Liver Unit, IRCCS Hospital 'Casa Sollievo della Sofferenza', San Giovanni Rotondo, Italy.
Liver Int. 2011 Jan;31(1):36-41. doi: 10.1111/j.1478-3231.2010.02357.x. Epub 2010 Oct 12.
The drugs currently licensed for the treatment of hepatitis C are Peg-Interferon (PEG-IFN) and ribavirin. In recent years, the recommendation to treat hepatitis C virus genotype 2- and 3-infected patients with a fixed 800 mg/day dose of ribavirin in combination with PEG-IFN and for just 24 weeks has been challenged by the concept of tailoring the length of therapy according to on-treatment viral response. Therefore, the objective of the present review was to highlight the different designs of the studies on short treatment duration and the role of wk4-R as a predictor of sustained virological response after an abbreviated course of treatment. The secondary aim was to verify whether we had enough evidence to support the implementation of a short treatment course in subsets of patients with genotype 2 and 3 infection. We will also focus on how drug dosing may have influenced the outcome of treatment. To clarify reasons for discrepant results in the studies so far published, the recently discovered genetic variant near the interleukin 28B gene will be presented and its predictive role will be discussed. Finally, we will face the debated issue of whether the subset of patients with genotype 2 or 3 requires an extended treatment duration.
目前获准用于治疗丙型肝炎的药物是聚乙二醇干扰素(PEG-IFN)和利巴韦林。近年来,根据治疗中病毒反应来调整治疗时间长短的概念,对治疗基因型 2 和 3 感染患者联合使用 PEG-IFN 和利巴韦林,每天固定剂量 800mg,治疗 24 周的建议提出了挑战。因此,本综述的目的是强调短期治疗研究的不同设计以及 wk4-R 作为缩短治疗后持续病毒学应答预测因子的作用。次要目的是验证我们是否有足够的证据支持在基因型 2 和 3 感染患者亚组中实施短期治疗。我们还将重点关注药物剂量如何影响治疗结果。为了阐明迄今为止发表的研究中结果不一致的原因,将介绍最近发现的白细胞介素 28B 基因附近的遗传变异体及其预测作用,并进行讨论。最后,我们将面对基因型 2 或 3 的患者亚组是否需要延长治疗时间的有争议的问题。