Department of Hepato-Gastroenterology, Hospital Saint Joseph, Marseille, France.
Liver Int. 2012 Feb;32 Suppl 1:113-9. doi: 10.1111/j.1478-3231.2011.02702.x.
Of all hepatitis C virus (HCV) patients, those with cirrhosis are most in need of treatment because of increased morbidity and mortality. Treatment with pegylated-interferon (PEG-IFN) and ribavirin (RBV) (PR) has definitely shown the benefits of successful treatment by improving fibrosis, causing the regression of cirrhosis and reducing and preventing cirrhosis-related complications. However, the sustained virological response (SVR) is lower in patients with cirrhosis. First generation protease inhibitors (boceprevir and telaprevir) in combination with PR are a major advancement in the treatment of both naïve and treatment-experienced genotype 1 patients. In naïve patients, the SVR rate with the triple regimen with boceprevir was increased by 14% in patients with severe fibrosis or cirrhosis compared with PR. This benefit was lower than that observed in patients with mild or moderate fibrosis (30%). The SVR rate of the triple regimen with telaprevir was increased by 10-30% compared with PR in patients with severe fibrosis or cirrhosis compared with nearly 30% in patients with mild or moderate fibrosis. In treatment-experienced patients, previous relapsers have the highest increase in SVR with the triple regimen compared with PR, whatever the status of fibrosis. Previous partial or non-responder patients with cirrhosis had lower SVR rates than those without cirrhosis. However, the benefits of telaprevir and boceprevir vs PR was maintained. Previous non-responder patients with cirrhosis benefited the least from treatment. The relapse rate was always higher and side effects were more frequent in patients with cirrhosis compared with those without. First generation protease inhibitors plus PR appear to be a new step forward in the management of HCV genotype 1 patients with cirrhosis.
所有丙型肝炎病毒 (HCV) 患者中，由于发病率和死亡率增加，肝硬化患者最需要治疗。聚乙二醇干扰素 (PEG-IFN) 和利巴韦林 (RBV) (PR) 的治疗确实通过改善纤维化、使肝硬化逆转以及减少和预防肝硬化相关并发症显示出成功治疗的益处。然而，肝硬化患者的持续病毒学应答 (SVR) 较低。第一代蛋白酶抑制剂（博赛泼维、特拉泼维）联合 PR 在治疗初治和治疗经验丰富的基因型 1 患者方面取得了重大进展。在初治患者中，与 PR 相比，严重纤维化或肝硬化患者三联疗法中博赛泼维的 SVR 率增加了 14%。这一获益低于轻度或中度纤维化患者（30%）。与 PR 相比，严重纤维化或肝硬化患者三联疗法中特拉泼维的 SVR 率增加了 10-30%，而轻度或中度纤维化患者的 SVR 率接近 30%。在治疗经验丰富的患者中，与 PR 相比，既往复发患者的三联疗法 SVR 增加最高，无论纤维化状况如何。既往部分或无应答且伴有肝硬化的患者的 SVR 率低于无肝硬化患者。然而，与 PR 相比，博赛泼维和特拉泼维的获益仍然存在。既往无应答且伴有肝硬化的患者从治疗中获益最少。与无肝硬化患者相比，肝硬化患者的复发率始终较高，且副作用更频繁。第一代蛋白酶抑制剂联合 PR 似乎是肝硬化丙型肝炎基因型 1 患者治疗的新进展。
