title: Ribavirin revisited in the era of direct-acting antiviral therapy for hepatitis C virus infection.
abstract: Over the past two decades, ribavirin has been an integral component of treatment for hepatitis C virus (HCV) infection, where it has been shown to improve the efficacy of (pegylated) interferon. However, because of treatment-limiting side effects and its additive toxicity with interferon, the search for interferon- and ribavirin-free regimens has been underway. The recent approvals of all-oral direct acting antivirals (DAAs) have revolutionized the HCV therapeutic landscape, and initially it was expected that the role of ribavirin with DAA regimens would be eliminated. On the contrary, what we have witnessed is that ribavirin retains an important role in the optimal treatment of some subgroups of patients, particularly those that historically have been considered the most difficult to cure. Fortunately, it has also been recognized that the safety profile of ribavirin is improved when co-administered with all-oral DAA combinations in the absence of interferon. Despite the antiviral mechanism of action of ribavirin being poorly understood, we now have a range of novel insights into the potential role of ribavirin in all-oral DAA HCV treatment and greater insight into the antiviral mechanism by which it continues to provide clinical benefit for defined patient groups.
authors.affiliation: Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, ON, Canada.
authors.forename: Jordan J
authors.initials: JJ
authors.lastname: Feld
authors.affiliation: Mount Sinai Beth Israel, New York, NY, USA.
authors.forename: Ira M
authors.initials: IM
authors.lastname: Jacobson
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Sulkowski
authors.affiliation: Texas Liver Institute, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Poordad
authors.affiliation: AbbVie Inc., North Chicago, IL, USA.
authors.forename: Fernando
authors.initials: F
authors.lastname: Tatsch
authors.affiliation: Department of Virology, National Reference Center for Viral Hepatitis B, C and Delta, Hôpital Henri Mondor, Université Paris-Est, Créteil, France.|INSERM U955, Créteil, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Pawlotsky
mesh_terms: D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D016898:Interferon-alpha / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012254:Ribavirin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000998:Antiviral Agents; D003692:Delayed-Action Preparations; D016898:Interferon-alpha; D012254:Ribavirin
keywords: direct-acting antiviral; hepatitis C virus; interferon-free; ribavirin