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No one size fits all—Shortening duration of therapy with direct‐acting antivirals for hepatitis C genotype 1 infection
Author(s) -
El Sherif O.,
Afhdal N.,
Curry M.
Publication year - 2017
Publication title -
journal of viral hepatitis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.329
H-Index - 100
eISSN - 1365-2893
pISSN - 1352-0504
DOI - 10.1111/jvh.12734
Subject(s) - medicine , sofosbuvir , ledipasvir , combination therapy , hepatitis c , genotype , antiviral therapy , ribavirin , viral load , chronic hepatitis , virology , biology , human immunodeficiency virus (hiv) , virus , biochemistry , gene
Summary The advent of shorter duration, highly effective and well‐tolerated interferon‐free therapy now provides an opportunity for virtually all HCV ‐infected individuals to be cured. However, there continues to be a need to simplify and shorten treatment duration. Shortening therapy to 8 weeks with sofosbuvir and ledipasvir can be considered in treatment patients with HCV genotype 1 infection and low baseline viral load. A number of other 8‐week dual and triple therapy direct‐acting antiviral ( DAA ) regimens are in advanced clinical development. Several small studies have further demonstrated the feasibility of 6 weeks of sofosbuvir therapy in combination with an NS 5A inhibitor and a protease inhibitor for HCV genotype 1. Four weeks of therapy with various combinations of the currently available DAA s appears to be suboptimal with poor response rates observed in phase 2 trials. Response‐guided therapy is another promising tool that may allow for shorter therapy but require further research. Shortening therapy and retreating relapsers may be a viable cost‐saving measure, but requires further cost‐benefit analysis and more data on the impact of resistance on retreatment options.