gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLCgastro-j-1260Research ArticleГЕПАТОЛОГИЯHEPATOLOGYСовременные схемы лечения больных хроническим гепатитом СModern modes of chronic hepatitis C treatmentИвашкинВ. Т.IvashkinV. T.МаевскаяМ. В.MayevskayaM. V.МорозоваМ. А.MorozovaM. A.ЛюсинаЕ. О.LyusinaYe. O.ГБОУ ВПО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздравсоцразвития РФRussian Federation2012100220122213644Copyright © Ивашкин В.Т., Маевская М.В., Морозова М.А., Люсина Е.О., 20122012Ивашкин В.Т., Маевская М.В., Морозова М.А., Люсина Е.О.Ivashkin V.T., Mayevskaya M.V., Morozova M.A., Lyusina Y.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1260

Цель обзора. Осветить современные схемы лечения хронического гепатита С.Основные положения. На сегодняшний день общепризнанным «золотым стандартом» лечения хронической HCV-инфекции остается комбинированная противовирусная терапия пегилированным интерфероном и рибавирином. В последнее время принципы противовирусного лечения серьезно пересматриваются, что неизбежно ведет к усложнению терапевтических схем. Так, сегодня признана целесообразной модификация схемы терапии в зависимости от вирусологического ответа.В ближайшей перспективе станет возможным добавление к стандартной комбинированной схеме лечения третьего препарата – ингибитора протеазы. Опубликованные результаты масштабных исследований свидетельствуют о значительно более высокой эффективности тройной терапевтической схемы у пациентов с 1-м генотипом вируса гепатита С, что открывает новые широкие перспективы в лечении больных данной группы.Заключение. В последнее время становится все более актуальным индивидуальный подход к лечению пациентов c хронической HCV-инфекцией. В частности, разработан алгоритм модификации терапевтической схемы в зависимости от вирусологического ответа на лечение у конкретного больного. В ряде случаев это дает возможность сократить сроки терапии, снизить ее стоимость и повысить приверженность пациента к лечению. Кроме того, в ближайшей перспективе ожидается появление на рынке новых противовирусных агентов – ингибиторов протеазы, которые позволят повысить эффективность противовирусного лечения у пациентов с 1-м генотипом вируса гепатита С.

The aim of review

The aim of review. To highlight up-to-date modes of chronic hepatitis C treatment.

Original positions

Original positions. Nowadays conventional «gold standard» treatment of chronic HCV-infection is antiviral therapy by pegilated interferon and ribavirin combination. Recently principles of antiviral treatment were seriously reconsidered, that inevitably leads to sophistication of therapeutic algorithms. So, modification of treatment mode according to virologic response is rational today. In near-term prospect addition of the third agent — protease inhibitor to the standard combination treatment mode will become possible soon. Published results of large investigations prove significantly higher efficacy of triple therapeutic mode in patients with the 1-st hepatitis C virus genotype, that opens new wide perspectives in treatment of these patients.

Conclusion

Conclusion. Recently individual approach to treatment of patients with chronic HCV-infection becomes more actual. In particular, the algorithm of therapeutic mode modification according to virologic response to treatment at the specific patient is developed. In some cases it enables reduction of treatment terms, decrease of cost and increase of patient’s compliance. Moreover, in the close perspective new antiviral agents - protease inhibitors will appear at the market, that allows to increase antiviral treatment efficacy in patients with the 1-st hepatitis C virus genotype.

