University of Chicago Medical Center, Chicago, IL, USA.
Liver Int. 2015 Jan;35 Suppl 1:11-7. doi: 10.1111/liv.12715.
Within the last few years, treatment of chronic hepatitis C infection has progressed beyond regimens containing the first-wave direct-acting antiviral agents (DAAs) boceprevir and telaprevir, which had high pill burdens as well as low efficacy and safety in treatment-experienced patients. Triple therapy regimens with newer second-wave DAAs combined with pegylated interferon (PEG-IFN) and ribavirin (RBV), have shown rates of sustained virological response never before achieved with previous regimens in treatment-naïve genotype 1 (HCV-1) patients. Additionally, increased response rates have been found with quadruple agent therapy in prior non-responders, partial-responders, and relapsers, including those with cirrhosis. This review will focus on the second-wave DAAs including protease inhibitors (PI), nucleotide inhibitors, and NS5B inhibitors combined with PEG-IFN and RBV for both treatment-naïve and treatment-experienced genotype 1 hepatitis C virus (HCV-1) infected patients. The current standard of care for treatment-naïve HCV-1 is the second-wave PI, sofosbuvir, plus PEG-IFN/RBV and sofosbuvir plus the second-wave nucleotide inhibitor simeprevir with or without RBV in treatment-experienced HCV-1 patients. These recommendations could change, especially for treatment-experienced patients based on the positive results obtained with the newest quadruple therapy studies.
在过去的几年中，慢性丙型肝炎感染的治疗已经超越了含有第一代直接作用抗病毒药物（DAAs）博赛泼维与特拉泼维的方案，这些药物的药丸负担沉重，且在治疗经验丰富的患者中的疗效和安全性较低。新型第二代 DAA 联合聚乙二醇干扰素（PEG-IFN）和利巴韦林（RBV）的三联疗法方案，在治疗初治基因型 1（HCV-1）患者方面显示出了前所未有的持续病毒学应答率，而这些方案在以前的方案中是无法达到的。此外，在先前无应答者、部分应答者和复发者中，包括肝硬化患者，四联药物治疗也发现了更高的应答率。本文将重点介绍第二代 DAA，包括蛋白酶抑制剂（PI）、核苷酸抑制剂和 NS5B 抑制剂，联合 PEG-IFN 和 RBV，用于治疗初治和治疗经验丰富的基因型 1 丙型肝炎病毒（HCV-1）感染患者。对于治疗初治 HCV-1 的标准治疗方案是第二代 PI，索非布韦，加 PEG-IFN/RBV，以及在治疗经验丰富的 HCV-1 患者中，索非布韦加第二代核苷酸抑制剂西米普韦，联合或不联合 RBV。这些建议可能会发生变化，特别是对于治疗经验丰富的患者，因为新的四联药物治疗研究取得了积极的结果。
