Direct-Acting Antiviral Combination Therapies Can Become Novel Therapeutic Standard in HCV Treatment

Protease inhibitors (PI) in a combination therapy with other direct-acting antivirals can improve sustained virological response (SVR) rates in HCV patients, even in those with prior partial or null virological response, according to a recent study.

Published online May 27, 2014, in the World Journal of Hepatology, the study evaluates NS3/4A protease inhibitors for criteria such as efficacy and safety. The researchers find that the prior standard combination therapy of pegylated interferon-α (PEG-IFNα) and ribavirin has been eclipsed by a new treatment paradigm, which should include a PI combined with PEG-IFNα and ribavirin.

In the wake of new PI treatments with improved safety and greater efficacy, the study finds an ideal combination therapy consists of an interferon-free regimen with a daily oral agent, stating that these agents are “highly effective and well tolerated, do not interact with the majority of well-known therapeutics, and can be used to treat concomitant disorders.”

Conventional treatments have an SVR rate of 40% to 50%; the addition of PIs such as simeprevir and faldaprevir can result in an improved SVR rate of up to 80%, along with improved safety and tolerance, the researchers note.

“Once, supposedly ideal regimens for HCV treatment implied interferon-free combinations,” the study authors wrote. “Now, the emergence of direct-acting antivirals makes it possible to develop optimally dosed treatments and completely exclude clinically significant [adverse events] related to interferon use." SPT