We’re living in an era where there are highly effective direct-acting antivirals (DAA) available for the treatment of chronic hepatitis C virus, but ribavirin (RBV) continues to be a necessary adjunct to DAA regimens for the virus.

A new cohort study published online in Alimentary Pharmacology and Therapeutics in November confirmed the RBV steady-state serum levels that correspond to high rates of efficacy and low adverse effect.

Co-lead authors of the study Faydra Lieveld, MD, University Medical Center Utrecht, The Netherlands, and Marjolein van Tilborg, MD, PhD, Erasmus MC University Medical Center, The Netherlands, determined the RBV steady-state plasma level at 8 weeks that correspond to a sustained virologic response (SVR) to the RBV-DAA regimen at 12 weeks.

“RBV has not left the therapeutic arena and still used as an additive under certain circumstances such as the presence of cirrhosis, genotype 3 infection, the presence of resistance-associated substitutes, previous antiviral treatment failure and/or in specific DAA regimens to increase treatment efficacy,” the authors wrote.

In an essay commenting on the study’s findings, Martin Lagging, MD, PhD and Jesper Waldenström, MD, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Sweden, elaborated on the role of RBV.

“In the setting of decompensated cirrhosis (Child-Pugh B or C), RBV likely will remain a pivotal component of HCV therapy as protease inhibitors should not be used and re-treatment options are limited,” they wrote.

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