The Era of Direct-acting Antivirals Has Begun

The Beginning of the End for HCV?

Marie-Louise Vachon, M.D., M.Sc.; Douglas T. Dieterich, M.D.

Disclosures

Semin Liver Dis. 2011;31(4):399-409. 

In This Article

Conclusion

After many years of little or no progress in the development of HCV DAAs, 2011 was a watershed year for several reasons. The most clinically significant development was the approval of boceprevir and telaprevir for the treatment of HCV genotype 1. That will revolutionize the treatment of HCV in the clinic and change the landscape of HCV treatment forever because of the dramatically increased SVR demonstrated by both drugs. The Berlin EASL meeting in March of 2011 showcased some equally dramatic and positive results of drugs in development. Among many huge advances in the field, we saw the first 100% SVR for pegIFN/RBV plus PSI-7977 for HCV genotypes 2 and 3, with a shortened course of treatment. The most revolutionary results were revealed by the combination of the PI BMS-650032 and the NS5A inhibitor BMS-790052. In previous null responders to interferon treated with quadruple therapy consisting of a PI, a NS5A inhibitor, pegIFN and RBV, 100% SVR was achieved. This alone would merit a special mention, but the truly groundbreaking results were in the other arm of the study, which combined only the PI and the NS5A compound without pegIFN/RBV. In that arm, an SVR of 36% was achieved demonstrating for first time ever, an interferon-free, RBV-free cure of HCV.

Not only did we have the first FDA, European Medicines Agency (EMEA), and Canadian approvals for the PIs telaprevir and boceprevir in 2011, but we saw the proof of principle that the Holy Grail of HCV therapy is achievable; SVR without interferon. There are dozens of new drugs in clinical development now and many will fall by the wayside, but there are clearly enough that will be approved to reassure us that the future is very bright indeed for DAA treatment of HCV.

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