Skip to main content
Log in

Treatment of Hepatitis C in 2011: What Can We Expect?

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Treatment for chronic hepatitis C virus (HCV) infection is the combination of a peginterferon and ribavirin. Although a fixed duration of treatment (24 weeks for patients with genotypes 2 and 3 and 48 weeks for patients with all other genotypes) has been advocated, the best results are likely to be achieved when the duration of therapy is adjusted based on the time to response. According to the principles of response-guided therapy, patients with rapid virologic response have a high rate of sustained virologic response (SVR) and a low rate of relapse, and can be treated for 24 weeks regardless of genotype. In contrast, patients who become HCV RNA undetectable at a slower rate need a longer duration of therapy. Direct-acting antiviral agents are currently being developed to treat patients with HCV genotype 1. These agents will significantly increase rapid virologic response when used with peginterferon and ribavirin; according to the concepts of response-guided therapy, such treatment will yield high rates of SVR with 24 to 28 weeks of treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Fried MW, Shiffman ML, Reddy KR, et al.: Combination of peginterferon alfa-2a (40 kd) plus ribavirin in patients with chronic hepatitis C virus infection. N Engl J Med 2002, 347:975–982.

    Article  CAS  PubMed  Google Scholar 

  2. Manns MP, McHutchinson JG, Gordon SC, et al.: Peginterferon-alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomized trial. Lancet 2001, 358:958–965.

    Article  CAS  PubMed  Google Scholar 

  3. McHutchison JG, Lawitz EJ, Shiffman ML, et al., for the IDEAL study team: Peginterferon alfa-2b or alfa-2a with ribavirin for treatment of hepatitis C infection. N Engl J Med 2009, 361:580–593.

    Article  CAS  PubMed  Google Scholar 

  4. El Makhzangy H, Esmat G, Said M, et al.: Response to pegylated interferon alfa-2a and ribavirin in chronic hepatitis C genotype 4. J Med Virol 2009, 81:1576–1583.

    Article  PubMed  Google Scholar 

  5. Yu ML, Chuang WL: Treatment of chronic hepatitis C in Asia: when East meets West. J Gastroenterol Hepatol 2009, 24:336–345.

    Article  CAS  PubMed  Google Scholar 

  6. Wasley A, Alter MJ: Epidemiology of hepatitis C: geographic differences and temporal trends. Semin Liver Dis 2000, 20:1–16.

    Article  CAS  PubMed  Google Scholar 

  7. Fensterl V, Sen GC: Interferons and viral infections. Biofactors 2009, 35:14–20.

    Article  CAS  PubMed  Google Scholar 

  8. Martin P, Jensen DM: Ribavirin in the treatment of chronic hepatitis C. J Gastroenterol Hepatol 2008, 23:844–855.

    Article  CAS  PubMed  Google Scholar 

  9. • McHutchison JG, Everson GT, Gordon SC, et al.: Telaprevir with peginterferon and ribavirin for chronic HCV genotype 1 infection. N Engl J Med 2009, 360:1827–1838. The combination of telaprevir, peginterferon, and ribavirin yields high rates of RVR and SVR with just 24 weeks’ total duration of therapy.

    Article  CAS  PubMed  Google Scholar 

  10. Hézode C, Forestier N, Dusheiko G, et al.: Telaprevir and peginterferon with or without ribavirin for chronic HCV infection. N Engl J Med 2009, 360:1839–1850.

    Article  PubMed  Google Scholar 

  11. Kwo P, Lawitz EJ, McCone J, et al.: HCV sprint-1: boceprevir plus peginterferon alfa-2b/ribavirin for treatment of genotype 1 chronic hepatitis C in previously untreated patients. Hepatology 2008, 48(Suppl 4):1027A.

    Google Scholar 

  12. Shiffman ML: Optimizing the current therapy for chronic hepatitis C virus. Peginterferon and ribavirin dosing and the utility of growth factors. Clin Liver Dis 2008, 12:487–505.

    Article  PubMed  Google Scholar 

  13. Ferenci P, Fried MW, Shiffman ML, et al.: Predicting sustained virological responses in chronic hepatitis C patients treated with peginterferon alfa-2a (40KD)/ribavirin. J Hepatol 2005, 43:453–471.

    Article  Google Scholar 

  14. Shiffman ML, Suter F, Bacon BR, et al.: Peginterferon alfa-2a and ribavirin for 16 or 24 weeks in HCV genotype 2 or 3. N Engl J Med 2007, 357:124–134.

