New promising agents, boceprevir and telapevir, for new standard care for the treatment of chronic HCV infection

Abstract

At present, hepatitis C infection becomes a major public health problem due to the increasing number of patients who infected by hepatitis C virus (HCV) worldwide.  HCV can be classified into at least 6 major genotypes (genotypes 1 to 6), genotype 1 is the most common.  After infected with HCV, most patients will have progressive into a chronic hepatitis, cirrhosis and liver cancer. The standard treatment guideline of HCV infection is pegylated interferon combined with ribavirin, but the effectiveness is not satisfactory as some patients do not achieve sustained virologic response (SVR).  Therefore, intensive efforts have been made to develop the compounds with antiviral activity against HCV genotype 1, which are referred to direct acting antiviral agents (DAAs).  To date, the two NS3/4A protease inhibitors, boceprevir and telaprevir, have been approved for the treatment of chronic HCV genotype 1 infection in combination with peginterferon alfa/ribavirin.  The results from clinical study of these two drugs in naive patients and who had failed standard therapy showed that SVR was significantly increased. Adverse effects of these drugs are anemia, allergic rashes, and neutropenia.  Dysgeusia, dry mouth, nausea, vomiting and diarrhea was reported in boceprevir.  Due to metabolism via CYP3A4, significant drug-drug interactions are possible with boceprevir and telaprevir.