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Ribavirin: Past, present and future.

Véronique Loustaud-Ratti1, Marilyne Debette-Gratien1, Jérémie Jacques1

  • 1Véronique Loustaud-Ratti, Marilyne Debette-Gratien, Jérémie Jacques, Denis Sautereau, Paul Carrier, Fédération Hépatologie, Service d'Hépato-gastroentérologie, CHU Limoges, 87042 Limoges, France.

World Journal of Hepatology
|January 26, 2016
PubMed
Summary

Ribavirin remains crucial for treating chronic hepatitis C, especially G2 and G3 infections, and in specific retreatment scenarios. However, its future role may be limited by newer interferon-free direct-acting antiviral combinations.

Keywords:
Direct acting antiviral agentsHepatitis CPeginterferonRibavirin

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Area of Science:

  • Hepatology
  • Virology
  • Pharmacology

Background:

  • Ribavirin, often combined with pegylated-interferon, was a cornerstone in treating chronic hepatitis C before direct-acting antiviral agents (DAAs).
  • Despite the advent of potent DAAs, ribavirin retains a role in specific patient populations and treatment regimens.

Purpose of the Study:

  • To evaluate the current and potential future role of ribavirin in the treatment of chronic hepatitis C.
  • To assess ribavirin's efficacy and safety in combination with various DAAs across different hepatitis C genotypes and patient profiles.

Main Methods:

  • Review of existing clinical data and treatment guidelines regarding ribavirin use in chronic hepatitis C.
  • Analysis of ribavirin's efficacy in combination therapies for genotypes G2, G3, G1, and G4, including difficult-to-treat and retreatment cases.

Main Results:

  • Ribavirin combined with sofosbuvir is effective for most G2 infections.
  • Current treatment options for cirrhotic G3 patients and shortened durations for G1/G4 compensated cirrhotic patients rely on ribavirin.
  • Ribavirin-based strategies may be useful for retreatment of patients with anti-NS5A resistance variants.
  • Addition of ribavirin increases mild adverse events, particularly in cirrhotic patients.
  • Preliminary data suggest newer interferon-free DAAs may reduce ribavirin's future utility, even in difficult-to-treat cases.

Conclusions:

  • Ribavirin continues to be a valuable component in managing specific chronic hepatitis C patient groups.
  • Optimizing ribavirin dosage based on blood levels is suggested for dual therapies but not for complex multi-DAA regimens.
  • The evolving landscape of DAAs may challenge ribavirin's long-term role in hepatitis C treatment.