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Title: New approaches in the treatment of hepatitis C.
Authors: González-Grande, Rocío
Jiménez-Pérez, Miguel
González Arjona, Carolina
Mostazo Torres, José
metadata.dc.contributor.authoraffiliation: Liver Transplantation and Hepatology Unit, UGC de Aparato Digestivo, Hospital Regional Universitario, Malaga, Spain.
Keywords: Hepatitis C;Treatment;Direct acting antiviral agents;Patients;Outcome;Hepacivirus;Hepatitis C crónica;Humanos;Interferones;Trasplante de hígado;Oligopéptidos;Prolina;Sistema de registros;Ribavirina;Sociedades científicas;Antivíricos;Estudios de cohortes;Testimonio experto;Genómica;Genotipo
metadata.dc.subject.mesh: Medical Subject Headings::Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Antiviral Agents
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies
Medical Subject Headings::Health Care::Health Care Economics and Organizations::Social Control, Formal::Jurisprudence::Expert Testimony
Medical Subject Headings::Disciplines and Occupations::Natural Science Disciplines::Biological Science Disciplines::Biology::Genetics::Genomics
Medical Subject Headings::Phenomena and Processes::Genetic Phenomena::Genotype
Medical Subject Headings::Organisms::Viruses::Hepatitis Viruses::Hepacivirus
Medical Subject Headings::Diseases::Virus Diseases::Hepatitis, Viral, Human::Hepatitis C::Hepatitis C, Chronic
Medical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans
Medical Subject Headings::Chemicals and Drugs::Biological Factors::Intercellular Signaling Peptides and Proteins::Interferons
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Surgical Procedures, Operative::Transplantation::Organ Transplantation::Liver Transplantation
Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Peptides::Oligopeptides
Medical Subject Headings::Chemicals and Drugs::Amino Acids, Peptides, and Proteins::Amino Acids::Amino Acids, Cyclic::Imino Acids::Proline
Medical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Registries
Medical Subject Headings::Chemicals and Drugs::Nucleic Acids, Nucleotides, and Nucleosides::Nucleosides::Ribonucleosides::Ribavirin
Medical Subject Headings::Health Care::Health Care Economics and Organizations::Organizations::Societies::Societies, Scientific
Issue Date: 28-Jan-2016
Publisher: Baishideng Publishing Group Inc
Citation: González-Grande R, Jiménez-Pérez M, González Arjona C, Mostazo Torres J. New approaches in the treatment of hepatitis C. World J Gastroenterol. 2016; 22(4):1421-32
Abstract: About 130-170 million people, is estimated to be infected with the hepatitis C virus (HCV). Chronic HCV infection is one of the leading causes of liver-related death and in many countries it is the primary reason for having a liver transplant. The main aim of antiviral treatment is to eradicate the virus. Until a few years ago the only treatment strategy was based on the combination of pegylated interferon and ribavirin (PEG/RBV). However, in genotypes 1 and 4 the rates of viral response did not surpass 50%, reaching up to 80% in the rest. In 2011 approval was given for the first direct acting antiviral agents (DAA), boceprevir and telaprevir, for treatment of genotype 1, in combination with traditional dual therapy. This strategy managed to increase the rates of sustained viral response (SVR) in both naive patients and in retreated patients, but with greater toxicity, interactions and cost, as well as being less safe in patients with advanced disease, in whom this treatment can trigger decompensation or even death. The recent, accelerated incorporation since 2013 of new more effective DAA, with pan-genomic properties and excellent tolerance, besides increasing the rates of SVR (even up to 100%), has also created a new scenario: shorter therapies, less toxicity and regimens free of PEG/RBV. This has enabled their almost generalised applicability in all patients. However, it should be noted that most of the scientific evidence available is based on expert opinion, case-control series, cohort studies and phase 2 and 3 trials, some with a reduced number of patients and select groups. Few data are currently available about the use of these drugs in daily clinical practice, particularly in relation to the appearance of side effects and interactions with other drugs, or their use in special populations or persons with the less common genotypes. This situation suggests the need for the generalised implementation of registries of patients receiving antiviral therapy. The main inconvenience of these new drugs is their high cost. This necessitates selection and prioritization of candidate patients to receive them, via strategies established by the various national organs, in accordance with the recommendations of scientific societies.
Description: Journal Article; Review;
metadata.dc.identifier.doi: 10.3748/wjg.v22.i4.1421
ISSN: 2219-2840 (Online)
1007-9327 (Print)
Appears in Collections:01- Artículos - Hospital Regional de Málaga

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