Drugs for Hepatitis C

Comprehensive overview of drugs used in the treatment of Hepatitis C

Introduction

Hepatitis C is a liver disease caused by the Hepatitis C virus (HCV). It is a significant public health concern due to its potential to cause chronic liver disease, cirrhosis, and hepatocellular carcinoma. The treatment of Hepatitis C has evolved dramatically over the past few decades, with the development of highly effective antiviral drugs that can cure the infection in most patients.

Antiviral Drugs for Hepatitis C

The primary goal of Hepatitis C treatment is to achieve a sustained virologic response (SVR), which is indicative of a cure. The following classes of drugs are used in the treatment of Hepatitis C:

Direct-Acting Antivirals (DAAs)

Direct-acting antivirals are the cornerstone of modern Hepatitis C treatment. They target specific nonstructural proteins of the virus, thereby disrupting viral replication. DAAs are classified into several categories based on their mechanism of action:

• NS3/4A Protease Inhibitors: These drugs inhibit the NS3/4A protease enzyme, which is essential for viral replication. Examples include Glecaprevir and Grazoprevir.

• NS5A Inhibitors: These drugs target the NS5A protein, which plays a role in viral replication and assembly. Examples include Ledipasvir, Velpatasvir, and Pibrentasvir.

• NS5B Polymerase Inhibitors: These drugs inhibit the NS5B polymerase enzyme, which is crucial for viral RNA replication. They are further divided into nucleoside and non-nucleoside inhibitors. Examples include Sofosbuvir (a nucleoside inhibitor) and Dasabuvir (a non-nucleoside inhibitor).

Ribavirin

Ribavirin is a nucleoside analog that has been used in combination with other antiviral drugs to enhance treatment efficacy. Although its exact mechanism of action is not fully understood, it is believed to interfere with viral RNA synthesis. Ribavirin is often used in combination with DAAs, especially in difficult-to-treat cases.

Interferon

Interferon was once a mainstay of Hepatitis C treatment, often used in combination with ribavirin. However, due to its significant side effects and lower efficacy compared to DAAs, its use has declined. Pegylated interferon, a long-acting form, was the most commonly used form before the advent of DAAs.

Treatment Regimens

The choice of treatment regimen depends on several factors, including the HCV genotype, the presence of cirrhosis, prior treatment history, and the patient's overall health. Commonly used regimens include:

• Sofosbuvir/Velpatasvir: A pan-genotypic regimen effective against all HCV genotypes.
• Glecaprevir/Pibrentasvir: Another pan-genotypic regimen with a high cure rate.
• Ledipasvir/Sofosbuvir: Effective for genotypes 1, 4, 5, and 6.

Side Effects and Considerations

While DAAs are generally well-tolerated, they can cause side effects such as fatigue, headache, and nausea. It is important to monitor for drug-drug interactions, especially in patients taking other medications. Ribavirin can cause hemolytic anemia, and its use requires careful monitoring of blood counts.

Conclusion

The development of DAAs has revolutionized the treatment of Hepatitis C, offering a cure for most patients with minimal side effects. Ongoing research continues to improve treatment options and accessibility, aiming to eliminate Hepatitis C as a public health threat.

Also see

• Hepatitis C virus
• Liver disease
• Antiviral drug
• Cirrhosis

Drugs for HIV Infection, in the Subclass Antiretroviral Agents

• Fusion Inhibitors (HIV)
  • Enfuvirtide, Maraviroc

• Integrase Inhibitors (HIV)
  • Dolutegravir, Elvitegravir, Raltegravir

• Monoclonal Antibodies
  • Ibalizumab

• Nonnucleoside Reverse Transcriptase Inhibitors (HIV)
  • Delavirdine, Efavirenz, Etravirine, Nevirapine, Rilpivirine

• Nucleoside Analogues (HIV)
  • Abacavir, Didanosine, Emtricitabine, Lamivudine, Stavudine, Tenofovir, Zidovudine

• Protease Inhibitors (HIV)
  • Amprenavir, Atazanavir, Darunavir, Fosamprenavir, Indinavir, Lopinavir, Nelfinavir, Ritonavir, Saquinavir, Tipranavir

Drugs for Hepatitis B

• Alpha Interferon, Adefovir, Emtricitabine, Entecavir, Lamivudine, Telbivudine, Tenofovir

Drugs for Hepatitis C

• Interferon Based Therapies
  • Alpha Interferon and Peginterferon, Ribavirin

HCV NS5A Inhibitors

• Daclatasvir, Elbasvir, Ledipasvir, Ombitasvir, Pibrentasvir, Velpatasvir

HCV NS5B Inhibitors (Polymerase inhibitors)

• Dasabuvir, Sofosbuvir

HCV Protease Inhibitors

• Asunaprevir, Boceprevir, Glecaprevir, Grazoprevir, Paritaprevir, Simeprevir, Telaprevir, Voxilaprevir

Combination Therapies

• Epclusa, Harvoni, Mavyret, Technive, Viekira Pak, Vosevi, Zepatier

Drugs for Herpes Virus

• infections (HSV), CMV, others

Acyclovir, Cidofovir, Famciclovir, Foscarnet, Ganciclovir, Valacyclovir, Valganciclovir

Drugs for Influenza

• Amantadine, Oseltamivir, Peramivir, Rimantadine, Zanamivir