Interferon-free therapies for chronic hepatitis C: toward a hepatitis C virus-free world?

Abstract

About 2% of the world’s population is estimated to be chronically infected with hepatitis C virus (HCV). These chronic carriers are at risk of developing liver cirrhosis and its complications. Successful treatment of HCV infection is associated with improved quality of life and increased survival. Antiviral approaches were formerly based on interferon and therefore all patients with a contraindication to interferon were excluded from treatment (e.g., patients with decompensated disease, severe impairment of other organs). Very recently, interferon-free combinations have become available for genotypes 2 and 3. This review focuses on the most recently reported data on the various interferon-free combinations used (namely, sofosbuvir-based combinations, the ABT-450/ombitasvir/dasabuvir/ribavirin combination, the daclatasvir/asunaprevir combination, and the MK-5172/MK-8742 combination). All these combinations yielded amazing results in terms of efficacy (90–100%), tolerability and safety. If the problem of the high cost is overcome, interferon-free therapies will lead to what has long been a chimera, namely, an HCV-free world.

Keywords::

• ABT-450
• asunaprevir
• daclatasvir
• dasabuvir
• interferon-free
• ledipasvir
• MK-5172
• MK-8742
• ombitasvir
• sofosbuvir

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties. Writing assistance was provided by Jean Ann Gilder (Scientific Communication srl., Naples, Italy) and was funded by the Department of Clinical Medicine and Surgery of the University of Naples “Federico II”.

Key issues

• Two percent of the world’s population is chronically infected with hepatitis C virus (HCV). These chronic carriers are at risk of liver cirrhosis and hepatocellular carcinoma.

• Antiviral treatment can interrupt and even revert the chain of events that lead from HCV-related chronic hepatitis to HCV-related cirrhosis and its complications.

• Antiviral therapy was based on interferon. Some interferon-free therapies are currently available in the USA and Europe (sofosbuvir-based combinations).

• Interferon-free approaches overcome the limitations of interferon and are therefore suitable for patients with contraindications to interferon (e.g., those with ascites).

• Other interferon-free combinations will be available in the near future. They include the ABT-450/ombitasvir/dasabuvir/ribavirin combination, the daclatasvir/asunaprevir combination and the MK-5172/MK-8742 combination.

• The efficacy of these combinations is excellent (rate of viral clearance of 90–100%). Tolerability and safety are optimal.

• The only problem of these drugs is their high cost. Should this problem be overcome, these treatments will lead to, what has long been a chimera, namely, an HCV-free world.