Special Issue: Proceedings of the 6th Paris Hepatitis Conference, International Conference on the Management of Patients with Viral Hepatitis
Volume 33, Issue Supplement s1, pages 105–110, February 2013
Patients with HCV and F1 and F2 fibrosis stage: treat now or wait?
- hepatitis C virus treatment;
- protease inhibitors;
- polymerase inhibitors;
HCV hepatitis C virus
RVR rapid virological response
SOC standard of care
SVR sustained virological response
The current standard of care (SOC) for the treatment of chronic hepatitis C virus (HCV) genotype 1 is the combination of a protease inhibitor, peginterferon (PEG-IFN) and ribavirin (RBV) . Two protease inhibitors are currently available: boceprevir and telaprevir. Either of these triple therapy combinations is significantly more effective in achieving a sustained virological response (SVR) than the previous SOC, PEG-IFN/RBV [2-5]. An improvement in SVR with triple therapy is observed in nearly all patient populations (treatment-naïve or prior PEG-IFN/RBV failure) and subpopulations (race, ethnicity, degree of fibrosis, viral load or IL28B status).
|1||Simeprevir||Peginterferon + ribavirin||2013–2014|
|1||Faldaprevir||Peginterferon + ribavirin||2013–2014|
|1,4,5,6||Sofosbuvir||Peginterferon + ribavirin||2013–2014|
|1||Sofosbuvir + GS5855||Ribavirin||Unknown|
|1||Faldaprevir + BI207127||± ribavirin||Unknown|
|1||ABT-450 + ABT-267 + ABT-333 + ritonavir||Ribavirin||Unknown|
These events have made healthcare providers question whether they should continue to treat patients with chronic HCV using our currently available therapy or wait until the next generation of medications is available. This manuscript will discuss the pros and cons of this dilemma.
Results with our current therapies – The argument to treat now
Future protease inhibitors – The argument to wait
Future polymerase inhibitors – The argument to wait
Interferon free therapies – The argument to wait longer
- Gilead: sobosfovir a nucleotide polymerase inhibitor in combination with several doses of GS-5855 an NS5A inhibitor with and without RBV for either 12 or 24 weeks.
- Abbott: ABT-450 a protease inhibitor, ABT-267 an NS5A inhibitor, ABT-333 a non-nucleoside polymerase inhibitor, and RBV all administered for 12 weeks.
- Boehringer Ingelheim: faldaprevir, BI207127 a non-nucleoside polymerase inhibitor, and RBV for 16 or 24 weeks.
Marketing of these treatments will depend upon the SVR rates achieved in the trials and whether companion studies in patients previously treated with PEG-IFN/RBV (with or without a protease inhibitor) are required for regulatory approval. Although these studies are very encouraging, actually deferring current HCV therapy for an interferon-free regimen may take several years, and thus waiting may not be appropriate for all patients with HCV.
Genotypes 2 and 3
The impact of disease severity
|Treat now||Delay treatment|
|Previous treatment||Naïve Prior relapse Prior partial response||Prior null response|
|Interferon||Relative contraindication or previous intolerance|
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