Desirable Characteristics of Hepatitis C Treatment Regimens: A Review of What We Have and What We Need.
Desirable Characteristics of Hepatitis C Treatment Regimens: A Review of What We Have and What We Need.
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DOI：
10.1007/s40121-016-0118-x
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发表时间：
2016-09
影响因子：
5.4
通讯作者：
Patel N
中科院分区：
文献类型：
--
作者：
Bidell MR;McLaughlin M;Faragon J;Morse C;Patel N
慢性丙型肝炎（HCV）感染的治疗已经取得了巨大进展。这在很大程度上是由于批准了几种直接作用的抗病毒剂（DAA），这些抗病毒剂来自各种药物类别，具有新的作用机制。这些疗法是一个受欢迎的进步，因为与基于聚乙二醇干扰素和利巴韦林（RBV）的方案相比，它们的疗效和耐受性有所改善。这些方便的全口服方案治疗各种基因型，通常在各种HCV感染人群中提供高治愈率。虽然这些疗法有一些好处，但也有明显的缺点。缺点包括难以治疗的人群（失代偿性肝硬化、活性物质滥用患者、晚期肾病等）对连续性RBV的反应减弱或需要，针对选择的基因型的活性、实质性的药物-药物相互作用潜力和高成本。因此，虽然目前基于DAA的疗法有几个有利的属性，但每个也有其局限性。本综述的目的是（1）确定理想的HCV治疗方案的特征，（2）描述现有方案的理想特征，（3）总结现有方案的局限性，（4）介绍有前途的新兴疗法。这份手稿将作为评估未来HCV治疗方案质量的指南。
There have been dramatic advancements in the treatment of chronic hepatitis C (HCV) infection. This is largely due to the approval of several direct-acting antiviral agents (DAAs) from a variety of medication classes with novel mechanisms of action. These therapies are a welcomed advancement given their improved efficacy and tolerability compared to pegylated interferon and ribavirin (RBV)-based regimens. These convenient, all-oral regimens treat a variety of genotypes and often offer high cure rates in a variety of HCV-infected populations. While there are several benefits associated with these therapies, there are also notable shortcomings. Shortcomings include diminished response or need for adjunctive RBV in difficult-to-treat populations (decompensated cirrhosis, active substance abuse patients, advanced kidney disease, etc.), activity against select genotypes, substantial drug–drug interaction potential, and high cost. Therefore, while current DAA-based therapies have several favorable attributes, each also has its limitations. The purpose of this review is to (1) identify the characteristics of an ideal HCV treatment regimen, (2) describe desirable features of existing regimens, (3) summarize limitations of existing regimens, and (4) introduce promising emerging therapies. This manuscript will serve as a guide for evaluating the caliber of future HCV treatment regimens.