Today’s hepatitis C treatments no longer require interferon.
The paradigm of hepatitis C virus (HCV) treatment has changed drastically in the past 20 years. In the early 1990s, treatment included interferon monotherapy for 48 weeks, resulting in an approximate 10% sustained virologic response (SVR) rates for genotype 1.1
In 1998, ribavirin was added to interferon to reduce the duration of treatment and to increase SVR rates to about 30%. Many toxicities were associated with this regimen, however, which made many patients ineligible for treatment and completing treatment challenging. By the early 2000s, pegylated interferon formulations had been developed to reduce toxicities and increase SVR rates to about 50%. The first protease inhibitors were approved in 2011 for treatment, leading to SVR rates of about 60% to 80% but also decreasing treatment duration to 24 to 28 weeks. In 2013, the FDA approved the first direct-acting antivirals (DAAs), simeprevir (SIM) and sofosbuvir (SOF). The advent of these agents allowed for interferon-free regimens, reduced the duration of treatment to as little as 12 weeks, and led to SVR rates of about 90%.
There are now 8 FDA-approved medications for HCV treatment, all of which bypass the use of interferon. The use of each medication varies based on HCV genotype, prior treatment exposure, presence of cirrhosis, HCV polymorphism, patient comorbidities, and drug–drug interactions (DDIs). Here is an overview of each FDA-approved HCV medication and its use as recommended by the American Association for the Study of Liver Diseases (AASLD).
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