The current Standard of Care (SoC) combination therapy for
chronic hepatitis C (CHC) is limited by its insufficient efficacy in
some patient groups, the drug side-effects and contraindications
and the high associated costs. There are an increasing number of
therapeutic failures, with patients who do not respond or who
relapse with the available SoC. Assuming there are no changes in
the type of treatment, the projection for the next 20 years is that
the total number of patients with advanced liver disease will be
4-fold higher than today, with nonresponders far exceeding
those actively treated and total medical costs being expected to
triple.
New therapeutic approaches will be especially important for
– Patients with significant adverse events (AEs) associated
with SoC therapy. In clinical trials, AEs imposed dosereduction
in more than 60% of the cases and treatment
withdrawal in 10–15% of cases; in clinical practice, the rate
of treatment discontinuation is substantially higher.
– Treatment-naive and challenging populations. These
include patients infected with viral genotypes 1 and 4
(which are refractory to the current SoC), especially those
Searching for new antiviral therapies | 59
with unfavorable pre-treatment characteristics (high VL,
advanced fibrosis, IL28B unfavorable genotypes CT or TT), as
well as other “difficult-to-treat” populations detailed in
chapter 3.
– Relapsers and nonresponders of all genotypes.
Different treatment options that can either augment the
efficacy of current therapy or potentially result in PegIFNand/
or ribavirin (RBV)-sparing regimens are being extensively
studied. New emerging therapies include
– improved interferon (IFN) alfa formulations (to enhance
efficacy and ease of administration)
– alternative RBV-like molecules (to reduce toxicity)
– direct-acting antivirals (DAAs) that target specific key steps
of the viral life cycle
chronic hepatitis C (CHC) is limited by its insufficient efficacy in
some patient groups, the drug side-effects and contraindications
and the high associated costs. There are an increasing number of
therapeutic failures, with patients who do not respond or who
relapse with the available SoC. Assuming there are no changes in
the type of treatment, the projection for the next 20 years is that
the total number of patients with advanced liver disease will be
4-fold higher than today, with nonresponders far exceeding
those actively treated and total medical costs being expected to
triple.
New therapeutic approaches will be especially important for
– Patients with significant adverse events (AEs) associated
with SoC therapy. In clinical trials, AEs imposed dosereduction
in more than 60% of the cases and treatment
withdrawal in 10–15% of cases; in clinical practice, the rate
of treatment discontinuation is substantially higher.
– Treatment-naive and challenging populations. These
include patients infected with viral genotypes 1 and 4
(which are refractory to the current SoC), especially those
Searching for new antiviral therapies | 59
with unfavorable pre-treatment characteristics (high VL,
advanced fibrosis, IL28B unfavorable genotypes CT or TT), as
well as other “difficult-to-treat” populations detailed in
chapter 3.
– Relapsers and nonresponders of all genotypes.
Different treatment options that can either augment the
efficacy of current therapy or potentially result in PegIFNand/
or ribavirin (RBV)-sparing regimens are being extensively
studied. New emerging therapies include
– improved interferon (IFN) alfa formulations (to enhance
efficacy and ease of administration)
– alternative RBV-like molecules (to reduce toxicity)
– direct-acting antivirals (DAAs) that target specific key steps
of the viral life cycle
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