Easier hepatitis C treatment
Easier hepatitis C treatment has arrived. Learn more about new antiviral drugs that can cure this serious chronic infection.By Mayo Clinic Staff
Although chronic hepatitis C has been treatable for some time, only a minority of those who start treatment can stick with it long enough to wipe out the virus. That's about to change, thanks to new medications and greater awareness of the disease. Here's an overview of recent developments in hepatitis C treatment.
What treatments are available for chronic hepatitis C infection?
Doctors treat chronic hepatitis C infection with antiviral drugs. These drugs act in different ways to eliminate hepatitis C virus from your liver and blood.
In recent clinical trials, several new antiviral drugs have shown high levels of effectiveness against hepatitis C infection. Three of these drugs have received Food and Drug Administration (FDA) approval, and more should be available soon. Because of these developments, guidelines for treating chronic hepatitis C are changing rapidly.
The types of antiviral drugs used to treat chronic hepatitis C infection are:
- Drugs with general antiviral properties. These include interferons — specifically, peginterferon alfa-2a (Pegasys) and peginterferon alfa-2b (Intron A) — and ribavirin (Rebetol, Copegus, others).
- Direct-acting antiviral agents. These include simeprevir (Olysio), sofosbuvir (Solvadi) and a combination pill (Harvoni) containing sofosbuvir with a third drug, ledipasvir. Several other direct-acting antivirals are in the pipeline for FDA approval.
Each type of anti-hepatitis C drug weakens hepatitis C virus at a different point in its life cycle. For this reason — and because many studies have shown that combination therapy increases effectiveness — treatment with two or three drugs at once is necessary. With new antiviral drugs, however, treatment of chronic hepatitis C is generally becoming simpler, easier to tolerate, more likely to result in a cure and, in some cases, a shorter length of treatment.
What is the role of interferon in treatment of chronic hepatitis C infection?
Interferon is a protein the immune system naturally produces in response to inflammation and infection. Pharmaceutical companies also manufacture distinct types of interferon to treat a number of conditions, including chronic hepatitis C. FDA-approved treatments for the most common type of hepatitis C in North America and Europe still include interferon — for those who can safely take it. But many people can't, including anyone with:
- An autoimmune disease, particularly autoimmune hepatitis
- Actively progressing liver disease
- A history of interferon alfa-2b intolerance or allergy to polyethylene glycol (PEG), a compound added to interferon alfa-2b to boost its antiviral effect
- Depression or a history of depression
- A heart condition or history of a heart condition
- A blood abnormality, such as too few red blood cells (anemia) or platelets
Even those who can take interferon safely may have trouble completing a course of treatment. Interferon is available only by injection, typically given once a week. Serious side effects include blood abnormalities, psychiatric problems and persistent fatigue. Also, anyone treated with the drug requires regular medical visits to manage side effects.
Additional clinical trials should soon produce enough data to justify a sharp turn away from interferon-based treatment of chronic hepatitis C. Until that happens, talk to your doctor about any concerns you may have before starting treatment. For some people, it may be best to postpone treatment until a better tolerated regimen is approved.
Nov. 08, 2014
- Ghany MG, et al. QUEST for a cure for hepatitis C virus: The end is in sight. The Lancet. 2014;384:381.
- Dugum M, et al. Hepatitis C virus: Here comes all-oral treatment. Cleveland Clinic Journal of Medicine. 2014;81:159.
- Jacobson IM, et al. Simeprevir with pegylated interferon alfa 2a plus ribavirin in treatment-naive patients with chronic hepatitis C virus genotype 1 infection (QUEST-1): a phase 3, randomised, double-blind, placebo-controlled trial. The Lancet. 2014;384:403.
- Manns M, et al. Simeprevir with pegylated interferon alfa 2a or 2b plus ribavirin in treatment-naive patients with chronic hepatitis C virus genotype 1 infection (QUEST-2): a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet. 2014;384:414.
- Manns M, et al. All-oral daclatasvir plus asunaprevir for hepatitis C virus genotype 1b: A multinational, phase 3, multicohort study. The Lancet. In press. Accessed Aug. 6, 2014.
- Tovo CV, et al. Chronic hepatitis C genotype 1 virus: Who should wait for treatment? World Journal of Gastroenterology. 2014;20:2867.
- Chopra S, et al. Treatment regimens for chronic hepatitis C, genotype 1. http://www.uptodate.com/home/. Accessed Aug. 1, 2014.
- Recommendations for testing, managing and treating hepatitis C. Alexandria and Arlington, Va.: American Association for the Study of Liver Diseases/Infectious Diseases Society of America. http://www.hcvguidelines.org. Accessed Aug. 6, 2014.
- Shiffman ML, et al. My treatment approach to chronic hepatitis C virus. Mayo Clinic Proceedings. 2014;89:934.
- Page K, et al. Acute hepatitis C virus infection in young adult injection drug users: A prospective study of incident infection, resolution and reinfection. Journal of Infectious Diseases. 2009;200:1216.
- Harvoni (prescribing information). Foster City, Calif.:Gilead Sciences; 2014. http://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/harvoni/harvoni_pi.pdf. Accessed Oct. 24, 2014.