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Emerging Antivirals in the Future

  • C. Nelson Hayes
  • Michio Imamura
  • Kazuaki ChayamaEmail author
Chapter

Abstract

The safety and effectiveness of antiviral therapy for chronic hepatitis C has improved markedly with the introduction of direct-acting antiviral drugs and a concomitant decrease in interferon use. Although DAAs are potent antivirals, the emergence of resistance against DAAs has spurred the development of new drugs. Second-generation NS5A inhibitors have a higher genetic barrier compared to first-generation NS5A inhibitors and are highly effective against strains that are resistant to first-generation NS5A inhibitors. While new drug development has primarily focused on DAAs, another way to counter DAA resistance is to develop combination therapies that target host factors in addition to viral factors because it is more difficult for the virus to overcome changes in the host environment. For example, miravirsen targets host microRNA-122, which is highly expressed in hepatocytes and essential for viral replication. Emergence of resistance mutations in such therapies is very low. Therefore, combined use of DAAs with other drugs is expected in the future to achieve high SVR rates while minimizing the risk of resistance.

Keywords

Chronic hepatitis C Second-generation NS5A inhibitors Non-nucleoside polymerase inhibitors Miravirsen Resistance-associated variants 

Abbreviations

DAA

Direct-acting antiviral

HCV

Hepatitis C virus

NI

Nucleoside inhibitor

NNI

Non-nucleoside inhibitor

PEG-IFN

Pegylated interferon

PI

Protease inhibitor

SVR

Sustained viral response

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Copyright information

© Springer Science+Business Media Singapore 2017

Authors and Affiliations

  • C. Nelson Hayes
    • 1
    • 2
  • Michio Imamura
    • 1
    • 2
  • Kazuaki Chayama
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of Gastroenterology and Metabolism, Applied Life Sciences, Institute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
  2. 2.Liver Research Project CenterHiroshima UniversityHiroshimaJapan
  3. 3.Laboratory for Digestive DiseasesCenter for Genomic Medicine, RIKENHiroshimaJapan

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