title: Second generation direct-acting antivirals - Do we expect major improvements?
abstract: The rapid progress in the development of direct-acting antiviral agents for hepatitis C has allowed the vast majority of patients to receive all oral therapy that will eliminate their virus. The success of the new regimens has led many to question the need for further developments in this field. Major improvements in drugs for hepatitis C are unlikely but we predict incremental improvements in the next few years. We hope that the next generation of drugs will address the unresolved issues for patients with genotype 3 infection where current treatments are still not entirely satisfactory and we anticipate improvements in the management of patients with renal failure. Shorter duration treatments, perhaps with novel modes of action, may allow simplified 'one-dose' treatments that will greatly expand our ability to treat patients who have difficulty accessing current services and we anticipate that the clinical community will better define the patients with advanced disease who will benefit from therapy prior to liver transplantation.
authors.affiliation: Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada. Electronic address: Jordan.feld@uhn.ca.
authors.forename: Jordan J
authors.initials: JJ
authors.lastname: Feld
authors.affiliation: Queen Mary University London, London, UK. Electronic address: g.r.foster@qmul.ac.uk.
authors.forename: Graham R
authors.initials: GR
authors.lastname: Foster
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D055808:Drug Discovery / Q000639:trends; D005838:Genotype; D006297:Health Services Accessibility; D016174:Hepacivirus / Q000187:drug effects / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000821:virology; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000378:metabolism; D016879:Salvage Therapy; D000072230:Sustained Virologic Response; D017211:Treatment Failure
chemical_list: D000998:Antiviral Agents
keywords: Chronic kidney disease (CKD); Cirrhosis; Direct-acting antivirals; Genotype 3; Hepatitis C virus; Pan-genotypic; Resistance-associated variants; Salvage regimens