Published online Mar 21, 2014. doi: 10.3748/wjg.v20.i11.2867
Revised: November 21, 2013
Accepted: January 6, 2014
Published online: March 21, 2014
Elucidation of the natural history of chronic hepatitis C (CHC) and the identification of risk factors for its progression to advanced liver disease have allowed many physicians to recommend deferral treatment (triple therapy) in favour of waiting for new drug availability for patients who are at low risk of progression to significant liver disease. Newer generation drugs are currently under development, and are expected to feature improved efficacy and safety profiles, as well as less complex and shorter duration delivery regimens, compared to the current standards of care. In addition, patients with cirrhosis and prior null responders have a low rate (around 15%) of achieving sustained virological response (SVR) with triple therapy, and physicians must also consider the decision to wait for new treatments in the future for these patients as well. Naïve patients are the most likely to achieve a close to 100% SVR rate; therefore, it may be advisable to recommend that patients with mild to moderate CHC should wait for the newer therapy options. In contrast, patients with advanced fibrosis and cirrhosis will be those with the greatest need for expedited therapeutic intervention. There remains a need, however, for establishing definitive clinical management guidelines to maximize the benefit of waiting for new drugs and minimize risk of side effects and non-response to the current triple therapy.
Core tip: Identification of risk factors for progression of chronic hepatitis C has allowed physicians to recommend treatment deferral (triple therapy) to wait for anticipated new drugs with better efficacy and safety profiles for patients with mild to moderate disease. Patients with cirrhosis and prior null responders rarely obtain sustained virological response with triple therapy and the decision to wait for new treatments must be considered. For each patient population, definitive clinical management guidelines are needed to maximize the benefit of waiting for new drugs and minimize risk of side effects and non-response to the current triple therapy.