Finally, some potential off-label use of this drug in most difficult-to-treat subjects is pointed out.
In conclusion, even if a sort of mystery surrounds ribavirin, its efficacy against hepatitis C virus infection fortunately remains lasting and stable.
Copyright © 2010 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
PMID: 21093391 [PubMed - as supplied by publisher]
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Ribavirin (brand names: Copegus, Rebetol, Ribasphere, Vilona and Virazole) is an anti-viral drug indicated for severe RSV infection (individually), hepatitis C infection (used in conjunction with peginterferon alfa-2b or peginterferon alfa-2a) and other viral infections. Ribavirin is a prodrug, which when metabolised resembles purine RNA nucleotides. In this form it interferes with RNA metabolism required for viral replication. How it exactly affects viral replication is unknown; many mechanisms have been proposed for this but none of these has been proven to date. Multiple mechanisms may be responsible for its actions.
The primary observed serious adverse side effect of ribavirin is hemolytic anemia, which may worsen preexisting cardiac disease. The mechanism for this effect is unknown. It is dose-dependent and may sometimes be compensated by decreasing dose. Ribavirin is also a teratogen in some animals species and thus poses a theoretical reproductive risk in humans, remaining a hazard as long as the drug is present, which can be as long as 6 months after a course of the drug has ended.
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TopAbstracts in Hepatitis C
12/07/2010
TopAbstracts™ in Hepatitis C are the abstracts most highly rated/most read by nearly 300,000 physicians who received a Doctor's Guide™ newsletter or visited a website Powered by Doctor's Guide™ in the past 14 days. Over 2000 peer-reviewed journals are covered by TopAbstracts.
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