Current issues in hepatology: treatment of viral hepatitis C
An important topic discussed during U.S. Digestive Awareness Week was new strategies for treating viral hepatitis C, including the ability to prescribe regimens without using interferons.
Combined treatment of viral hepatitis C, including pegylated interferon and ribavirin, has long remained the standard treatment regimen for patients with chronic infection. Despite its great effectiveness, this treatment regimen has a number of serious and even sometimes threatening side effects. As a result, the development and registration of two effective protease inhibitors, telaprevir and boceprevir, have been called a new era in the treatment of patients with viral hepatitis C genotype 1.
According to the results of a number of studies, treatment with developed direct-acting antiviral drugs is the shortest and most effective regimen. For example, in patients with genotype 1 hepatitis C virus, in which standard regimens were not effective in eliminating the virus, the use of these protease inhibitors was significantly more effective; the number of persistent virological responses increased by 2 to 3 times compared to conventional treatment. A report to a plenary meeting of the American Association for the Study of Liver Diseases (AASLD) noted that when using telaprevir in combination with peginterferon and ribavirin, the dose of the latter may be considerably reduced. Reducing the dose of ribaverine to less than 600 mg / day did not affect the frequency of persistent virological response (CBO) in patients receiving this drug in combination with telaprevir. According to the results of another study, the addition of boceprevir to the combination of peginterferon and ribavirin made it possible to obtain a CBO in patients who did not respond to previous treatment.
Despite optimistic views on the possibility of using this regimen for the treatment of viral hepatitis C, it should be remembered that telaprevir and bocepprir should be prescribed in combination with peginterferon and ribavirin. This approach to treatment is far from ideal. Due to poor drug tolerance, many patients refuse to continue treatment or prefer to delay the start of treatment until milder treatment regimens are possible.
However, according to other studies, treatment regimens without the use of interferon are becoming a reality (perhaps even when prescribing treatments without ribavirin). A number of regimens are currently being studied using several different classes of drugs. The development of new drugs brings us closer to the creation of the most advanced therapeutic regimens to avoid injecting interferon.
The researchers noted that in patients with viral hepatitis C 2 and 3 genotypes according to the results of clinical studies, the level of CBO reaches 70-80%. However, in clinical practice, this level was slightly lower - 55-65%. According to the results of the studies presented, the predictors of the ineffectiveness of the prescribed treatment were a daily consumption of alcohol of more than 40 g in terms of pure ethanol, a concomitant infection by HIV, low levels of stimulating hormone thyroid (TSH), cirrhosis and duration of infection. When choosing a treatment regimen, the above factors should be taken into account and, if necessary, strengthen the prescribed treatment.
In addition, data were presented on the main factor responsible for genetic predisposition: the unique nucleotide polymorphism in the ascending region of the gene coding for interleukin 28 V. The CC genotype is the most significant predictor of CBO in patients with genotype 1 hepatitis C during treatment with peginterferon and ribavirin. The relation between the SS genotype and a significant increase in the frequency of spontaneous elimination of the virus has also been shown, both in Caucasian patients and in African-Americans carrying the hepatitis C virus. This information will be evaluated after examining the patients.