a 1 Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
b 2 Divisions of Hepato-Biliary-Pancreatic Surgery and Liver transplantation, Japanese Red Cross Medical Center, 4-1-22 Hiroo, Shibuya-ku, Tokyo, 150-8935, Japan.
Expert Rev Anti Infect Ther. 2015;13(11):1307-17. doi: 10.1586/14787210.2015.1091724. Epub 2015 Sep 28.
Asunaprevir, a second-generation NS3 protease inhibitor of hepatitis C virus (HCV), exhibits strong antiviral activity against HCV genotypes 1 and 4, but relatively weak activity against genotypes 2 and 3. For chronic HCV infection, asunaprevir with daclatasvir as an interferon-free dual treatment achieves a sustained virologic response of nearly 90% in genotype 1b, and a triple regimen with beclabuvir achieves an sustained virologic response >90%. Asunaprevir and daclatasvir dual treatment can be safely and effectively administered to liver transplant recipients with recurrent HCV. The major drawback of asunaprevir is its low threshold to resistance, which can be overcome by combining it with other direct-acting antivirals. Further studies of asunaprevir in combination with other direct-acting antivirals for the treatment of patients with HCV genotypes 1 or 4 and renal impairment or end-stage renal disease under hemodialysis, HIV-coinfection and liver and/or kidney transplant recipients are warranted.
asunaprevir 是一种第二代丙型肝炎病毒 (HCV) NS3 蛋白酶抑制剂，对 HCV 基因型 1 和 4 具有很强的抗病毒活性，但对基因型 2 和 3 的活性相对较弱。对于慢性 HCV 感染，无干扰素的 asunaprevir 联合 daclatasvir 双治疗方案在基因型 1b 中可实现近 90%的持续病毒学应答，三联方案联合 beclabuvir 可实现>90%的持续病毒学应答。asunaprevir 和 daclatasvir 双治疗方案可安全有效地用于肝移植后复发 HCV 的患者。asunaprevir 的主要缺点是其耐药性阈值较低，可通过与其他直接作用抗病毒药物联合使用来克服。有必要进一步研究 asunaprevir 与其他直接作用抗病毒药物联合用于治疗基因型 1 或 4 且有肾功能损害或终末期肾病行血液透析、HIV 合并感染以及肝和/或肾移植受者的 HCV 患者。
