Page 14 - The Flying Publisher Guide to Hepatitis C Treatment

14 | Hepatitis C Treatment

The primary goal of treatment for CHC is to obtain a sustained
virological response (SVR), defined as undetectable HCV RNA
level at 6 months after treatment completion. Long-term
follow-up studies have shown that 97-100% of sustained
responders retain undetectable HCV RNA in serum, and, in many
cases, also in liver and peripheral blood mononuclear cells,
strongly suggesting that SVR is associated with eradication of
HCV infection. SVR can be also attained, even if at lower rates,
in patients with extensive fibrosis or cirrhosis, decreasing the
risk of HCC development and improving the overall survival
rates (Dieterich 2009).
The decision to treat or not to treat is made on an
individualized basis. Treatment should be considered for all
infected patients, particularly for those at risk for progression of
liver disease. However, treatment regimens and treatment
inclusion criteria have changed over time, as new therapeutic
approaches are developed and more individualized regimens are
introduced. As we will see in chapter 4, in May 2011, The US Food
and Drug Administration (FDA) has approved two new drugs –
both viral protease inhibitors – to be used in combination with
PegIFN/RBV for the treatment of CHC genotype 1 infection:
– Boceprevir (Victrelis™, Merck)
– Telaprevir (Incivek™, Vertex Pharmaceuticals Inc.)
Interferons (IFNs) are cytokines with species-specific, but non-
virus-specific antiviral, immunomodulatory and anticellular
activities. PegIFN derives from attachment of an inert
polyethyleneglycol (Peg) chain – a unique polymer that does not
have a definite tertiary structure – to conventional IFN-alfa. This
confers an improved pharmacokinetic profile for the drug, by
slowing subcutaneous absorption, reducing degradation and
clearance and prolonging its half-life. PegIFN maintains high
sustained plasma IFN levels that allow for weekly dosing
(compared with 3 times weekly administration of standard IFN),
while also reducing its adverse side effects (AEs) and
immunogenicity.