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首页> 外文期刊>Clinics and research in hepatology and gastroenterology >Management of side-effects.
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Management of side-effects.

机译：副作用的管理。

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The current treatment of chronic hepatitis C is the triple combination of pegylated interferon, ribavirin and a new direct-acting antiviral [either telaprevir (TVR) or boceprevir (BOC)]. This new association produces better viral response rates, but may induce or enhance adverse events, which can lead to discontinuation of treatment. TVR regimens are associated with an increased risk of dermatological side-effects such as rash, albeit generally mild. In these cases, optimal skincare treatments, including emollient creams and topical corticosteroids, allow the continuation of antiviral treatment. In a minority of cases, the rash may be severe and life-threatening, leading to immediate discontinuation of all treatments. The goal for the physician is to differentiate severe cutaneous adverse reactions (SCARs), including DRESS (drug reactions with eosinophilia and systemic symptoms). Anaemia is also more frequent with triple combinations using TVR or BOC. The management of anaemia requires the use of erythropoietin alpha (EPO) and the need to decrease ribavirin doses. Thus, monitoring haemoglobin has to be more frequent in difficult-to-treat patients such as cirrhosis cases; nevertheless, despite the use of EPO and ribavirin-dose adaptation, blood transfusion is sometimes still required. Thus, triple combination therapy with a DAA is effective, but it increases the rate of adverse events, and adds to the well-known adverse effects of pegylated interferon and ribavirin. This suggests the need for a different clinical and biological management of patients treated with the triple combination.
机译：慢性丙型肝炎的当前治疗方法是将聚乙二醇化干扰素，利巴韦林和新型直接作用抗病毒药[telaprevir（TVR）或boceprevir（BOC）]结合使用。这种新的联系产生更好的病毒反应率，但可能诱发或增强不良事件，从而导致治疗中断。 TVR疗法与皮疹等皮肤病副作用的发生风险增加有关，尽管通常是轻度的。在这些情况下，最佳的皮肤护理治疗方法（包括润肤霜和局部皮质类固醇激素）可以继续进行抗病毒治疗。在少数情况下，皮疹可能很严重且危及生命，导致立即停止所有治疗。医师的目标是区分严重的皮肤不良反应（SCAR），包括DRESS（具有嗜酸性粒细胞增多和全身症状的药物反应）。使用TVR或BOC的三联组合时，贫血也更常见。贫血的治疗需要使用促红细胞生成素α（EPO），并需要减少病毒唑的剂量。因此，在肝硬化等难以治疗的患者中，血红蛋白的监测必须更加频繁。尽管如此，尽管使用了EPO和利巴韦林剂量调整，有时仍需要输血。因此，DAA的三联疗法是有效的，但它增加了不良事件的发生率，并增加了聚乙二醇化干扰素和利巴韦林的众所周知的不良反应。这表明需要对三联治疗的患者进行不同的临床和生物学治疗。

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