Breakthroughs in Treating Hepatitis C
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.
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.
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.
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.
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.
Today, even more medications are available with high cure rates and mild side effects. Drugs like Zepatier (a combination of elbasvir and grazoprevir), Harvoni (a combination of ledipasvir and sofosbuvir), and Epclusa (combining sofosbuvir and velpatasvir) come in the form of one pill to take daily.
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.
Consult your doctor about the best treatment for hepatitis C. He or she will help you weigh all the benefits and risks and make the right choice for you—whether that’s newer therapy, older therapy, or close monitoring of the disease to ensure it doesn’t worsen.
- In 2011, the FDA approved boceprevir (Victrelis) and telaprevir (Incivek). These drugs were added to peginterferon and ribavirin to create triple therapy, which works for up to 75% of people with genotype 1 virus.
- Simeprevir (Olysio), approved in 2013, is another option for people with genotype 1 and has fewer severe side effects.
- In 2013, the FDA approved the first drug that works without interferon. Sofosbuvir (Sovaldi) is taken orally, which makes it easier for many people to handle.
- In late 2014, the FDA approved a new combination treatment containing four drugs (Viekira Pak). In clinical trials, more than 90% of participants achieved a cure.
- The introduction of even more novel antiviral medications, as well as combination drug strategies, offers renewed hope to many infected with HCV.