만성 C형 간염 진료 가이드라인 비교
Comparison of Guidelines for Management of Chronic Hepatitis C
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초록
새롭게 개발되는 경구 항바이러스제들이 임상 적용됨에따라 C형 간염 치료법은 지속적으로 변화, 발전하고 있다. 새롭게 개발된 경구 항바이러스 약제들은 기존 치료에 비해 치료 효과가 뛰어나고 부작용이 적다. 따라서 C형 간염 치료의대상이 확대되고 치료 금기가 거의 없어지고 있다. 새로운항바이러스제의 임상 도입 시기, 비용효과, 사회경제 상황, 가이드라인 개정 시기 등이 달라서 현재 C형 간염 가이드라인은 각 나라마다 상당한 차이가 있다. 더 효과적이고 부작용이 적은 경구 C형 간염 약제들이 지속적으로 개발되고 있어 C형 간염 치료 가이드라인은 향후 수년간 꾸준히 변화할것으로 예상된다. 이 글에서는 현재 국내 C형 간염 치료 가이드라인, 미국, 유럽 치료 가이드라인을 소개한다.
Abstract
Therapeutic options for patients with hepatitis C virus infection have evolved substantially with the advent of highly effective direct- acting antiviral agents (DAA). Guidelines for treatment of hepatitis C have changed with the evolution of hepatitis C treatments. However, it differs considerably among nations, as the approval and availability of new DAAs, cost-effectiveness, socioeconomic status, and timing of guideline revisions vary. Guidelines for management of hepatitis C by the Korean Association for the Study of the Liver, which was established in November 2013, recommend response-guided therapy with combination of peg-interferon- α and ribavirin (PR). Recommendations for testing, managing, and treating hepatitis C by the American Association for the Study of Liver Disease, which was established in January 2014 and keeps updated, recommend the combination therapy including new DAAs such as sofosbuvir, ledipasvir/sofosbuvir, simeprevir and ritonavir-boosted paritaprevir/ombitasvir/dasabuvir, and discourage use of PR with or without a first-generation protease inhibitor. The European Association of the Study of the Liver recommendations for treatment of hepatitis C revised in April 2015 suggest combination therapy, including new DAAs, such as sofosbuvir, ledipasvir/sofosbuvir, simeprevir, daclatasvir, and ritonavir-boosted paritaprevir/ombitasvir/dasabuvir. Guidelines for treating hepatitis C will be changing soon in Korea with the approval and release of new DAAs.
참고문헌 (3)
- Korean Association for the Study of the Liver (KASL), "KASL clinical practice guidelines: management of hepatitis C", Clin Mol Hepatol, 20, pp.89~136 (2014)
- "Recommendations for testing, managing, and treating hepatitis C"[URL]
- European Association for the Study of the Liver, "EASL Recommendations on Treatment of Hepatitis C 2015", Journal of Hepatology, 63(1), pp.199~236 (2015), Elsevier BV[DOI]