гепатит Спротивовирусная терапиявирусологический ответингибиторы протеазытелапревирбоцепревирhepatitis Cantiviral therapyvirologic responseprotease inhibitorstelaprevirboceprevirReferencesИвашкин В.Т. Иммунная система и повреждения печени при хронических гепатитах В и С. Рос журн гастроэнтерол гепатол колопроктол. 2009; 19(6):4–10.Ивашкин В.Т. Иммунная система и повреждения печени при хронических гепатитах В и С. Рос журн гастроэнтерол гепатол колопроктол. 2009; 19(6):4–10.Ivashkin V.T. Immune system and liver damages at chronic B and C hepatites. Ros zhurn gastroenterol hepatol coloproctol. 2009; 19 (6):4–10.Ivashkin V.T. Immune system and liver damages at chronic B and C hepatites. Ros zhurn gastroenterol hepatol coloproctol. 2009; 19 (6):4–10.Никитин И.Г. Противовирусная терапия хронического гепатита С: современное состояние проблемы и перспективы. Best Сlinical Practice. Русское изд. 2011; 5:3–12.Никитин И.Г. Противовирусная терапия хронического гепатита С: современное состояние проблемы и перспективы. Best Сlinical Practice. Русское изд. 2011; 5:3–12.Nikitin I.G. Antiviral therapy of chronic hepatitis C: state-of-the-art and prospects. Best Сlinical Practice. Russian ed. 2011; 5:3–12.Nikitin I.G. Antiviral therapy of chronic hepatitis C: state-of-the-art and prospects. Best Сlinical Practice. Russian ed. 2011; 5:3–12.Anand B, Currie S, Dieperink E, et al. Alcohol use and treatment of hepatitis C virus: results of a national multicenter study. Gastroenterology. 2006; 130:1607–16.Anand B, Currie S, Dieperink E, et al. Alcohol use and treatment of hepatitis C virus: results of a national multicenter study. Gastroenterology. 2006; 130:1607–16.Berg T, Sarrazin C, Herrmann E, et al. Prediction of treatment outcome in patients with chronic hepatitis C: significance of baseline parameters and viral dynamics during therapy. Hepatology. 2003; 37:600–9.Berg T, Sarrazin C, Herrmann E, et al. Prediction of treatment outcome in patients with chronic hepatitis C: significance of baseline parameters and viral dynamics during therapy. Hepatology. 2003; 37:600–9.Davis G, Wong J, Mc Hutchison J, et al. Early virologic response to treatment with peginterferon alfa-2b plus ribavirin in patients with chronic hepatitis C. Hepatology. 2003; 38:645–52.Davis G, Wong J, Mc Hutchison J, et al. Early virologic response to treatment with peginterferon alfa-2b plus ribavirin in patients with chronic hepatitis C. Hepatology. 2003; 38:645–52.De Bruijne J, Buster E, Gelderblom H, et al. Treatment of chronic hepatitis C virus infection – Dutch national guidelines. Netherlands J Med. 2008; 66:311–22.De Bruijne J, Buster E, Gelderblom H, et al. Treatment of chronic hepatitis C virus infection – Dutch national guidelines. Netherlands J Med. 2008; 66:311–22.Deuffic-Burban S, Babany G, Lonjon-Domanec I, et al. Impact of pegylated interferon and ribavirin on morbidity and mortality in patients with chronic hepatitis C and normal aminotransferases in France. Hepatology. 2009; 50:1351–59.Deuffic-Burban S, Babany G, Lonjon-Domanec I, et al. Impact of pegylated interferon and ribavirin on morbidity and mortality in patients with chronic hepatitis C and normal aminotransferases in France. Hepatology. 2009; 50:1351–59.EASL Clinical Practice Guidelines: Management of hepatitis C virus infection. European Association for the Study of the Liver. J Hepatol. 2011; 55:245–64.EASL Clinical Practice Guidelines: Management of hepatitis C virus infection. European Association for the Study of the Liver. J Hepatol. 2011; 55:245–64.Ghany G, Nelson D, Strader D, et al. Updated treatment guidelines genotype 1 chronic HCV infection. Hepatology. 2011; 54(4):1433–44.Ghany G, Nelson D, Strader D, et al. Updated treatment guidelines genotype 1 chronic HCV infection. Hepatology. 