Treatment of hepatitis C: Results in real life
Treatment of hepatitis C: Results in real life
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DOI：
10.1111/liv.13638
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发表时间：
2018-02-01
影响因子：
6.7
通讯作者：
Hezode, Christophe
中科院分区：
文献类型：
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作者：
Hezode, Christophe
直接作用抗病毒药物（DAA）已经改变了丙型肝炎病毒（HCV）感染的传统治疗选择。在临床试验中，DAA组合已被证明在降低慢性HCV感染的负担方面非常有效，并且已被欧洲肝脏研究协会（EASL）治疗指南推荐。本综述检查了第二代DAA组合在基因型1 -3患者和合并感染HIV患者（基因型4-6的真实数据很少见）的临床实践中的结果。第二代DAA（索非布韦加达卡他韦、索非布韦/ledipasvir、奥比他韦/帕利匹韦/利托那韦加达沙布韦、索非布韦加维帕他韦、格列匹韦加匹布他韦、格拉佐匹韦加elbasvir）具有非常高的SVR率和良好的安全性特征、更高的耐药屏障并且更方便。所有3种基因型的真实世界数据通常支持EASL指南，并且推荐方案报告了较高的总体持续病毒学应答率。然而，只有索非布韦加达卡他韦、索非布韦/ledipasvir、奥比他韦/帕利匹韦/利托那韦加达沙布韦的真实数据可用。此外，由于现有的证据水平，很难根据真实世界的数据（即，治疗持续时间，何时包括利巴韦林和肝硬化患者的选择）定义最佳方案。还讨论了管理HIV合并感染患者的现实挑战，显示避免DAA和抗逆转录病毒药物之间的药物相互作用的额外负担。
Direct-acting antivirals (DAAs) have transformed traditional treatment options for hepatitis C virus (HCV) infection. DAA combinations have been shown to be highly effective in reducing the burden of chronic HCV infection in clinical trials and have been recommended by the European Association for the Study of the Liver (EASL) treatment guidelines. This review examines the results of second-generation DAA combinations in real-life clinical practice in patients with genotypes1-3 and in those co-infected with HIV (real-world data in genotypes 4-6 are rare). Second generation DAAs (sofosbuvir plus daclatasvir, sofosbuvir/ledipasvir, ombitasvir/paritaprevir/ritonavir plus dasabuvir, sofosbuvir plus velpatasvir, glecaprevir plus pibrentasvir, grazoprevir plus elbasvir) have very high SVR rates and good safety profiles, higher resistance barriers and are more convenient. Real-world data in all 3 genotypes generally support the EASL guidelines and high overall sustained virological response rates are reported with recommended regimens. However, real-world data are only available for sofosbuvir plus daclatasvir, sofosbuvir/ledipasvir, ombitasvir/paritaprevir/ritonavir plus dasabuvir. Furthermore, because of the existing level of evidence, it is difficult to define optimal regimens based on real-world data (ie, treatment duration, when to include ribavirin and options for patients with cirrhosis). The real-life challenges of managing HIV-coinfected patients are also discussed showing the additional burden of avoiding drug-drug interactions between DAAs and antiretrovirals.