慢性丙肝的治疗进展课件.pptVIP

直接抗病毒药物（DAAs） AASLD 对初治的基因2型慢丙肝的治疗指南 Population Recommended Regimen Duration Treatment naive and previous relapsers, genotype 2 Sofosbuvir 400 mg + RBV 1000-1200 mg/day 12 wks AASLD对经治的基因2型慢丙肝的指标指南 AASLD/IDSA treatment recommendations. *Pts with cirrhosis may benefit by extension of therapy to 16 wks. Population Recommended Regimen Duration Nonresponse to previous treatment with pegIFN/RBV Sofosbuvir 400 mg + RBV 1000-1200 mg/day 12 wks* Population Alternative Regimen Duration Nonresponse to previous treatment with pegIFN/RBV with IFN eligibility Sofosbuvir 400 mg + pegIFN + RBV 1000-1200 mg/day 12 wks Cirrhotic Patients  Cirrhosis: A Continuous Spectrum of Disease ESLD Child-Pugh B Portal hypertension – high risk Cirrhosis – treatment candidate Liver disease is not optimally represented by Child-Pugh stage (A, B, or C) or MELD score DAA, direct-acting antiviral; GT, genotype; HCV, hepatitis C virus; IFN, interferon; NI, nucleotide polymerase inhibitor; P/R, peginterferon + ribavirin; RBV, ribavirin; SOF, sofosbuvir. Some of you will recall that interferon was first approved for hepatitis C at a thrice-weekly dose of 3?million units in about 1991, and we soon learned that the results, in terms of SVR, were quite meager, particularly in genotype 1 patients. The next major advance occurred in 1998 with the introduction of ribavirin, a relatively weak antiviral when given by itself, but it did augment considerably the SVR rate when added to interferon. The next advance was a modification rather than a quantum leap but was an important one nevertheless and consisted of the introduction of pegylated interferons, such that either peginterferon alfa-2b or -2a could be administered parenterally once a week, instead of 3 times a week, with somewhat better results and greater convenience for the patients, though still similar safety profiles. ? Some of you may recall the excitement that attended the presentation, at AASLD in 2002, of the first proof of concept for