Di Marco Lorenza, Cannova Simona, Ferrigno Emanuele, Landro Giuseppe, Nonni Rosario, Mantia Claudia La, Cartabellotta Fabio, Calvaruso Vincenza, Di Marco Vito
SIcilian Network for Therapy, Epidemiology and Screening In Hepatology (SINTESI), 90127 Palermo, Italy.
Department of Oncology and Hematology, Azienda Ospedaliero-University Hospital of Mod, 41124 Modena, Italy.
Viruses. 2025 Jan 24;17(2):163. doi: 10.3390/v17020163.
The treatment landscape for hepatitis C virus (HCV) infection has transformed over the past few decades, evolving from the limited efficacy of interferon (IFN) monotherapy to the highly successful pan-genotypic direct-acting antivirals (DAAs) used today. Initially, alpha-interferon monotherapy, introduced in the 1990s, was the standard treatment, yet it provided low sustained virological response (SVR) rates and caused significant adverse effects, limiting its utility. The development of pegylated interferon (peg-IFN) improved the pharmacokinetic profile of IFN, allowing for less frequent dosing and modestly improved response rates. When combined with ribavirin, peg-IFN achieved higher SVR rates, especially in non-genotype 1 HCV infections, but the combination also brought additional side effects, such as anemia and depression. The advent of the first-generation DAAs, such as telaprevir and boceprevir, marked a significant milestone. Combined with peg-IFN and ribavirin, these protease inhibitors boosted response rates in patients with genotype 1 HCV. However, high rates of adverse effects and drug resistance remained challenges. Second-generation DAAs, like sofosbuvir and ledipasvir, introduced IFN-free regimens with improved safety profiles and efficacy. The most recent advances are pan-genotypic DAAs, including glecaprevir-pibrentasvir and sofosbuvir-velpatasvir, which offer high SVR rates across all genotypes, shorter treatment durations, and fewer side effects. Current pan-genotypic regimens represent a cornerstone in HCV therapy, providing an accessible and effective solution globally.
在过去几十年中,丙型肝炎病毒(HCV)感染的治疗格局发生了转变,从干扰素(IFN)单药治疗效果有限,发展到如今使用的极为成功的泛基因型直接抗病毒药物(DAA)。最初,20世纪90年代引入的α干扰素单药治疗是标准疗法,但它的持续病毒学应答(SVR)率较低,且会引起严重不良反应,限制了其应用。聚乙二醇化干扰素(peg-IFN)的研发改善了IFN的药代动力学特征,减少了给药频率,应答率也略有提高。当与利巴韦林联合使用时,peg-IFN实现了更高的SVR率,尤其是在非1型HCV感染中,但这种联合用药也带来了额外的副作用,如贫血和抑郁。第一代DAA药物,如特拉匹韦和博赛匹韦的出现,标志着一个重要的里程碑。这些蛋白酶抑制剂与peg-IFN和利巴韦林联合使用,提高了1型HCV患者的应答率。然而,高不良反应率和耐药性仍然是挑战。第二代DAA药物,如索磷布韦和来迪帕司韦,引入了无IFN方案,安全性和疗效有所改善。最新进展是泛基因型DAA药物,包括格卡瑞韦-哌仑他韦和索磷布韦-维帕他韦,它们在所有基因型中都具有高SVR率、更短的治疗疗程和更少的副作用。目前的泛基因型治疗方案是HCV治疗的基石,在全球范围内提供了一种可及且有效的解决方案。
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