| Summary: | Approximately 242,000 Canadians are infected with the hepatitis C virus (HCV), although there are believed to be a number of infected individuals who are unaware that they have HCV. Of those infected, approximately 25% clear infection spontaneously (range 15% to 45%) and the remainder develop chronic hepatitis C (CHC). There are six genotypes and treatment strategy tends to differ depending on genotype. Genotype 1 infections account for most HCV infections in Canadians (55% to 65%). For these patients, standard therapy has traditionally been pegylated interferon plus ribavirin (PR) therapy, administered for 48 weeks, however newer agents for treatment of HCV have recently been developed. Greater understanding of the hepatitis C viral replication cycle has resulted in the development of direct-acting antiviral agents (DAAs) that target several types of proteins used to support viral replication. The first two DAAs, telaprevir (Notice of Compliance [NOC] 16 August 2011) and boceprevir (NOC 29 July 2011), are protease inhibitors approved in combination with PR for treatment of genotype 1 CHC infection. Recently, two new DAA agents have been approved by Health Canada, simeprevir (NOC 18 November 2013) and sofosbuvir (NOC 13 December 2013). Simeprevir is a protease inhibitor approved for the treatment of genotype 1 CHC, while sofosbuvir employs a novel mechanism of action targeting an HCV polymerase and is approved for the treatment of CHC of multiple genotypes. This report will review evidence-based guidelines and recommendations for treatment options and timing of treatment initiation in patients infected with genotype 1 CHC.
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