Safety of direct antiviral agents in the management of hepatitis C

ABSTRACT

Introduction: Hepatitis C virus is a hepatotropic virus that generally leads to chronic hepatitis and various harmful sequelae. The lone standard of treatment has been pegylated interferon and ribavirin, which produces a modest response and many side effects. However, a new era of management was declared with the introduction of various directly acting antiviral agents.

Areas covered: Recent direct antiviral agents (DAAs) primarily target the non-structural proteins of the virus and affect its replication. These agents successfully achieve a sustained virologic response. However, some serious side effects were reported, which may or may not be drug-related effects. Important drug-drug interactions were also reported. The treating physician should be reasonably familiar with these effects. We review the safety profile of these agents in the management of HCV.

Expert opinion: Cautious concomitant drug intake is necessary for the new HCV therapies. Future HCV management will depend on interferon-free and likely ribavirin-free regimens. The co-administration of direct antiviral agents of different classes increases the probability of side effects and drug-drug interactions.

KEYWORDS:

• Direct antiviral agents
• drug interactions
• hepatitis C (HCV)
• safety
• side effects

Article highlights

• HCV direct antiviral agents targeting the viral replication achieved a great success in terms of viral eradication.

• Despite this great achievement, there were some reported side effects for these agents as well as important drug-drug interactions.

• Cautious concomitant drug intake is a must while taking the new HCV therapies.

• Different DAAs classes have shown marked variations in their safety and drug-drug interactions profile.

• Future HCV management depending mainly on DAAs combination regimens will raise more attention to the higher probabilities for side effects and drug-drug interactions.

This box summarizes key points contained in the article.

Declaration of interest

G Esmat is advisory committee member for MSD, Gilead Sc, Bristol-Meyers Squibb. Has participated in speaking and teaching activities for Bristol Meyers Squibb, Roche, MSD and GlaxoSmithKline. G Esmat has also received grant and research support from Gilead Sc, Roche, MSD, Bristol Meyers Squibb, AbbVie and Janssen. The authors have no other 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 apart from those disclosed.

Additional information

Funding

This paper was not funded.