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Ideal oral combinations to eradicate HCV: The role of ribavirin

  • Christophe Hézode
    Correspondence
    Corresponding author. Address: Service d’Hépatologie, Hôpital Henri Mondor, 51 Avenue du maréchal de Lattre de Tassigny, 94000 Créteil, France. Tel.: +33 149812325; fax: +33 149812352.
    Affiliations
    Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, AP-HP, Université Paris-Est, INSERM U955, Créteil, France
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  • Jean-Pierre Bronowicki
    Affiliations
    Department of Hepatology and Gastroenterology, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, INSERM U954, Vandoeuvre-les-Nancy, France
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Published:September 24, 2015DOI:https://doi.org/10.1016/j.jhep.2015.09.009

      Summary

      Current all-oral interferon-free regimens offer sustained virological response (SVR) rates above 90% as well as 12-week treatment durations for the majority of patients with chronic hepatitis C virus (HCV), including treatment-naïve and -experienced patients with or without cirrhosis. There are multiple direct-acting antiviral (DAA) combinations that can be selected to optimize efficacy and safety outcomes. Each of them can be tailored according to different parameters including the use of ribarivin (RBV). For sofosbuvir (SOF)-based combinations, RBV is useful in the following situations: HCV genotype 1, treatment-experienced, cirrhotic patients, or patients with decompensated cirrhosis, and HCV genotype 3, cirrhotic patients. In these situations the addition of RBV allows to shorten the treatment to 12 weeks in the majority of cases and therefore decreases the cost of the treatment. The need of RBV remains to be determined in cirrhotic patients with a SOF plus simeprevir regimen. RBV-containing regimens are recommended in all HCV genotype 1a patients who receive the 3-DAA combination: paritaprevir/r, ombitasvir, dasabuvir. Globally, the addition of RBV to the different combinations of DAA increases slightly the risk of anaemia. However severe anaemia was rare and easily manageable with RBV dose reduction without any impact on SVR.
      In practice, because RBV is cheap and well tolerated when combined with interferon-free regimen, it remains a useful tool to fine tune anti-HCV treatment regimens and optimize their results.

      Abbreviations:

      HCV (hepatitis C virus), SVR (sustained virological response), RBV (ribavirin), IFN (interferon), Peg-IFN (pegylated interferon), DAA (direct-acting antiviral), ALT (alanine transaminase), GTP (guanosine triphosphate), IMPDH (inosine monophosphate dehydrogenase), APRI (aspartate aminotransferase: platelet ratio index), SOF (sofosbuvir), SMV (simeprevir), DCV (daclatasvir), LDV (ledipasvir), ASV (asunaprevir), RAVs (resistance-associated variants), BMS (Bristol-Myers Squibb)

      Keywords

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