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Hepatitis C: The Evolution of Treatment

Hepatitis C: The Evolution of Treatment

Hepatitis C treatment has evolved relatively quickly

Last week I discussed the history of hepatitis C. This week I focus on the evolution of hepatitis C treatment.

Treatment for chronic hepatitis C infection began in the early 1990s with interferon-alfa. The response rates were low, ranging from 10% to 20%.[i] This injectable drug worked by boosting the immune system, rather than by specifically attacking the virus. It is like giving a gun to people to fight off intruders. If you are a good shot, you win the fight; if you aren’t, you are overwhelmed with intruders.

In 1998, the oral drug ribavirin was added to interferon. The success rates increased dramatically, averaging 37% to 43%,[ii] but so did the side effects. We still don’t know precisely how ribavirin works, other than it seems to weaken HCV. A good way of looking at HCV treatment is that ribavirin cuts the leg off HCV making it easier for interferon to finish the job.

After that, the next big treatment advance occurred in 2002 with the approval of pegylated interferon-alfa, a process that makes interferon more durable and effective. Combined with ribavirin, the average patient could expect about a 52%[iii] permanent response. Pegylated interferon compared to plain interferon is like the difference between a handgun and an automatic weapon.

In 2011, two protease inhibitors were added to our arsenal—boceprevir (Victrelis) and telaprevir (Incivek). These drugs directly targeted HCV and prevent the virus from replicating. Protease inhibitors are like precision-guided weapons designed to destroy a specific virus. In case any HCV is hiding, you finish the job with peginterferon and ribavirin. The triple therapy approach was approved for genotype 1 patients with results hovering around 79%.[iv] Patients with genotypes 2 or 3 continued to use peginterferon and ribavirin without the need for a third drug. This group has good response rates at 82%.[v]

However, the success of boceprevir and telaprevir came with a terrible price as both had horrendous side effects. Patients had suffered through the older treatments, but there were terrible. We needed something new, and quickly.

At the end of 2013, simeprevir (Olysio) and sofosbuvir (Sovaldi) were approved. Treatment was now easier and more effective. However, the game changer was the approval of Harvoni (sofosbuvir and ledipasvir) in 2014.

Things didn’t stop there. Viekira Pak (ombitasvir, paritaprevir, ritonavir and dasabuvir) came out this year. Then came Daklinza (daclatasvir) for use with sofosbuvir to treat patients with genotype 3 and Technivie (ombitasvir, paritaprevir and ritonavir) for use with ribavirin to treat noncirrhotic patients with genotype 4.

Reviewing the history of hepatitis C gives me perspective. Yes, hepatitis C is still looming large. Yes, not everyone can or will be treated with 100% cure rates. Nevertheless, we have still come a long way in a short time and our weapons are improving. This allows us to work on prevention and creating a world free of hepatitis C.

[i] National Institutes of Health Consensus Development ConfeA Brief History of Hepatitis C, by Alan Franciscusrence Statement: Management of Hepatitis C Hepatology March 1997

[ii] Rebetol, Intron and Rebetron product information

[iii] Compilation of data from product information of peginterferon alfa-2a with ribavirin (Pegasys/Copegus) and peginterferon alfa-2b with ribavirin (PegIntron/Rebetron)

[iv]Incivek (telaprevir) prescribing information

[v] Compilation of data from product information of peginterferon alfa-2a with ribavirin (Pegasys/Copegus) and peginterferon alfa-2b with ribavirin (PegIntron/Rebetron)

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  • Greg October 5, 2015, 11:03 AM

    Hi Lucinda: I have Genotype 2a Hepatitis C. Two years ago I had a CBC done and my numbers reviewed. At that time I was in somewhat good health. I had a viral load of one million, slightly elevated AST/ALT but a 5.1 albumin rating along with other promising numbers. At any rate, my GI doctor didn’t think I needed to act on treatment options right away. He recommended the basic Interferon/Ribavirin but after doing enough research I said ‘no’ to that idea. I’ve read that combination can even cause other problems such as Glaucoma.

    I’m going to see another doctor soon to try and get another CBC and see where I stand. But my question is: 1.) How can someone feel secure in taking what isn’t from the earth?

    I worry about side-effects from ingesting pharmaceutical drugs. Thanks.

    • Lucinda Porter October 5, 2015, 12:16 PM

      Hi Greg – treatment has change a lot since then, and the option are much, much better. However, rather than answer your question directly, I am going to suggest two things. 1) You join a group or forum (such as my favorite: Hep Forum, and ask this same question – you will get lots of different responses, and you can see what sounds best for you. 2) While it is normal to be be concerned about drug side effects, wouldn’t it be better to worry about the hep C that is multiplying a trillion times a day in your liver? You have a virus that kills more people in the U.S. every year than HIV does, and increases early death from all causes (cancer, heart disease, stroke, etc) by 15 years and can be cured. Perhaps you are worrying about the wrong thing?

  • April Stump October 1, 2017, 11:39 PM

    How can someone get help with the cost of the medicine? There is no way I can afford $97,000. I am not working at the moment. My mind and thoughts are all messed up. Depression and confusion, not sleeping, and anxiety, are just some. I also have fibromyalgia, and degeneration in my back and neck. Don’t know where to turn or what to do. Lost hope.

    • Lucinda Porter October 11, 2017, 2:31 PM

      There is lots of help for people who need treatment, especially for those with an inability to pay for it. I suggest you try the following:
      Contact the Hep C Careline – http://www.hepatitisc.pafcareline.org 1-800-532-5274.
      Call Help4Hep and ask them for assistance: 877 Help 4 Hep (877 435 7443).
      Join the Hep Forum http://forums.hepmag.com/