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Indexed/Abstracted in: CAB, EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1642
Andrea ARLEO, Alessandra MANGIA
Liver Unit, IRCCS, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
The development of potent antivirals able to directly block multiple step of viral lifecycle (DAAs) led to a revolution in HCV treatment. These compounds are associated with unprecedent high rates of SVR and can be administered orally, regardless of the severity of the associated liver disease, allowing treatment of large number of HCV infected patients. Three main classes of DAAs are currently available, NS3/4 inhibitors, NS5A inhibitors and NS5B inhibitors. They can be combined according to 2 different strategies, the use of a backbone drug with high barrier of resistance as the NS5B inhibitor sofosbuvir, with the addition of a second drug either NS3/4 or NS5A, or the use of more than 1 drug from different classes to simultaneously attack the virus at different sequence sites. DAAs can be administered for 12 or 24 weeks in the majority of patients, although attempts to reduce to 6-8 weeks the treatment duration in patients with baseline favorable characteristics are ongoing. Overall, SVR rates ensured by the currently approved combinations, are 90% or higher. Although cirrhotic patients and in particular patients with decompensated disease may represent a difficult to cure group, data from real life confirm evidence derived from phase III studies, showing improvement in biochemical parameters, even in such a special populations. We can expect, the number of patients with unmet medical needs will decline over time in the next 4 years. This review aims to discuss updated regimens by HCV genotype and to provide a brief summary of the coming strategies.