Table of Contents
Advances in Hepatology
Volume 2014, Article ID 493087, 13 pages
Review Article

Ribavirin at the Era of Novel Direct Antiviral Agents for the Treatment of Hepatitis C Virus Infection: Relevance of Pharmacological Monitoring

1Department of Hepatology, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, 103 grande rue de la Croix-Rousse, 69004 Lyon, France
2INSERM U1052, 69003 Lyon, France
3Université Lyon I, Lyon, France
4Ecole Normale Supérieure, 69007 Lyon, France
5Department of Pharmacology, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69003 Lyon, France
6Institut Universitaire de France, Paris, France

Received 2 June 2014; Revised 29 August 2014; Accepted 11 September 2014; Published 30 September 2014

Academic Editor: Jun Yong Park

Copyright © 2014 Pierre Pradat et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Ribavirin is often used for the treatment of hepatitis C virus (HCV) infection. Although its mechanisms of action remain to be clearly elucidated, ribavirin plays a beneficial role for achieving virological response and decreasing the rate of virological relapse after treatment cessation. However, ribavirin may induce side effects leading to early treatment discontinuation. Among them, hemolytic anemia is the most frequent and results from intraerythrocyte accumulation. Pharmacological studies have shown that early ribavirin exposure assessed by the area under the curve (AUC) at day 0 and ribavirin trough concentration during the first three months of therapy were correlated with sustained virological response (SVR). These studies highlighted the relevance of ribavirin pharmacologic monitoring and early dose adaptation during therapy. Although the role of ribavirin within new direct acting antiviral (DAA) combinations will probably decrease in the future, its potential benefit in difficult-to-treat patients such as patients with severe hepatopathy or patients who failed triple therapy including patients with multiresistance will need to be further investigated.