title: Safety of direct-acting antivirals in the treatment of chronic hepatitis C.
abstract: BACKGROUND
  Combination therapy with pegylated interferon, ribavirin and the two first-generation NS3/4A protease inhibitors (PIs), telaprevir (TVR) and boceprevir (BOC), is the new standard-of-care therapy for patients who are chronically infected with genotype 1 hepatitis C virus. These combinations significantly increase sustained virological response (SVR) rates, but they also increase the rates of adverse events (AEs). Appearance of significant AEs may necessitate dose reduction or discontinuation of treatment, and may impact on virological response.
  
  
  METHODS
  In registration trials, IFN-related AEs were a dominant feature in both types of therapy. Some events were more frequent with PI-containing regimens, like anemia and dysgeusia with BOC and anemia, pruritus, rash and anorectal symptoms with TVR. This review addresses the early identification and management of AEs to improve tolerance, and to avoid reduction in SVR rates.
  
  
  CONCLUSIONS
  Every patient will experience adverse effects to differing degrees; a systematic approach to their management can be very helpful. Early recognition and intervention can help clinicians ensure that patients are able to complete therapy where possible and achieve the goal of viral eradication. Treatment with the next generation of antivirals will improve safety and efficacy.
authors.affiliation: Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno "CEMIC", Department of Medicine, Hepatology Section , Avda. Las Heras 2939, (C1425ASG) Ciudad Autónoma de Buenos Aires , Argentina +54 11 5299 1221 ; +54 11 5299 0600 ext 5900 ; eridruejo@gmail.com.
authors.forename: Ezequiel
authors.initials: E
authors.lastname: Ridruejo
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects* / Q000379:methods; D064420:Drug-Related Side Effects and Adverse Reactions; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000009:adverse effects / Q000627:therapeutic use; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha; D011480:Protease Inhibitors; D012254:Ribavirin