Breakthroughs in Treating Hepatitis C

By

Cindy Kuzma

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As recently as 1986, doctors had just one drug for hepatitis C: interferon, similar to a protein that occurs naturally in the body. And it worked in only 6% of patients.

Now, new approaches that combine multiple medications can successfully treat more than 80% of people with this virus.

In fact, hepatitis C, which causes inflammation of the liver, is one of the few chronic diseases that doctors have cured—meaning no traces of the virus remain in the bloodstream. And researchers continue to make discoveries that improve the safety and effectiveness of hepatitis C therapies.

In the last few years, a lot has changed in the way we treat hepatitis C. Do you know all the facts?

Medical Reviewer: William C. Lloyd III, MD, FACS Last Review Date: Oct 23, 2015

Genotyping the Virus

Scientists have now identified six different types of hepatitis C virus, based on their genetic makeup. Each responds differently to treatment. Three-fourths of people with hepatitis C have genotype 1. Your doctor can order a blood test for genotype and use this information to choose the treatment that will work best.

From Double to Triple to Quadruple Therapy

Doctors first combined interferon with another medication—ribavirin (brand names Copegus, Rebetol, and Ribasphere)—in the 1990s. By the early 2000s, this combination served as the standard of care. For many patients, including those with genotypes 2 and 3, 6 to 12 months of this so-called double therapy still works best for clearing the virus from their system.

In 2011, the U.S. Food and Drug Administration (FDA) approved two new medications, boceprevir (Victrelis) and telaprevir (Incivek). These drugs were added to peginterferon and ribavirin to create triple therapy. Another medication—simeprevir (Olysio)—was approved in 2013.

Drugs that Work Without Interferon

Interferon and peginterferon have done wonders for many people with hepatitis C, reducing the amount of the virus in their bodies. But even in its newer formulations, the drug is administered by injection and has potentially serious side effects. These include suicidal thoughts, heart attack, and autoimmune disorders. Patients must be monitored closely while taking it.

For these reasons, doctors continue to search for new treatments. In 2013, the FDA approved the first drug that works without interferon,  initially prescribed for people with genotype 2 or 3 hepatitis C. The drug, sofosbuvir (Sovaldi), is taken orally, which makes it easier for many people to handle. It still must be combined with ribavirin for patients with genotype 2 or 3.

High Cure Rate With Newest Treatment

Another significant breakthrough occurred in December 2014, when the FDA approved a new combination treatment containing four drugs (Viekira Pak). The therapy combines three new medications—ombitasvir, paritaprevir and dasabuvir—with the previously known ritonavir. The pack treats people with genotype 1 infection, including those with cirrhosis, and can be used with or without ribavirin.

In clinical trials, 91 to 100% of participants achieved a sustained viral response (SVR)—meaning they did not have the virus in their bloodstream 24 weeks after finishing treatment. Almost all patients who achieve SVR are cured. In the trials, side effects of the new treatment included fatigue, itching, lack of energy, nausea, and trouble sleeping.

Therapies on the Horizon

Researchers continue work on several new antiviral medications to treat chronic hepatitis C infection. The goals: increase success rates, shorten the duration of treatment, reduce side effects, and provide new options for people who can’t tolerate or don’t respond to existing regimens. It's hard to keep up with all the breakthroughs! Multiple antiviral combination strategies have proven very effective for HCV patients, even for those who failed prior therapy, those with less common genotypes, and those with signs of cirrhosis. 

Within the next 10 years, some experts predict, several molecules that treat hepatitis C could be combined into a single pill. Taking this pill once a day for 3 to 6 months would cure an estimated 90% of people, they report.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 7, 2016

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Medical References

  1. Alao H, Jake Liang T. Alternative interferons and immunomodulators in the treatment of hepatitis C. Liver Int. 2014;34 Suppl 1:133-8.
  2. Shiffman ML, Benhamou Y. HCV F1/F2 patients: treat now or continue to wait. Liver Int. 2014;34 Suppl 1:79-84.
  3. Trepo C. A brief history of hepatitis milestones. Liver Int. 2014;34 Suppl 1:29-37.
  4. Olysio (simeprevir) for the treatment of chronic hepatitis C in combination antiviral treatment. U.S. Food and Drug Administration. http://www.fda.gov/ForPatients/Illness/HepatitisBC/ucm377234.htm
  5. Approval of Sovaldi (sofosbuvir) tablets for the treatment of chronic hepatitis C. U.S. Food and Drug Administration. http://www.fda.gov/ForPatients/Illness/HepatitisBC/ucm377920.htm
  6. FDA approves Viekira Pak to treat hepatitis C. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm427530.htm
  7. Hepatitis C medications: A review and update for patients. U.S. Department of Veterans Affairs. http://www.hepatitis.va.gov/products/patient/treatment-update.asp
  8. Anticipating New Regimens with Direct Acting Antivirals for Hepatitis C. U.S. Department of Veterans Affairs. http://www.hepatitis.va.gov/provider/hcv/DAA-update.asp
  9. Peginterferon Alfa-2b (PEG-Intron). MedlinePlus, U.S. National Library of Medicine. . http://www.nlm.nih.gov/medlineplus/druginfo/meds/a605030.html

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