Divisione di Gastroenterologia, Policlinico S. Orsola - Malpighi, Bologna, Italy.
Dig Liver Dis. 2011 Jun;43(6):425-30. doi: 10.1016/j.dld.2010.10.007. Epub 2010 Nov 18.
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. 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.
二十年前，利巴韦林首次被用于慢性丙型肝炎的治疗。几年后，利巴韦林与干扰素-α联合使用，对丙型肝炎病毒感染显示出显著的协同疗效，使约 50%的患者病毒清除。最近发现丙型肝炎病毒蛋白酶的强效抑制剂并没有取代利巴韦林作为慢性丙型肝炎联合治疗的主要药物。尽管利巴韦林具有这一基本作用，但作用机制以及最佳剂量和治疗持续时间的许多方面仍有待发现或解决。在本综述中，作者回顾了利巴韦林的历史里程碑，并试图阐明利巴韦林作用和应用的更相关特征，以及在管理和优化慢性丙型肝炎治疗中遇到的临床问题。最后，指出了该药在一些最难治疗的患者中潜在的超适应证用途。总之，尽管利巴韦林的疗效存在一些争议，但它对丙型肝炎病毒感染的疗效仍然持久稳定。
