Optimal therapy of genotype‐2 chronic hepatitis C: what's new?

Abstract

The standard of care (SOC) for the treatment of HCV genotype 2 (HCV‐2) was pegylated interferon alpha plus ribavirin (PEG‐IFN/RBV) at weight‐based doses for a response‐guided duration. The launches of sofosbuvir and daclatasvir in 2014 have resulted in new, better tolerated and shorter treatment. The combination of sofosbuvir and RBV for 12 weeks appears to be the new SOC in both European and American guidelines. The cost and therefore the access to this treatment remains a problem in many countries because of major economic constraints. For the few more difficult‐to‐treat patients, a combination of direct acting antivirals may be suitable and is being studied in ongoing trials. Because of rapidly changing treatment recommendations, the decision to treat HCV‐2 patients with currently approved drugs or to wait until a better option is available in the future, must be made according to the stage of fibrosis.

New drugs and new concerns: Gaining insight through Pharmacovigilance of direct acting Anti-Viral’s in chronic HCV patients

“…6 Ribavirin use has been significantly linked to anemia, especially among decompensated and End-Stage Renal Disease (ESRD) patients, therefore it use in addition to DAA is not recommendable as it may be harmful. 20,21 Furthermore, the cirrhotic incidences added up to the occurrence of AEs among the enrolled HCV patients (p<0.05). It is evident that among HCV patients the presence of cirrhosis delays the treatment and negatively affects that therapeutic approach by significantly encouraging the occurrence of AEs.…”

Resistance characterization of hepatitis C virus genotype 2 from Japanese patients treated with ombitasvir and paritaprevir/ritonavir

“…Several DAA‐based therapies with high sustained virologic response (SVR) rates at post‐treatment week 12 (SVR 12 ) are approved for the treatment of HCV GT1 infection in Japan . For HCV GT2 infection, the standard of care was previously a combination of pegylated interferon alpha (pegIFN) plus ribavirin (RBV) for 24 weeks, which demonstrated SVR rates of 71‐80% in large clinical trials worldwide . The first IFN‐free DAA regimen for HCV GT2 infection with high SVR 12 rates of 93‐98% was the combination of the NS5B nucleotide polymerase inhibitor sofosbuvir (SOF) plus RBV for 12 weeks, approved for the treatment of GT2‐infected patients in 2015 .…”

Genotype 2 Patients: What is the Optimum Therapy so Far?

“…The identification of the single nucleotide polymorphism in the interleukin 28B (IL28B) region as the strongest baseline predictor of SVR in other genotypes [12] did not show significant impact in HCV-2 patients, as baseline prediction was significantly overwhelmed by viral kinetics on-treatment [13]. Consequently, in HCV-2 patients, individualization of dual therapy consisted in the possibility of shortening treatment to 12-16 weeks in patients with RVR and absence of baseline negative predictors, and on the other side, extending treatment to 48 weeks in non-RVR patients with a slower HCV-RNA decline [14][15][16][17]. The main limit of dual therapy was low efficacy in cirrhosis and limited patient eligibility to receive treatment, due to comorbid conditions, such as autoimmune diseases, psychiatric disorders, end-stage renal disease, and most of all, decompensated cirrhosis that contraindicated PegIFN/ Rbv.…”