    Article  CAS  PubMed  Google Scholar 

  15. Ferenci P, Laferl H, Scherzer TM, et al.: Peginterferon alfa-2a and ribavirin for 24 weeks in hepatitis C type 1 and 4 patients with rapid virological response. Gastroenterology 2008, 135:451–458.

    Article  CAS  PubMed  Google Scholar 

  16. Jensen DM, Morgan TR, Marcellin P, et al.: Early identification of HCV genotype 1 patients responding to 24 weeks peginterferon alpha-2a (40 kd)/ribavirin therapy. Hepatology 2006, 43:954–960.

    Article  CAS  PubMed  Google Scholar 

  17. Shiffman ML, Hamzeh FM, Chung RT: Effect of time to response on viral breakthrough and relapse rates in patients infected with HCV genotype 1 and treated with peginterferon alfa-2a plus ribavirin. Hepatology 2008, 48(Suppl):862A.

    Google Scholar 

  18. Hadziyannis SJ, Sette H Jr, Morgan TR, et al.: Peginterferon-alfa 2a and ribavirin combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. Ann Intern Med 2004, 140:346–355.

    CAS  PubMed  Google Scholar 

  19. Willems B, Hadziyannis SJ, Morgan TR, et al.: Should treatment with peginterferon plus ribavirin be intensified in patients with HCV genotype 2/3 without a rapid virological response? J Hepatol 2007, 46:S6.

    Article  Google Scholar 

  20. Berg T, von Wagner M, Nasser S, et al.: Extended treatment duration for hepatitis C virus type 1: comparing 48 versus 72 weeks of peginterferon-alfa-2a plus ribavirin. Gastroenterology 2006, 130:1086–1097.

    Article  CAS  PubMed  Google Scholar 

  21. Sánchez-Tapias JM, Diago M, Escartín P, et al.: Peginterferon-alfa2a plus ribavirin for 48 versus 72 weeks in patients with detectable hepatitis C virus RNA at week 4 of treatment. Gastroenterology 2006, 131:451–460.

    Article  PubMed  Google Scholar 

  22. Pearlman BL, Ehleben C, Saifee S: Treatment extension to 72 weeks of peginterferon and ribavirin in hepatitis C genotype 1-infected slow responders. Hepatology 2007, 46:1688–1694.

    Article  CAS  PubMed  Google Scholar 

  23. Asselah T, Benhamou Y, Marcellin P: Protease and polymerase inhibitors for the treatment of hepatitis C. Liver Int 2009, 29(Suppl 1):57–67.

    Article  PubMed  Google Scholar 

  24. McHutchison JG, Manns MP, Muir A, et al.: Prove 3 final results and 1-year durability of SVR with telaprevir-based regimen in hepatitis C genotype 1-infected patients with prior non-response, viral breakthrough or relapse to peginterferon-alfa-2a/b and ribavirin therapy. Hepatology 2009, in press.

  25. Poordad F, Shiffman ML, Sherman K, et al.: A study of telaprevir with peginterferon alfa-2a and ribavirin in subjects with well-documented prior peginterferon/ribavirin null response, non-response or relapse: preliminary results. J Hepatology 2008, 48(Suppl 2):S374–S375.

    Article  Google Scholar 

  26. Kwo PY, Lawitz E, McCone J, et al.: High sustained virologic response in genotype 1 null responders to peg-interferon alfa-2b plus ribavirin when treated with boceprevir combination therapy. Hepatology 2009, in press.

  27. • Ge D, Fellay J, Thompson AJ, et al.: Genetic variation in IL-28B predicts hepatitis C treatment-induced viral clearance. Nature 2009, 461:399–401. The identification of the IL-28B polymorphism, which predicts SVR, will significantly enhance the selection of patients who will receive peginterferon and ribavirin treatment before the introduction of DAA in late 2011.

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

Dr. Shiffman has served as a consultant, speaker, and/or on advisory boards for, and/or has received grant support from, Anadys, Biolex, Bristol-Myers Squibb, Conatus, GlaxoSmithKline, Globeimmune, Human Genome Sciences, Idenix, Johnson & Johnson/Tibotec, Novartis, Pfizer, Roche, Romark, Schering-Plough, Valeant, Vertex, Wyeth, and Zymogenetics. These companies have products for treatment of HCV infection.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mitchell L. Shiffman.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shiffman, M.L. Treatment of Hepatitis C in 2011: What Can We Expect?. Curr Gastroenterol Rep 12, 70–75 (2010). https://doi.org/10.1007/s11894-009-0085-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-009-0085-4

Keywords

Navigation