Hepatitis C: Treatment of difficult to treat patients

Table 1 Chronologically listed, Food and Drug Administration approved treatment regimens for hepatitis C virus

HCV (identified in 1989)
Approved drugs 1991-2001
Interferon (approved in 1991)
RBV + standard interferon (1998)
Peg-IFNs (approved in 2001)
Peg-IFN
Peg-IFN + RBV
DAAs 2011-present
Telaprevir and boceprevir
Increase SVR rates and provide the option of response-guided therapy and retreatment for genotype 1 patients
Telaprevir + peg-IFN + RBV, genotype 1 only (2011)
Boceprevir + peg-IFN + RBV, genotype 1 only (2011)
Sofosbuvir
Approved for use in all genotypes. High SVR rates with better tolerability, shorter duration, use in HIV-HCV co-infection, and first interferon-free all-oral regimen in genotype 2, 3 and certain other patients
Sofosbuvir + peg-IFN + RBV, in genotype 1 only (2013)
Sofosbuvir + RBV, without interferon, in genotype 2 and 3, in HIV-HCV co-infection, with any genotype, and in selected situations of genotype 1 (2013)
Simeprevir
High SVR rates with better tolerability and shorter duration for genotype 1
Simeprevir + peg-IFN + RBV, in genotype 1 only (2013)

Adapted from http://www.hepatitis.va.gov. DAAs: Direct acting antivirals; SVR: Sustained virological response; HIV: Human immunodeficiency virus; HCV: Hepatitis C virus; RBV: Ribavirin; Peg-IFN: Pegylated interferon.

Table 2 Currently available Food and Drug Administration approved pharmaceuticals for treatment of hepatitis C virus

Approved treatments for hepatitis C
Brand name	Generic names	Manufacturer name
Sovaldi	SOF	Gilead Sciences
Olysio	SIM	Janssen
Incivek	TVR	Vertex
Victrelis	BOC	Merck and Co.
Pegasys	Peg-IFN	Roche
CoPegus	RBV	Roche
Pegintron	Peg-IFN alpha-2b	Schering
Intron A	IFN alpha-2b	Schering
Rebetol	RBV	Schering
Roferon	IFN alpha-2a	Roche
Infergen	IFN aphacon-1	Three Rivers Pharma

Adapted from http://www.fda.gov/. SOF: Sofosbuvir; SIM: Simeprevir; TVR: Telaprevir; BOC: Boceprevir; RBV: Ribavirin; Peg-IFN: Pegylated interferon.

Table 3 Food and Drug Administration approved and investigational drugs by mechanism of action

HCV NS3/4 protease inhibitors	Nucleos(t)ide HCV NS5Bpolymerase inhibitors	Non-nucleos(t)ide HCVNS5B polymerase inhibitors	HCV NS5A inhibitors
Telaprevir1	Sofosbuvir1	BI-207127	Daclatasvir
Boceprevir1	Mericitabine	VX-222	Ledipasvir
Danoprevir		ABT-333	ABT-267
Simeprevir1		BMS-791325
ABT-450 (with ritonavir)		Tegobuvir
Faldaprevir		GS-9669
Asunaprevir
GS-9451

¹Drugs have received Food and Drug Administration approval. Adapted from http://www.hepatitis.va.gov. HCV: Hepatitis C virus.