Sandbox JA: Difference between revisions

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{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
|+'''''Antiviral Agents Used in the Treatment of Hepatitis C'''''
|+'''''Antiviral Agents Used in the Treatment of Hepatitis C'''''
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Lines of Treatment}}
! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Treatment}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Drug Group}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Drug Group}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Drugs}}
! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Drugs}}
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| style="padding: 5px 5px; background: #DCDCDC;" |'''First Line'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''First Line'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
180 mcg subcutaneously once weekly<ref name="pmid22525303">{{cite journal| author=Yee HS, Chang MF, Pocha C, Lim J, Ross D, Morgan TR et al.| title=Update on the management and treatment of hepatitis C virus infection: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program Office. | journal=Am J Gastroenterol | year= 2012 | volume= 107 | issue= 5 | pages= 669-89; quiz 690 | pmid=22525303 | doi=10.1038/ajg.2012.48 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22525303  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |  
''Serious adverse events'': <1%<ref name="pegasys">[[http://www.pegasys.com/hcp/about-pegasys/what?cid=peg_we_F001113_P000517&c=MVPEHCF479P0533&gclid=CPC0iO_U5r8CFc1i7AodqzUAhQ | PEGASYS Prescribing Information. Genentech, Inc. 2013.]]</ref>
* [[Depression]] with suicide
* Relapse of drug abuse/overdose
* Severe bacterial infections ([[osteomyelitis]], [[endocarditis]], [[pyelonephritis]], [[pneumonia]], and [[sepsis]])
* Hepatic decompensation (2% of patients with HIV coinfection)
 
''Common adverse events'': 99% of patients experience at least one of the following<ref name="pegasys">[[http://www.pegasys.com/hcp/about-pegasys/what?cid=peg_we_F001113_P000517&c=MVPEHCF479P0533&gclid=CPC0iO_U5r8CFc1i7AodqzUAhQ | PEGASYS Prescribing Information. Genentech, Inc. 2013.]]</ref>
* Psychiatric reactions, including depression, insomnia, irritability, anxiety
* Flu-like symptoms such as fatigue, pyrexia, myalgia, headache, and rigors
* [[Anorexia]]
* Nausea and vomiting
* [[Diarrhea]]
* Arthralgias
* Injection site reactions
* [[Alopecia]]
* [[Pruritus]]
|-
|-
| style="padding: 5px 5px; background: #DCDCDC;" |'''Second Line'''
| style="padding: 5px 5px; background: #DCDCDC;" |'''Second Line'''
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
1.5 mc / kg SC once weekly<ref name="pmid22525303">{{cite journal| author=Yee HS, Chang MF, Pocha C, Lim J, Ross D, Morgan TR et al.| title=Update on the management and treatment of hepatitis C virus infection: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program Office. | journal=Am J Gastroenterol | year= 2012 | volume= 107 | issue= 5 | pages= 669-89; quiz 690 | pmid=22525303 | doi=10.1038/ajg.2012.48 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22525303  }} </ref>
| style="padding: 5px 5px; background: #F5F5F5;" |
| style="padding: 5px 5px; background: #F5F5F5;" |
''Serious adverse events'': <1%<ref name="pegintron">[[http://www.merck.com/product/usa/pi_circulars/p/pegintron/pegintron_pi.pdf | PEGINTRON Prescribing Information. Merck & Co., Inc. 2013.]]</ref>
* Suicidal/homicidal thoughts
* Cardiovascular events
* Loss of vision, [[retinopathy]] including [[macular edema]], retinal artery or vein thrombosis
* [[Stroke]]
* Bone marrow toxicity
* Development or exacerbation of autoimmune disorders
* [[Colitis]]
* [[Pancreatitis]]
* Pulmonary disorders including dyspnea, pulmonary infiltrates, [[pneumonia]], [[bronchiolitis obliterans]]
* Liver failure especially with [[HIV]] coinfection
''Common adverse events'': 50% of patients have at least one of the following<ref name="pegintron">[[http://www.merck.com/product/usa/pi_circulars/p/pegintron/pegintron_pi.pdf | PEGINTRON Prescribing Information. Merck & Co., Inc. 2013.]]</ref>
* Injection site reaction
* Mood instability and [[depression]]
* Nausea
* Fatigue/asthenia
* Headache
* Rigors and fevers
* [[Myalgia]]
|-
|-
|}
|}

Revision as of 14:29, 30 July 2014

Progress

Antiviral Agents Used in the Treatment of Hepatitis C
Treatment Drug Group Drugs
First Line
Second Line





Antiviral Medications

There are three types of treatment groups:

  1. Interferon (IFN)
  2. Nucleoside analogs
  3. Nucleotide analogs

First Line agents

Entecavir (ETV)
  • An anti-HBV nucleoside analog
  • A 94% clearance rate after 5 years of treatment is observed in HBeAg positive patients.[1]
  • A 90% clearance rate after 48 weeks of treatment is observed in HBeAg negative patients.[2]
  • A necroinflammation improvement of 96% and fibrosis improvement of 88% is seen after a treatment for 6 years.[1]
Tenofovir (TDF)
  • An anti-HBV nucleotide analog
  • A 68% clearance rate in HBV DNA after 4 years of treatment is observed in HBeAg positive patients.[3]
  • A 84% clearance rate in HBV DNA after 4 years of treatment is observed in HBeAg negative patients.
Interferons
  • Antiviral and antiproliferative glycoprotein.
  • No antiviral resistance have been noted
  • Best results noted with genotype A or B who are HBeAg positive.

Second line agents

Telbivudine (LDT)
  • Nucleoside analog
  • Worse resistance than first line agents and not indicated if resistance to other nucleoside analogs are noted.
Adefovir (ADV)
  • Nucleotide analog
  • Worse resistance than first line agents
  • Used in cases of nucleotide analog resistance.
Lamivudine

Pathogenesis

Treatment

When listeric meningitis occurs, the overall mortality may reach 70%; from septicemia 50%, from perinatal/neonatal infections greater than 80%. In infections during pregnancy, the mother usually survives. Reports of successful treatment with parenteral penicillin or ampicillin exist. Trimethoprim-sulfamethoxazole has been shown effective in patients allergic to penicillin.

Bacteriophage treatments have been developed by several companies. EBI Food Safety and Intralytix both have products suitable for treatment of the bacteria. The FDA of the United States approved a cocktail of six bacteriophages from Intralytix, and a one type phage product from EBI Food Safety designed to kill the bacteria L. monocytogenes. Uses would potentially include spraying it on fruits and ready-to-eat meat such as sliced ham and turkey.

Table

Disease Findings
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  1. ↑ 1.0 1.1 "Chronic Hepatitis B: Integrating Long-Term Treatment Data and Strategies to Improve Outcomes in Clinical Practice".
  2. ↑ Lai, CL.; Shouval, D.; Lok, AS.; Chang, TT.; Cheinquer, H.; Goodman, Z.; DeHertogh, D.; Wilber, R.; Zink, RC. (2006). "Entecavir versus lamivudine for patients with HBeAg-negative chronic hepatitis B.". N Engl J Med. 354 (10): 1011–20. doi:10.1056/NEJMoa051287. PMID 16525138. Unknown parameter |month= ignored (help)
  3. ↑ "http://jid.oxfordjournals.org/content/204/3/415.full". External link in |title= (help)
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