Hepatitis C: Difference between revisions
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==Treatment== | ==Treatment== | ||
Most studies have examined the outcome of sustained virologic response. The Cochrane Collaboration raises the question of whether this is an adequate outcome | Most studies have examined the outcome of sustained virologic response. The Cochrane Collaboration raises the question of whether this is an adequate outcome<ref name="pmid20839385">{{cite journal| author=Brok J, Gluud LL, Gluud C| title=Meta-analysis: ribavirin plus interferon vs. interferon monotherapy for chronic hepatitic C - an updated Cochrane review. | journal=Aliment Pharmacol Ther | year= 2010 | volume= 32 | issue= 7 | pages= 840-50 | pmid=20839385 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20839385 }} </ref> due to a trial that showed virological benefit but not clinical benefit.<ref name="pmid19052125">{{cite journal| author=Di Bisceglie AM, Shiffman ML, Everson GT, Lindsay KL, Everhart JE, Wright EC et al.| title=Prolonged therapy of advanced chronic hepatitis C with low-dose peginterferon. | journal=N Engl J Med | year= 2008 | volume= 359 | issue= 23 | pages= 2429-41 | pmid=19052125 | doi=10.1056/NEJMoa0707615 | pmc=PMC2606037 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19052125 }} </ref> | ||
===Direct acting antiviral (DAA)=== | ===Direct acting antiviral (DAA)=== | ||
Revision as of 09:41, 13 October 2012
Hepatitis C is "inflammation of the liver in humans caused by hepatitis c virus, a single-stranded RNA virus. Its incubation period is 30-90 days. Hepatitis C is transmitted primarily by contaminated blood parenterally, and is often associated with transfusion and intravenous drug abuse. However, in a significant number of cases, the source of hepatitis C infection is unknown."[1]
Treatment
Most studies have examined the outcome of sustained virologic response. The Cochrane Collaboration raises the question of whether this is an adequate outcome[2] due to a trial that showed virological benefit but not clinical benefit.[3]
Direct acting antiviral (DAA)
Direct acting antiviral (DAA) also called Specifically Targeted Antiviral Therapy for HCV (STAT-C) target HCV viral nonstructural proteins essential to replication and life of the virus.
NS3 protease inhibitors
| Trial | Patients | Intervention | Comparison | Outcome | Results | |
|---|---|---|---|---|---|---|
| Intervention | Control | |||||
| ADVANCE Study[4] 2011 |
Previously untreated patients | telaprevir | peginterferon-ribavirin | HCV RNA 24 weeks after last treatment | 69% to 75% | 44% |
| REALIZE Study[5] 2011 |
Previously treated patients | telaprevir | peginterferon-ribavirin | HCV RNA 24 weeks after last treatment | 83% to 88% (prior reponse) 54% to 59% (prior partial response) 29% to 33% (prior non-response) |
24% (prior reponse) 15% (prior partial response) 5% (prior non-response) |
| SPRINT-2 study[6] 2011 |
Previously untreated patients | boceprevir | peginterferon-ribavirin | HCV RNA level | 59% to 66% | 21% |
| HCV RESPOND-2 study[7] 2011 |
Previously treated patients | boceprevir | peginterferon-ribavirin | HCV RNA level | 67% to 68% (nonblack patients) 42% to 53% (black patients) |
40% (nonblack patients) 23% (black patients) |
Two NS3/4A serine protease inhibitors, telaprevir and boceprevir may add benefit to standard therapy of genotype 1 infection with peginterferon and ribavirin. Telaprevir adds to peginterferon and ribavirin for previously treated[4] and untreated[5] patients. Boceprevir adds to peginterferon and ribavirin for previously treated[7] and untreated[6] patients.
The NS3 protease inhibitor, asunaprevir, might help treat hepatitis C.[8]
The NS3/4A protease inhibitor, BI 201335, might help treat hepatitis C.[9]
NS5 replication complex inhibitors
The NS5A replication complex inhibitor, daclatasvir, might help treat hepatitis C.[8]
The NS5B replication complex inhibitor, BI 207127, might help treat hepatitis C.[9]
Screening
The United States Centers for Disease Control and Prevention issued draft recommendation for screening individuals born between 1945 and 1965.[10]
References
- ↑ Anonymous (2024), Hepatitis C (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Brok J, Gluud LL, Gluud C (2010). "Meta-analysis: ribavirin plus interferon vs. interferon monotherapy for chronic hepatitic C - an updated Cochrane review.". Aliment Pharmacol Ther 32 (7): 840-50. PMID 20839385. [e]
- ↑ Di Bisceglie AM, Shiffman ML, Everson GT, Lindsay KL, Everhart JE, Wright EC et al. (2008). "Prolonged therapy of advanced chronic hepatitis C with low-dose peginterferon.". N Engl J Med 359 (23): 2429-41. DOI:10.1056/NEJMoa0707615. PMID 19052125. PMC PMC2606037. Research Blogging.
- ↑ 4.0 4.1 4.2 Zeuzem S, Andreone P, Pol S, Lawitz E, Diago M, Roberts S et al. (2011). "Telaprevir for retreatment of HCV infection.". N Engl J Med 364 (25): 2417-28. DOI:10.1056/NEJMoa1013086. PMID 21696308. Research Blogging.
- ↑ 5.0 5.1 5.2 Jacobson IM, McHutchison JG, Dusheiko G, Di Bisceglie AM, Reddy KR, Bzowej NH et al. (2011). "Telaprevir for previously untreated chronic hepatitis C virus infection.". N Engl J Med 364 (25): 2405-16. DOI:10.1056/NEJMoa1012912. PMID 21696307. Research Blogging.
- ↑ 6.0 6.1 6.2 Poordad F, McCone J, Bacon BR, Bruno S, Manns MP, Sulkowski MS et al. (2011). "Boceprevir for untreated chronic HCV genotype 1 infection.". N Engl J Med 364 (13): 1195-206. DOI:10.1056/NEJMoa1010494. PMID 21449783. Research Blogging.
- ↑ 7.0 7.1 7.2 Bacon BR, Gordon SC, Lawitz E, Marcellin P, Vierling JM, Zeuzem S et al. (2011). "Boceprevir for previously treated chronic HCV genotype 1 infection.". N Engl J Med 364 (13): 1207-17. DOI:10.1056/NEJMoa1009482. PMID 21449784. Research Blogging.
- ↑ 8.0 8.1 Lok AS, Gardiner DF, Lawitz E, Martorell C, Everson GT, Ghalib R et al. (2012). "Preliminary study of two antiviral agents for hepatitis C genotype 1.". N Engl J Med 366 (3): 216-24. DOI:10.1056/NEJMoa1104430. PMID 22256805. Research Blogging.
- ↑ 9.0 9.1 Zeuzem S, Asselah T, Angus P, Zarski JP, Larrey D, Müllhaupt B et al. (2011). "Efficacy of the protease inhibitor BI 201335, polymerase inhibitor BI 207127, and ribavirin in patients with chronic HCV infection.". Gastroenterology 141 (6): 2047-55; quiz e14. DOI:10.1053/j.gastro.2011.08.051. PMID 21925126. Research Blogging.
- ↑ Centers for Disease Control and Prevention (2012) CDC Announces First Ever National Hepatitis Testing Day and Proposes that All Baby Boomers Be Tested Once for Hepatitis C