The dilemma for patients with chronic hepatitis C: Treat now or warehouse?

Abstract

Dual therapy with peginterferon and ribavirin, the only treatent for chronic hepatitis C available In Italy and in many other ountries worldwide up to 2013, obtains satisfactory response ates in infections with hepatitis C virus (HCV) genotype 2, but far rom optimal for other genotypes [1,2]. Eradication requires 6–12 onths of therapy, with significant inconvenience for patients: dverse reactions force premature termination in about 20% of atients and reduced the quality of life for almost all who persist n treatment. In view of the important and prolonged side effects, nterferon-based treatment is perceived as a nightmare by many symptomatic,well-being, socially activepatients (the largemajorty of those eligible for therapy), Paradoxically, treatment is often ontraindicated in the patients most in need, those with sympomatic cirrhosis. Not surprisingly, considering the limited efficacy f therapy and the long, unpredictable course of chronic HCV infecion, a proportion of patients refuse therapy or choose to postpone, ambling on lack of progression of their liver disease or on the ultiate advent ofmore tolerable and effective drugs should their liver isease progress [3]. A study published in 2005 reported that, in the nvestigators’ view, 40.7% of 4084 subjects with HCV were candiates for interferon alpha plus ribavirin. However, 23.8% of eligible atients declined therapy. Of these, 50.3% deferred treatment until etter therapies became available. Another 21.6% declined because f concerns over adverse events [4]. First generation HCV NS3 protease inhibitors (PI), boceprevir nd telaprevir, to be used in combination with peginterferon (PegFN) and ribavirin (triple therapy) as treatment for chronic hepatitis genotype 1 were made available in Italy in mid-2013, even hough licensed by the European Medicine Agency (EMA) at the nd of 2011, due to a lengthy process of approval for reimburseent from the governmental regulatory authorities. Albeit Italy as among the last countries in the EU to register triple therpy, to be followed only by Portugal, various Eastern European and on-European countries still do not have access to PIs, while many ave major restrictions to their use mostly limiting treatment to