This document compares different treatments for hepatitis C virus (HCV), including pegylated interferon plus ribavirin, interferon-beta plus ribavirin, sofosbuvir, simeprevir, and combinations. Studies found sofosbuvir in combination with ribavirin and pegylated interferon-alpha to be the most effective treatment, with an 89% sustained virologic response at 12 weeks and 91% at 24 weeks. The conclusion is that the sofosbuvir combination is the most efficient and safest treatment with the best response rates.

1. A Comparison of different treatments for HCV
Ramón B. Colón Rivera1
1University of Puerto Rico, Cayey, Puerto Rico, Department of Natural Sciences
Abstract
Introduction
 Hepatitis C
 Description
 Treatments
Comparison of each treatment:
 Pegylated Interferon plus Ribavirin Treatment Pegylated interferon plus ribavirin
(PEG-IFN/RBV) and Interferon-beta plus ribavirin (IFN-β/RBV)
 Sofosbuvir (GS-7977) plus peginterferon/ribavirin
 Simeprevir (SVR) plus peginterferon alpha-2a/ribavirin (PegIFNα-2a/RBV)
 Sofosbuvir (GS-7977)
Conclusion
Cited references
Abstract:
Hepatitis C is an inflammatory disease that affects the liver. This disease is transmitted by the
blood of someone infected with Hepatitis C virus (HCV). Seventy-five to eighty- five percent of
people who become infected with HCV develop chronic infection. Japan has one of the highest
rates of HCV infection worldwide, with an estimation of 2 million people infected. Treatments
exist and can be used together. Some treatments are pegylated interferon plus ribavirin (PEG-IFN/
RBV) and Interferon-beta plus ribavirin (IFN-β/RBV), sofosbuvir (GS-7977) plus
peginterferon/ribavirin, simeprevir (SVR) plus peginterferon alpha-2a/ribavirin (PegIFNα-
2a/RBV) and sofosbuvir (GS-7977). Comparing all of the combinations of treatments, the best
one to battle the HCV is sofosbuvir with ribavirin and pegylated interferon-α because is the most
efficient, safest and have the best SVR12 percent. The results of Liu et al. (2014) estimated that
the SVR 12 percent is 89% and the SVR 24 percent is 91%.

2. Introduction:
Hepatitis C (HCV) is an
inflammatory disease that affects the liver.
Infection with hepatitis C virus (HCV) is
one of the leading causes of liver failure
worldwide, and resulted in 195, 000 deaths
in 2010 (Jacobson et al. 2014). People at
risk are those who: have unprotected sex
with someone who has the disease, received
an organ transplant from a donor with the
virus, and blood related infections.
Approximately 75%–85% of people
who become infected with Hepatitis C virus
develop chronic infection. A three percent of
the world's population is chronically
infected with hepatitis C. Japan has one of
the highest rates of hepatitis C virus (HCV)
infection worldwide (Hayashi et al. 2014).
HCV can develop cirrhosis and liver cancer
and most often result in a liver
transplantation. The treatments that I would
present are pegylated interferon plus
ribavirin, interferon-beta plus ribavirin,
sofosbuvir, simeprevir, pegylated interferon
alfa-2a plus ribavirin and sofosbuvir plus
peginterferon/ribavirin . The best treatment
for the Hepatitis C virus is the sofosbuvir
with ribavirin and pegylated interferon-α.
Comparison of each treatment:
 Pegylated interferon plus
ribavirin (PEG-IFN/RBV)
and Interferon-beta plus
ribavirin (IFN-β/RBV)
A study was conducted on132
subjects 65 years or older who had HCV.
These subjects were treated for 24–48 weeks
with interferon-beta plus ribavirin or
pegylated interferon-alpha plus ribavirin.
IFN-β/RBV therapy is associated with a
lower incidence of the onset of depression
symptoms or insomnia. A smaller
percentage decrease in hemoglobin (Hb)
levels seen in the IFN-β/RBV therapy group
in comparison with the PEG-IFN/RBV
therapy group at or after week 8. The cause
is not known. The ITT analysis indicated
that the SVR rates did not differ between
PEG-IFN/RBV and IFN-β/RBV therapies
among patients with either genotype 1 or 2.
The results of examination of parameters
such as IL28B, IFN-β/RBV therapy should
be considered in patients with HCV
genotype 1 (Nomura et al. 2014). If you use
IFN-β/RBV therapy often, it is desirable in
elderly patients with HCV genotype 2,
because IFN-β/RBV and PEG-IFN/RBV
therapies provide similar SVR rates.

