Medications for Hepatitis C

By

Sarah Lewis, PharmD

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Deciding to start treatment for hepatitis C—or hep C—can be complicated. It’s a matter of weighing the risks and the benefits. And taking hep C medications can be difficult. It may require commitment to weeks of treatment that could have significant side effects.

Fortunately, there has been a lot of progress in recent years. There are now more options with fewer side effects. And treatment times are shorter than ever, with many regimens lasting only 8 to 12 weeks. So take a look at your options and work with your doctor to design the best treatment plan for you.

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

Pegylated Interferon (Pegasys)

Pegylated interferon is a potent immune stimulator. It helps your body fight hep C infection. It’s a weekly injection and is very effective at battling hep C. But its effectiveness comes at a cost—it has significant side effects. This includes fatigue, flu-like symptoms, headache, nausea, and fever with chills and shaking. And nearly half of people taking pegylated interferon experience these side effects.

Until recently, pegylated interferon was the standard treatment for hep C. Doctors used it in combination with another drug, ribavirin. Treatment guidelines from the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) now recommend other treatments for most genotypes—or strains of the virus.

Ribavirin (Copegus, Ribasphere, Virazole)

Ribavirin is an oral antiviral medicine. It is not effective against hep C by itself. So doctors always use ribavirin in combination with other drugs. In the past, pegylated interferon was always the other drug. Today, doctors can choose other drugs to combine with ribavirin.

Ribavirin has two side effects that are potentially serious. The first one is a blood disorder—hemolytic anemia—and the second is birth defects. Women should avoid pregnancy during treatment and for six months afterwards. Men who have pregnant partners should also avoid this drug.

Boceprevir (Victrelis)

Boceprevir is a protease inhibitor. You take protease inhibitors by mouth. Drugs in this class directly attack the hep C virus. Protease inhibitors are very effective at treating hep C. However, boceprevir tends to have more side effects and require longer treatment than other drugs in this class. As a result, it isn’t listed as a preferred treatment in the AASLD/IDSA guidelines.

Daclatasvir (Daklinza)

Daclatasvir is a NS5A replication complex inhibitor. This first-in-class drug blocks viral production in very early stages. AASLD/IDSA guidelines recommend it in combination with sofosbuvir (Sovaldi) for hep C genotypes 1a, 1b, 2 and 3. This is remarkable because it is the first drug to show it can treat genotype 3 without interferon or ribavirin. The most common side effects are fatigue, headache, nausea and diarrhea.

Simeprevir (Olysio)

Simeprevir is also a protease inhibitor. It treats genotype 1, which is the most common genotype in the United States. Doctors use it in combination with another antiviral drug, sofosbuvir, and sometimes ribavirin. The most common side effects are rash, itching and nausea.

Sofosbuvir (Sovaldi)

Sofosbuvir is a polymerase inhibitor. This drug also directly attacks the hep C virus. It just works on a different enzyme than protease inhibitors. Sofosbuvir is a primary or alternate treatment for all hep C genotypes. Doctors can also use it to treat people with both hep C and HIV. Like all hep C medicines, sofosbuvir must be combined with other antiviral drugs. Most people tolerate this medicine very well.

Telaprevir (Incivek)

Telaprevir is another protease inhibitor. And like boceprevir it is not a preferred treatment in the AASLD/IDSA guidelines. Regimens with telaprevir tend to have more side effects and require longer treatment.

 

Ledipasvir-Sofosbuvir (Harvoni)

This oral combination product treats hep C genotypes 1, 4 and 6 in the AASLD/IDSA guidelines. Most people tolerate this medicine very well. The most common side effects are fatigue and headache.

Ombitasvir-Paritaprevir-Ritonavir and Dasabuvir (Viekira Pak)

This combination pack contains two tablets. One has ombitasivr, paritaprevir and ritonavir. The other is dasabuvir. All four are anti-viral medicines. The AASLD/IDSA guidelines recommend this product in combination with ribavirin to treat genotype 1. Doctors may also use it without the dasabuvir tablet to treat genotype 4. The triple-combination of ombitasvir-paritaprevir-ritonavir is available under the brand name, Technivie. Like other newer drugs, people generally tolerate these products well. Fatigue, nausea, and skin reactions are the most common side effects. 

The goal of these initial treatments for hep C is a sustained viral response (SVR). You achieve SVR when lab tests can’t detect any hep C virus in your blood six months after you stop medicines. There are many factors that determine your likelihood of SVR. But according to the AASLD/IDSA, it’s possible in over 90% of people using newer treatments. It’s a remarkable time to witness these enormous advances in the treatment of hep C.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Dec 22, 2015

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View Sources

Medical References

  1. Can Hepatitis C Be Cured? American Liver Foundation. http://hepc.liverfoundation.org/diagnosis/can-hepatitis-c-be-cured/
  2. Initial Treatment of HCV Infection. American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America. http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection
  3. Monitoring Patients. American Association for the Study of Liver Diseases and Infectious Diseases Society of America. http://www.hcvguidelines.org/full-report/monitoring-patients-who-are-starting-hepatitis-c-treatment-...
  4. When and in Whom to Initiate HCV Therapy. American Association for the Study of Liver Diseases and Infectious Diseases Society of America http://www.hcvguidelines.org/full-report/when-and-whom-initiate-hcv-therapy
  5. Hepatitis C Genotypes and Quasispecies. U.S. Department of Veterans Affairs. http://www.hepatitis.va.gov/provider/reviews/genotypes.asp
  6. Medications to Treat HCV. Hepatitis C Online. http://www.hepatitisc.uw.edu/page/treatment/drugs.

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