Abstract
Recent improvements have been made in the treatment of hepatitis C virus (HCV) infection with the introduction of direct-acting antiviral agents (DAAs). However, despite successful viral clearance, many patients continue to have HCV-related disease progression. Therefore, new treatments must be developed to achieve viral clearance and prevent the risk of HCV-relateddiseases. In particular, the use of pitavastatin together with DAAs may improve the antiviral efficacy as well as decrease the progression of liver fibrosis and the incidence of HCV-related hepatocellular carcinoma. To investigate the management methods for HCV-related diseases using pitavastatin and DAAs, clinical trials should be undertaken. However, concerns have been raised about potential drug interactions between statins and DAAs. Therefore, pre-clinical trials using a replicon system, human hepatocyte-like cells, human neurons and human cardiomyocytes from human-induced pluripotent stem cells should be conducted. Based on these pre-clinical trials, an optimal direct-acting antiviral agent could be selected for combination with pitavastatin and DAAs. Following the pre-clinical trial, the combination of pitavastatin and the optimal direct-acting antiviral agent should be compared to other combinations of DAAs ( e.g., sofosbuvir and velpatasvir) according to the antiviral effect on HCV infection, HCV-related diseases and cost-effectiveness.
Highlights
Hepatitis C virus (HCV) infection is an important public health problem worldwide, as many HCV-infected patients develop liver cirrhosis and/or hepatocellular carcinoma (HCC)[1].Recent improvements in the treatment of HCV infection have focused on the use of direct-acting antiviral agents (DAAs)[1]
Clinical trials for pitavastatin against HCV infection After performing a search of the PubMed database, we identified three clinical trials using pitavastatin for the treatment of HCV infection[7,8,10]
Clinical trials to investigate the management methods of HCV-related diseases in the era of DAAs Butt et al.[13] showed that statin use was associated with improved antiviral efficacy as well as decreased progression of liver fibrosis and a reduced incidence of HCC among a large cohort of HCVpositive veterans
Summary
Hepatitis C virus (HCV) infection is an important public health problem worldwide, as many HCV-infected patients develop liver cirrhosis and/or hepatocellular carcinoma (HCC)[1].Recent improvements in the treatment of HCV infection have focused on the use of direct-acting antiviral agents (DAAs)[1]. When Shimada et al.[7] considered two reports published in 2010 investigating the antiviral efficacy of pitavastatin against HCV infection in vitro[9,11], they conducted a randomized controlled trial[7].
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