Souvignet Claude, Lejeune Olivier, Trepo Christian
Hospices Civils de Lyon, Hôtel Dieu, Service d'Hépatologie et Gastroentérologie, 69002 Lyon, France.
Biochimie. 2007 Jun-Jul;89(6-7):894-8. doi: 10.1016/j.biochi.2007.04.017. Epub 2007 May 8.
The treatment of patients with chronic hepatitis C has rapidly evolved in the past 10 years centered on the use of interferon alpha 2 as an antiviral and immunomodulatory agent against hepatitis C virus. Firstly used as a monotherapy associated with a deceiving long-term efficacy, interferon alpha was then combined with ribavirin, a nucleoside analog with large antiviral properties. Combination of both drugs dramatically improved the efficacy of treatment with 50% of patients reaching a sustained viral response, characterized by the final eradication of the virus from the infected individual. Surprisingly, this synergistic effect remains greatly unexplained. The third step consisted in the use of pegylated interferon in order to adapt its pharmacokinetics and to allow a better efficacy with a more tolerable dosing schedule: once weekly subcutaneous injection instead of thrice weekly. Pegylated interferon combined with ribavirin during 24-48 weeks of treatment is the current standard of care with nearly 60% of sustained virologic response, overall. Development of new forms of interferon alpha are on the way with promising preliminary results.
在过去10年中，慢性丙型肝炎患者的治疗方法迅速演变，主要围绕使用α-2干扰素作为抗丙型肝炎病毒的抗病毒和免疫调节剂展开。α-2干扰素最初作为单一疗法使用，长期疗效令人失望，随后与利巴韦林联合使用，利巴韦林是一种具有强大抗病毒特性的核苷类似物。两种药物联合使用显著提高了治疗效果，50%的患者实现了持续病毒学应答，其特征是从感染个体中最终清除病毒。令人惊讶的是，这种协同效应仍未得到很好的解释。第三步是使用聚乙二醇化干扰素，以调整其药代动力学，并通过更易于耐受的给药方案（每周一次皮下注射而非每周三次）实现更好的疗效。聚乙二醇化干扰素与利巴韦林联合进行24至48周的治疗是目前的标准治疗方案，总体上持续病毒学应答率接近60%。新型α-2干扰素正在研发中，初步结果令人期待。
