Federation d'Hépatologie, CHU de Limoges, Limoges, France.
Dig Liver Dis. 2011 Nov;43(11):850-5. doi: 10.1016/j.dld.2011.04.002. Epub 2011 May 18.
Ribavirin remains today a pivotal drug in the treatment of hepatitis C; in standard double therapy, as well as in triple combination with direct antiviral agents, ribavirin reduces relapse and can double the sustained virological response obtained with peginterferon alone or in association with direct antiviral agents. In the complex network of interacting factors determining sustained virological response independently of known predictive factors related to host and virus, two modern tools are emerging: polymorphisms in the IL28B gene and very early exposure to ribavirin. The use of a pharmacokinetic-pharmacodynamic model of early ribavirin exposure to adjust the dose individually would help promote a safer ribavirin use and improve sustained virological response. The variability of the influence of ribavirin exposure on anaemia is probably genetically determined; however, the low prevalence of the implicated protective alleles of the inosine triphosphate pyrophosphatase gene could explain their lack of influence on sustained virological response.
利巴韦林至今仍是治疗丙型肝炎的重要药物；在标准的双联治疗中，以及与直接抗病毒药物的三联治疗中，利巴韦林可降低复发率，并可将单用聚乙二醇干扰素或与直接抗病毒药物联合治疗获得的持续病毒学应答提高一倍。在决定持续病毒学应答的相互作用因素的复杂网络中，有两个现代工具正在出现：IL28B 基因的多态性和利巴韦林的早期暴露。使用利巴韦林早期暴露的药代动力学-药效学模型来个体化调整剂量，将有助于促进更安全的利巴韦林使用和提高持续病毒学应答。利巴韦林暴露对贫血影响的可变性可能是由遗传决定的；然而，肌苷三磷酸焦磷酸酶基因的保护性等位基因的低患病率可能解释了它们对持续病毒学应答的影响。
