Costo ed efficacia delle nuove strategie terapeutiche nell'epatite cronica C

45 Pages·2015·3.2 MB·English

Costo ed efficacia delle
Rome, June 25, 2015
nuove strategie terapeutiche
nell’epatite cronica C

Mario Angelico
Liver Unit, Università Tor Vergata, Roma

Where do we come from ?
“A priori” probability of response to dual (Peg-IFN + ribavirin) therapy
24 to 72 weeks
SVR Virological Profile
80-95% HCV-2 “Easy-to-Treat”
75-80% HCV-3 Low viremia
60-70% HCV-3 High viremia
50-60% HCV-4
50% HCV-1 Low viremia
30-35% HCV-1 High viremia “Difficult-to-Treat”
DAA

(Directly Acting Agents)
The HCV replication complex
A polyprotein of approx 3100 aminoacids
6 nonstructural HCV proteins (incl. enzymes essential for HCV life cycle)

2013-2014
Birth ……and premature death of 1st
wave DAAs (protease NS3/4 inhibitors)
• Boceprevir
• Telaprevir
2013-2014
Birth ……and premature death of 1st
wave DAAs (protease NS3/4 inhibitors)
• Boceprevir
• Telaprevir
Potent, but……….

Severe side effects
Too many pills
Potentially harmful drug-drug interactions
Need of peg-IFN and ribavirin coadministration
Still long-treatment schedules
2nd wave DAAs
Approved
Virological targets
NS5B
NS5A
NS3/4A
DAAs as components of new
treatment paradigm for hepatitis C
Peg-IFN + RBV (SOC)
Prospect of
IFN-based 1 x DAA + SOC shorter
treatment
duration
for a greater
2 x DAAs + SOC proportion of
patients
IFN-free IFN-free
2000 2013 2015
Time
DAA=direct-acting antiviral; SOC=standard of care