New direct-acting antiviral agents for the treatment of hepatitis C virus infection and perspectives
- 1Department of Internal Medicine I, J W Goethe University Hospital, Frankfurt/Main, Germany
- 2Division of Gastroenterology and Hepatology, Center for the Study of Hepatitis C, NewYork–Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
- Correspondence to Dr Christoph Welsch, Department of Internal Medicine I, J W Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany;
Until recently, the standard of care (SOC) for patients with chronic hepatitis C virus (HCV) infection has consisted of a combination of pegylated interferon-N1 plus ribavirin, administered for 24- to 48-weeks depending on the HCV genotype. The sustained virologic response rate for this SOC has been only about 50% in patients infected with genotype 1 HCV, the most prevalent genotype in Europe and North America. HCV therapy has been revolutionised recently by the approval of two direct-acting antiviral agents (DAA) against the NS3/4A serine protease for use in genotype 1 HCV, the ketoamide inhibitors boceprevir and telaprevir. The novel SOC marks the beginning of an extraordinary new era in HCV therapy. We review this new SOC with an emphasis on practical issues related to protease inhibitors, e.g. prescribing guidelines, futility rules and management of adverse events. We also give a perspective on what to expect in the coming years. Newer DAA with simplified dosing regimens and/or minimal toxicity which, when used in combination, will lead to viral eradication in most if not all CHC patients who undergo treatment. The novel agents in clinical development are paving the way for future interferon-sparing regimens.
- Antiviral therapy
- hepatitis C
- new standard of care
- protease inhibitor
Competing interests SZ has served as a consultant for Abbott, Achillion, Anadys, BMS, Boehringer, Gilead, iTherX, Janssen, Merck, Novartis, Pfizer, Pharmasset, Roche, Santaris, Tibotec and Vertex. IMJ has served as a consultant for Abbott, Achillion, Boehringer-Inghelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen/Tibotec, Merck, Novartis, Pfizer, Pharmasset, Roche/Genentech and Vertex, and as a speaker for Bristol-Myers Squibb, Gilead, Merck and Vertex. The remaining authors disclose no competing interests.
Provenance and peer review Commissioned; externally peer reviewed.