(Nomura et al. 2014)
Sofosbuvir (GS-7977) plus
peginterferon/ribavirin
Sofosbuvir is a pyrimidine
nucleotide analog inhibitor of the HCV
NS5B polymerase (Rodríguez et al. 2013).
Rodríguez and other scientists studied 64
subjects with chronic HCV genotype 1
infection ages18–65 with a body mass of
18–36 kg/m2. The subjects receive one of

3. three possible once-daily doses of
sofosbuvir (100, 200, or 400 mg) or
sofosbuvir plus PegIFN/RBV for 28 days.
After that time span, some patients
continued treatment with PegIFN/RBV for
an additional 44 weeks. In this study, more
rapid and substantial viral suppression
occurred in on-treatment and post-treatment
responses than with patients receiving
48 weeks of PegIFN/RBV. In day 21, all
three sofosbuvir groups experienced
reductions of more than 5 log10 IU/ml in
HCV RNA compared to 2.2 IU/ml in
patients receiving PegIFN/RBV. During day
28 of the dosing period, sofosbuvir was
generally safe and well tolerated. Changes in
hematology parameters relating to anemia
and neutropenia were consistent with those
observed for PegIFN/RBV (Rodríguez et al.
2013).
 Simeprevir (SVR) plus
peginterferon alpha-
2a/ribavirin (PegIFNα-
2a/RBV)
Over 183 patients were treated in the
research by Hayashi et al. (2014), to
simeprevir 100 mg plus PegIFNα-2a/RBV
for 12 weeks followed by response-guided
therapy with PegIFNα-2a/RBV alone for 12
or 36 weeks. The primary efficacy endpoint
was achieved in 88.6% of simeprevir and
61.7% of placebo-treated patients. The
adverse event profile in simeprevir treated
patients was comparable to that in patients
who received peginterferon α-2a/ ribavirin
alone. Simeprevir with peginterferon α-2a/
ribavirin once daily significantly improved
sustained virologic response rate 12 weeks
after treatment ended in “treatment naïve
patients” with chronic hepatitis C. A ninety
one point nine percent of simeprevir-treated
patients met RGT criteria and were eligible
to stop PegIFNα-2a/RBV at week 24. The
SVR12 rate was achieved by 92.0%. The
SVR rate of PegIFNα-2a/RBV for 48 weeks
was consistent with the original assumption
for sample size estimation.
Jacobson et al. (2014) also study the
simeprevir (SVR) with peginterferon alpha-
2a/ribavirin (PegIFNα-2a/RBV). Overall
treatment duration in the simeprevir group
was either 24 weeks or 48 weeks and the
control group received placebo plus
peginterferon alfa plus ribavirin for 48
weeks. Patients were 18 years and older with
confirmed chronic HCV genotype 1
infection and no history of treatment for
HCV infection. Patients in the simeprevir
group received simeprevir plus
peginterferon alfa 2a plus ribavirin for 12
weeks, followed by peginterferon alfa 2a
plus ribavirin without simeprevir for 12
weeks or 36 weeks. The placebo group
(Rodríguez et al. 2013)
(Hayashi et al. 2014)

