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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2016; 22(4): 1421-1432
Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1421
New approaches in the treatment of hepatitis C
Rocío González-Grande, Miguel Jiménez-Pérez, Carolina González Arjona, José Mostazo Torres
Rocío González-Grande, Miguel Jiménez-Pérez, José Mostazo Torres, González Arjona, Liver Transplantation and Hepatology Unit, UGC de Aparato Digestivo, Hospital Regional Universitario, 29010 Malaga, Spain
Author contributions: González-Grande R, Jiménez-Pérez M, González Arjona C and Mostazo Torres J contributed equally to this work.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Miguel Jiménez-Pérez, MD, UGC de Aparato Digestivo, Unidad de Hepatología-Trasplante Hepático, Hospital Universitario Regional de Málaga, Avenida Carlos Haya, 29010 Malaga, Spain. mjimenezp@commalaga.com
Telephone: +34-61-095935 Fax: +34-95-1291941
Received: May 1, 2015
Peer-review started: May 8, 2015
First decision: July 14, 2015
Revised: August 5, 2015
Accepted: October 12, 2015
Article in press: October 13, 2015
Published online: January 28, 2016
Processing time: 264 Days and 11.2 Hours
Abstract

About 130-170 million people, is estimated to be infected with the hepatitis C virus (HCV). Chronic HCV infection is one of the leading causes of liver-related death and in many countries it is the primary reason for having a liver transplant. The main aim of antiviral treatment is to eradicate the virus. Until a few years ago the only treatment strategy was based on the combination of pegylated interferon and ribavirin (PEG/RBV). However, in genotypes 1 and 4 the rates of viral response did not surpass 50%, reaching up to 80% in the rest. In 2011 approval was given for the first direct acting antiviral agents (DAA), boceprevir and telaprevir, for treatment of genotype 1, in combination with traditional dual therapy. This strategy managed to increase the rates of sustained viral response (SVR) in both naive patients and in retreated patients, but with greater toxicity, interactions and cost, as well as being less safe in patients with advanced disease, in whom this treatment can trigger decompensation or even death. The recent, accelerated incorporation since 2013 of new more effective DAA, with pan-genomic properties and excellent tolerance, besides increasing the rates of SVR (even up to 100%), has also created a new scenario: shorter therapies, less toxicity and regimens free of PEG/RBV. This has enabled their almost generalised applicability in all patients. However, it should be noted that most of the scientific evidence available is based on expert opinion, case-control series, cohort studies and phase 2 and 3 trials, some with a reduced number of patients and select groups. Few data are currently available about the use of these drugs in daily clinical practice, particularly in relation to the appearance of side effects and interactions with other drugs, or their use in special populations or persons with the less common genotypes. This situation suggests the need for the generalised implementation of registries of patients receiving antiviral therapy. The main inconvenience of these new drugs is their high cost. This necessitates selection and prioritization of candidate patients to receive them, via strategies established by the various national organs, in accordance with the recommendations of scientific societies.

Keywords: Hepatitis C; Treatment; Direct acting antiviral agents; Patients; Outcome

Core tip: About 130-170 million people, is estimated to be infected with the hepatitis C virus. Chronic hepatitis C is one of the leading causes of liver-related death and in many countries it is the primary reason for having a liver transplant. Until a few years ago the only treatment strategy was based on the combination of pegylated interferon and ribavirin (RBV). Since 2011 the accelerated incorporation of direct acting antiviral agents has created a new scenario: increasing the rates of sustained viral response, shorter therapies, less toxicity and regimens free of interferon and/or RBV and can even modify the natural history of the disease.