2011; 54(4):1433–44.Italian Association for the study of the liver, Italian Society of infectious td, Italian Society for the study of sexually transmitted diseases. Practice guidelines for the treatment of hepatits C: recommendations from AISF/ SIMIT/SIMAST. Dig Liver Dis. 2010; 42:81–91.Italian Association for the study of the liver, Italian Society of infectious td, Italian Society for the study of sexually transmitted diseases. Practice guidelines for the treatment of hepatits C: recommendations from AISF/ SIMIT/SIMAST. Dig Liver Dis. 2010; 42:81–91.Jacobson I, McHutchison J, Dusheiko G, et al. Telaprevir for previously untreated chronic hepatitis C virus infection. N Engl J Med. 2011; 364:2405–16.Jacobson I, McHutchison J, Dusheiko G, et al. Telaprevir for previously untreated chronic hepatitis C virus infection. N Engl J Med. 2011; 364:2405–16.Kenneth E. Sherman, Steven L. Flamm, Nezam H. Afdhal et al. Response-guided telaprevir combination treatment for hepatitis C virus infection. N Engl J Med. 2011; 365:1014–24.Kenneth E. Sherman, Steven L. Flamm, Nezam H. Afdhal et al. Response-guided telaprevir combination treatment for hepatitis C virus infection. N Engl J Med. 2011; 365:1014–24.Manns MP, Wedemeyer H, Cornberg M. Treating viral hepatitis C: efficacy, side effects, and complications. Gut. 2006; 55:1350–9.Manns MP, Wedemeyer H, Cornberg M. Treating viral hepatitis C: efficacy, side effects, and complications. Gut. 2006; 55:1350–9.McCaughan GW. Asian Pacific Association for the Study of the Liver consensus statements on the diagnosis, management and treatment of hepatitis C virus infection. J Gastroenterol Hepatol. 2007; 22:615–33.McCaughan GW. Asian Pacific Association for the Study of the Liver consensus statements on the diagnosis, management and treatment of hepatitis C virus infection. J Gastroenterol Hepatol. 2007; 22:615–33.McHutchison J, Lawitz E, Shiffman M, et al. Peginterferon alfa-2b or alfa-2a with ribavirin for treatment of hepatitis C infection. New Engl J Med. 2009; 361:580– 93.McHutchison J, Lawitz E, Shiffman M, et al. Peginterferon alfa-2b or alfa-2a with ribavirin for treatment of hepatitis C infection. New Engl J Med. 2009; 361:580– 93.Moradpour D, Penin F, Rice C. Replication of hepatitis C virus. Nat Rev Microbiol. 2007; 5:453–63.Moradpour D, Penin F, Rice C. Replication of hepatitis C virus. Nat Rev Microbiol. 2007; 5:453–63.Pawlotsky JM. The results of Phase III clinical trials with telaprevir and boceprevir presented at the Liver Meeting 2010: a new standard of care for hepatitis C virus genotype 1 infection, but with issues still pending. Gastroenterology. 2011; 141(2):778.Pawlotsky JM. The results of Phase III clinical trials with telaprevir and boceprevir presented at the Liver Meeting 2010: a new standard of care for hepatitis C virus genotype 1 infection, but with issues still pending. Gastroenterology. 2011; 141(2):778.Poordad F, McCone J, Bacon B, et al. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011; 364(13):1195–206.Poordad F, McCone J, Bacon B, et al. Boceprevir for untreated chronic HCV genotype 1 infection. N Engl J Med. 2011; 364(13):1195–206.Romero-Gomez M, Andrade R, Salmeron J, et al. Insulin resistance impairs sustained response rate to peginterferon plus ribavirin in chronic hepatitis C patients. Gastroenterology. 2005; 128:636–41.Romero-Gomez M, Andrade R, Salmeron J, et al. Insulin resistance impairs sustained response rate to peginterferon plus ribavirin in chronic hepatitis C patients. Gastroenterology. 2005; 128:636–41.Sarrazin C, Berg T, Ross R, et al. Prophylaxis, diagnosis and therapy of hepatitis C virus (HCV) infection: the German guidelines on the management of HCV infection. Z Gastroenterol. 2010; 48:289–351.Sarrazin C, Berg T, Ross R, et al. Prophylaxis, diagnosis and therapy of hepatitis C virus (HCV) infection: the German guidelines on the management of HCV infection. Z Gastroenterol. 2010; 48:289–351.Sarrazin C, Susser S, Doehring A, et al. Importance of IL28B gene polymorphisms in hepatitis C virus genotype 2 and 3 infected patients. J Hepatol. 2011; 54:415–21.Sarrazin C, Susser S, Doehring A, et al. Importance of IL28B gene polymorphisms in hepatitis C virus genotype 2 and 3 infected patients. J Hepatol. 2011; 54:415–21.Zeuzem S, Andreone P, Pol S, Lawitz E. Telaprevir for retreatment of HCV infection. N Engl J Med. 2011;Zeuzem S, Andreone P, Pol S, Lawitz E. Telaprevir for retreatment of HCV infection. N Engl J Med. 2011;:2417–28.:2417–28.

The authors declare that there are no conflicts of interest present.