Recent advances in the treatment of hepatitis C.

Hepatitis C virus (HCV) therapeutics is amidst a revolution. With the recent approval of sofosbuvir (Sovaldi) and simeprevir (Olysio), clinicians and patients started to recognize that for the first time in the history, hepatitis C can be cured in a majority of patients without interferon. These new regimens are safe, and have excellent efficacy and minimal adverse events. Sofosbuvir, a nucleotide analogue (NS5B polymerase inhibitor), is a potent drug with excellent tolerability and pan-genotypic activity with a high barrier to resistance. Simeprevir, a second-generation protease inhibitor which inhibits the initial cleavage of the HCV poly-protein by the NS3/4A protease. Simeprevir has been evaluated in clinical trials in combination with interferon and ribavirin based therapy and also in the COSMO trial in combination with sofosbuvir. More directly acting antiviral therapy drugs are in the pipeline with several drugs being expected to be approved by the FDA in late 2014. Although these drugs have excellent efficacy, they are more costly. The price of these drugs limits treatments of many patients in the world especially in countries with limited economic resources. However, with the availability of a variety of excellent directly acting antivirals (DAAs) in the near future, hopefully many patients would be able to afford the treatment. The future in HCV therapy will focus on special groups of patients who were excluded from initial HCV clinical trials such as post-liver transplant HCV recurrence, patients with HCV/HIV co-infection, and patients with advanced cirrhosis.