Medication of Chronic Hepatitis C: A Review on Sofosbuvir as a New Antiviral Drug

In the last decade, standard of care (SOC) anti-HCV treatment has been represented by the combination of Peginterferon (Peg-IFN) plus ribavirin (Rbv). The main disadvantages of Peg-IFN plus Rbv therapy were suboptimal rates of sustained virological response (SVR) in difficult-to-treat patients and side effects profile resulting in poor tolerability. Therefore, strategies to improve SVR rates and limited side effects have been an important issue for clinical physicians. Recently, direct antiviral agents (DAAs) opened the gate for a new era for management of HCV and have revolutionized the treatment of chronic hepatitis c (CHC) patients. Furthermore, the approval of sofosbuvir by FDA represents the first key step towards the new era in the management of CHC patients, since it is the first approved DAAs with excellent tolerability and favorable pharmacokinetic profile, limited potential for drug interactions, higher specificity, shorter treatment durations, low side effects, oral administration, potent antiviral activity and high genetic barrier against all HCV genotypes and acts as a chain terminator during the HCV replication process. Sofosbuvir efficacy and safety was demonstrated in many large and well-designed phase 2 and phase 3 clinical trials like PROTON, ATOMIC, NEUTRINO, ELECTRON, QUANTUM, FISSION, FUSION, POSITRON and LONSTAR studies. In this concept, sofosbuvir represents an almost ideal backbone, especially in difficult-to-treatCHCpatients with cirrhosis or liver impairment, liver transplant recipients, and co-infection with HIV. This review summarizes the development of different anti-HCV agents, and also provides an overview of sofosbuvir clinical efficacy and discussing key results and potential future developments