How to optimize HCV therapy in genotype 1 patients: management of side‐effects

Abstract

Antiviral therapy for chronic hepatitis C has dramatically changed with the advent of triple therapy incorporating direct-acting antivirals (DAAs) such as the protease inhibitors (PI) boceprevir and telaprevir. Such triple-therapy is associated with a new spectrum of side-effects which can hamper quality of life. These may lead to dosage reduction and sometimes discontinuation of therapy. This review presents practical tips to help manage adverse effects appropriately and efficiently. The main adverse effects causing discontinuation of therapy are varied. Although the most common adverse effects are the 'flu'-like symptoms of fatigue, myalgia, fever and lassitude, these are usually easily managed and do not lead to treatment discontinuation. Cytopaenia, particularly anaemia, has emerged as perhaps the most troublesome side-effect. Cirrhotic patients are especially prone to moderate or severe anaemia with boceprevir and telaprevir triple-therapy regimens. Aggressive ribavirin dosage reductions, erythropoietin and blood transfusions are effective for managing anaemia. Skin rash can be controlled with moisturization and corticosteroid ointment. Rarely, dermatology consultation is required for further management. Anal discomfort, with or without diarrhoea, sometimes responds to barrier creams and haemorrhoidal ointments. Dysgeusia is treated by sipping water frequently, oral ointments and mouth washes to maintain salivary flow and oral hygiene. Successful adherence to treatment can be enhanced by a strong support network for the patient, including specially-trained hepatitis nurses and a multidisciplinary team incorporating pharmacists, counsellors and social workers.

Unique Extension of Peritonsillar Abscess to the Masticator Space Encountered in the Early Phase of Antiviral Therapy for Hepatitis C

“…The first is the contribution of adverse effects of the antiviral HCV therapy, including blood cytopenia [12]. The HCV protease inhibitor telaprevir, administered in addition to peginterferon andribavirin, significantly increases the rate of sustained response in patients with genotype 1 chronic HCV infection [13,14].…”

Approaches and Considerations for the Successful Treatment of HCV Infection

“…Providing a support network, such as availability of nurses and an after-hours telephone health link, improves adherence to treatment and patient satisfaction. Additionally, the right timing and the adequate injection of the PEG-INF injection can be helpful [29].…”

“…Dysgeusia is treated by sipping water frequently. To maintain salivary low and oral hygiene, oral ointments and mouth washes are used [29]. Anal discomfort, with or without diarrhea, may respond to barrier creams and hemorrhoidal ointments.…”

Hepatitis C Virus and Hepatitis C-Infection

“…Almost all patients treated with PEG-IFNα and RIB presents one or more adverse side effects during the course of treatment that includes influenza-like symptoms, neuropsychiatric effects, hematologic abnormalities, and induction of autoimmune disorders. (31) The clinical trials show that, approximately 10-15% of patients discontinued Peg-IFNα and RIB therapy due to adverse effects. (32) Changes in lifestyle are recommendations in managing chronic hepatitis C similar to those for obesity, diabetes and metabolic syndrome, confirming the role and injury caused by metabolic factors on the clinical course of HCV infection.…”