COMMENTARY

Sofosbuvir for Hepatitis C: Simpler, Shorter, Safer?

William F. Balistreri, MD

Disclosures

December 03, 2013

In This Article

Aiming for the Ideal Strategy

In 2011, the American Association for the Study of Liver Diseases (AASLD) issued an updated version of its practice guidelines for the treatment of chronic genotype 1 hepatitis C virus (HCV) infection.[1] The current standard-of-care regimens include a protease inhibitor -- telaprevir or boceprevir -- in combination with pegylated interferon (PEG-IFN) and ribavirin. Protease inhibitor-based strategies for patients with genotype 1 HCV have led to high rates of sustained virologic response (SVR); however, there are several recurring concerns.

The disadvantages of IFN treatment are well known. Moreover, this strategy presents a complex and prolonged therapeutic course (24-48 weeks), low tolerability, a low barrier to resistance, and reduced efficacy in prior null responders or cirrhotic patients. These regimens are not an option for many patients because of contraindications or intolerability to IFN.[2,3,4,5,6,7]

To address these concerns, there has been a massive effort to create the ideal agent or strategy for use in updated therapeutic efforts. The pace of discovery has been unprecedented, and several agents are in the later phases of development. The approach has been to discover drugs that directly target various aspects of the HCV life cycle -- hopefully leading to combinations of agents that will more effectively treat patients, while minimizing intolerable side effects or adverse events.

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