New therapies for chronic hepatitis C infection: a systematic review of evidence from clinical trials

TY - JOUR

T1 - New therapies for chronic hepatitis C infection

T2 - a systematic review of evidence from clinical trials

AU - Lee, L. Y.

AU - Tong, C. Y. W.

AU - Wong, Terry

AU - Wilkinson, Mark

PY - 2012/4

Y1 - 2012/4

N2 - Introduction: Hepatitis C virus (HCV) affects approximately 3% of the world population. The current standard of care for treatment of HCV is a combination of pegylated interferon and ribavirin. Approximately 10% of patients will stop treatment and 30% of patients require dose reduction because of side effects. For genotype 1 HCV-infected patients, only 40% of patients will achieve undetectable viral load 26 weeks posttreatment.  Aims: The objectives of this review were to identify new treatments that are in clinical trials. These include boceprevir and telaprevir which are in routine clinical use and form part of the American Association for the Study of Liver Diseases (AASLD) 2011 guidelines as well as drugs based on observational studies, improving/modifying ribavirin or interferon- based therapies, modifying the host response and finally the use of direct- acting antiviral agents (DAA).  Materials and methods: MEDLINE and EMBASE databases were searched from 2008 to 2011 for treatments for hepatitis C. Furthermore, abstracts and poster presentations for the annual European Association Study of the Liver, AASLD, Digestive Disease Week and Asian Pacific Association for the study of the Liver were searched for relevant material.  Results: All four classes of DAA; NS3/NS4a serine protease inhibitors, cyclophilin inhibitors, NS5b polymerase inhibitors and NS5a inhibitors, show good success rates. Trials have been performed without ribavirin or interferon and demonstrate good antiviral activity with a decreased side effect profile. Combinations of DAA are a promising area of research with a high success rate.  Conclusions: Clinical trials show that future HCV therapy could be personalised, achieve higher success rates with decreased adverse incidents.

AB - Introduction: Hepatitis C virus (HCV) affects approximately 3% of the world population. The current standard of care for treatment of HCV is a combination of pegylated interferon and ribavirin. Approximately 10% of patients will stop treatment and 30% of patients require dose reduction because of side effects. For genotype 1 HCV-infected patients, only 40% of patients will achieve undetectable viral load 26 weeks posttreatment.  Aims: The objectives of this review were to identify new treatments that are in clinical trials. These include boceprevir and telaprevir which are in routine clinical use and form part of the American Association for the Study of Liver Diseases (AASLD) 2011 guidelines as well as drugs based on observational studies, improving/modifying ribavirin or interferon- based therapies, modifying the host response and finally the use of direct- acting antiviral agents (DAA).  Materials and methods: MEDLINE and EMBASE databases were searched from 2008 to 2011 for treatments for hepatitis C. Furthermore, abstracts and poster presentations for the annual European Association Study of the Liver, AASLD, Digestive Disease Week and Asian Pacific Association for the study of the Liver were searched for relevant material.  Results: All four classes of DAA; NS3/NS4a serine protease inhibitors, cyclophilin inhibitors, NS5b polymerase inhibitors and NS5a inhibitors, show good success rates. Trials have been performed without ribavirin or interferon and demonstrate good antiviral activity with a decreased side effect profile. Combinations of DAA are a promising area of research with a high success rate.  Conclusions: Clinical trials show that future HCV therapy could be personalised, achieve higher success rates with decreased adverse incidents.

KW - PEGYLATED INTERFERON ALPHA-2A

KW - HCV GENOTYPE 1

KW - PLUS PEGINTERFERON ALPHA-2B/RIBAVIRIN

KW - NONNUCLEOSIDE POLYMERASE INHIBITOR

KW - SUSTAINED VIROLOGICAL RESPONSE

KW - TREATMENT-NAIVE SUBJECTS

KW - NS3 PROTEASE INHIBITOR

KW - ANTIVIRAL ACTIVITY

KW - RIBAVIRIN THERAPY

KW - ALBINTERFERON ALPHA-2B

U2 - 10.1111/j.1742-1241.2012.02895.x

DO - 10.1111/j.1742-1241.2012.02895.x

M3 - Literature review

SN - 1368-5031

VL - 66

SP - 342

EP - 355

JO - International Journal of Clinical Practice

JF - International Journal of Clinical Practice

IS - 4

ER -