Department of Internal Medicine I, J W Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt/Main, Germany.
Gut. 2012 May;61 Suppl 1:i36-46. doi: 10.1136/gutjnl-2012-302144.
Until recently, the standard of care (SOC) for patients with chronic hepatitis C virus (HCV) infection has consisted of a combination of pegylated interferon-α [corrected] plus ribavirin, administered for 24- to 48-weeks depending on the HCV genotype. The sustained virologic response rate for this SOC has been only about 50% in patients infected with genotype 1 HCV, the most prevalent genotype in Europe and North America. HCV therapy has been revolutionised recently by the approval of two direct-acting antiviral agents (DAA) against the NS3/4A serine protease for use in genotype 1 HCV, the ketoamide inhibitors boceprevir and telaprevir. The novel SOC marks the beginning of an extraordinary new era in HCV therapy. We review this new SOC with an emphasis on practical issues related to protease inhibitors, e.g. prescribing guidelines, futility rules and management of adverse events. We also give a perspective on what to expect in the coming years. Newer DAA with simplified dosing regimens and/or minimal toxicity which, when used in combination, will lead to viral eradication in most if not all CHC patients who undergo treatment. The novel agents in clinical development are paving the way for future interferon-sparing regimens.
直到最近，慢性丙型肝炎病毒 (HCV) 感染患者的标准治疗 (SOC) 一直包括聚乙二醇干扰素-α [更正]加利巴韦林联合治疗，根据 HCV 基因型，疗程为 24-48 周。在感染 HCV 基因型 1 的患者中，这种 SOC 的持续病毒学应答率仅约为 50%，HCV 基因型 1 是欧洲和北美的最常见基因型。最近，两种针对 NS3/4A 丝氨酸蛋白酶的直接作用抗病毒药物 (DAA) 的批准彻底改变了 HCV 治疗，这些药物可用于 HCV 基因型 1，分别为酮酰胺抑制剂博赛泼维和特拉泼维。新型 SOC 标志着 HCV 治疗的一个非凡新时代的开始。我们重点介绍了与蛋白酶抑制剂相关的实际问题，例如处方指南、无效规则和不良反应管理，以此来回顾这种新的 SOC。我们还展望了未来几年的情况。新型 DAA 具有简化的剂量方案和/或最小的毒性，当联合使用时，将导致大多数（如果不是全部）接受治疗的 CHC 患者的病毒清除。临床开发中的新型药物为未来无干扰素的治疗方案铺平了道路。