4. received placebo plus peginterferon alfa 2a
plus ribavirin for the first 12 weeks,
followed by peginterferon alfa 2a plus
ribavirin for 36 weeks. All patients in the
placebo group continued this combination
until week 48. A 80% of treated patients
who were receiving simeprevir in
combination with peginterferon alfa 2a and
ribavirin achieved SVR12 than did those
receiving placebo in combination with
peginterferon alfa 2a and ribavirin. The 85%
of patients in the simeprevir group met
criteria for response-guided therapy and
were eligible to complete treatment at week
24, and 91% of these subsequently achieved
SVR12.
(Jacobson et al. 2014)
(Liu et al. 2014)
 Sofosbuvir (GS-7977)
Liu et al. (2014) wanted to know the
efficacy and effectiveness of sofosbuvir with
ribavirin (RBV) and pegylated interferon-α
(peg-IFN) or sofosbuvir with RBV only
among adults with HCV infection. They
organized the experimental group by the
treatments that they were going to study.
The subjects needed 18 years old with
chronic HCV infection. One group was
treated with sofosbuvir, RBV, and peg-IFN.
The result was that the SVR12 was 89%. In
the table we can see that we also have the
SVR 24 that was a 91%. The other group
was treated with sofosbuvir and RBV; the
result was that SVR12 was 72%. The
authors concluded that sofosbuvir-based
treatment is effective and safe in treating
chronic HCV infection, although the SVR12
of its combination with RBV, especially in
treatment-experienced patients, requires
improvement. Liu and the other scientist
said that, “The current meta-analysis
indicates that sofosbuvir-based therapy is
generally effective and safe in the majority
of adults with chronic HCV infection with
various genotypes”.
Conclusion
Comparing all of the combinations
of treatments, the best one to battle the HCV
is sofosbuvir with ribavirin and pegylated
interferon-α because is the most efficient,
safest and have the best SVR12 percent. The
results of Liu et al. (2014) estimated that the
SVR 12 percent is 89% and the SVR 24
percent is 91%. All this research will help
the medicine doctors know what is the best
treatment for their patients.

5. Cited References:
1. Hayashi N, Izumi N, Kumada H,
Okanoue T, Tsubouchi H, Yatsuhashi H, Kato M,
Ki R, Komada Y, Seto C, Goto S.2014.Simeprevir with peginterferon/ribavirin
for treatment-naïve hepatitis C genotype 1 patients in Japan: CONCERTO-1, a
phase III trial.J of Hepathology [Internet].[cited 2014 October 9];61(2):219–
227.Available from:
http://www.sciencedirect.com.uprcdb.cayey.upr.edu:2048/science/article/pii/S016
8827814002219?np=y
2. Jacobson I, Dore G, Foster G,
Fried M, Radu M, Rafalsky V, Moroz L, Craxi A,
Peeters M, Lenz O et al.2014. Simeprevir with pegylated interferon alfa 2a plus
ribavirin in treatment-naive patients with chronic hepatitis C virus genotype 1
infection (QUEST-1): a phase 3, randomised, double-blind, placebo-controlled
trial.The Lancet [Internet].[cited 2014 October 31];384(9941):403-413.Available
from:
http://www.sciencedirect.com.uprcdb.cayey.upr.edu:2048/science/article/pii/S014
0673614604943?np=y
3. Liu X, Wang Y, Zhang G, Li N,
Zhu G, Chang H, Han Q, Lv Y, Liu Z.2014. Efficacy
and safety of sofosbuvir-based therapy for the treatment of chronic hepatitis C in
treatment-naïve and treatment-experienced patients.Int J of Antimicrobial
Agents[Internet].[cited 2014 October 2];44(2):145-151.Available from:
http://www.sciencedirect.com.uprcdb.cayey.upr.edu:2048/science/article/pii/S092
4857914001630?np=y
4. Nomura H, Miyagi Y, Tanimoto
H et al.2014.Interferon-beta plus ribavirin therapy
can be safely and effectively administered to elderly patients with chronic
hepatitis C.Journal of Infection and Chemotherapy[Internet]; [cited 2014
September 25]; 20 (8): 489 - 492. Available from:
http://www.sciencedirect.com.uprcdb.cayey.upr.edu:2048/science/article/pii/S134
1321X14001755?np=y
5. Rodríguez M, Lawitz E,
Kowdley K, Nelson D, DeJesus E, McHutchison J,
Cornpropst M, Mader M, Albanis E, Jiang D et al.2013. Sofosbuvir (GS-7977)
plus peginterferon/ribavirin in treatment-naïve patients with HCV genotype 1: A
randomized, 28-day, dose-ranging trial.J of Hepatology[Internet];[cited 2014
October 31];58(4):663-668.Available from:
http://www.sciencedirect.com.uprcdb.cayey.upr.edu:2048/science/article/pii/S016
8827812008872?np=y

6. References:
1. http://www.niddk.nih.gov/health- information/health-topics/liver-disease/hepatitis-c/
Pages/ez.aspx
2. http://ideas.health.vic.gov.au/diseases/hepatitis-c.asp