Until recently, the medication options available to treat patients infected with the Hepatitis C virus caused unpleasant side effects. Now two new drugs are offering fewer side effects, shortened treatment times, and higher success rates. More good news: Additional drugs are on the horizon.
In the U.S. alone, between 3 million and 4 million people are infected with the Hepatitis C virus. It is likely that half of them don’t know that they have it until they begin to experience symptoms of liver damage. In addition to causing permanent liver damage, Hepatitis C is the leading cause of liver cancer and liver transplants; roughly 5 percent of those who are chronically infected will die of cancer or cirrhosis. However, medical intervention can prevent the most serious outcomes in many cases.
Typically, Hepatitis C has been treated with a combination of drugs. Traditional treatment has included telaprevir or boceprevir plus ribavirin and interferon. These drugs, particularly interferon, can cause fevers, headaches, fatigue, mood swings ranging from depression to anxiety, and gastrointestinal symptoms such as nausea and diarrhea. Some side effects can be severe.
New Drugs, Fewer Side Effects
The Food and Drug Administration (FDA) has recently approved two new drugs—sofosbuvir and simeprevir—that don’t cause many of the most uncomfortable side effects that accompanied previous drug treatment while promising significantly improved outcomes. Late last year, sofosbuvir became the first all-oral, interferon-free drug regimen to be proven effective in treating Hepatitis C. It is used primarily in combination with ribavirin. Investigators believe that sofosbuvir-based treatment may be effective for patients with advanced liver disease, including decompensated cirrhosis. Another drug, simeprevir, was approved just a few weeks earlier. Simeprevir is the first once-daily protease inhibitor effective in treating chronic Hepatitis C when used in a combination antiviral regimen for adults with compensated liver disease. Several pharmaceutical companies are working on more new drugs that are expected to be available soon.
In addition to producing fewer and more tolerable side effects, these new drugs are expected to offer significantly higher success rates in a shorter duration of treatment. Data suggests that these medications can produce a high cure rate in only 12 weeks—half the time required by combinations of oral medications previously available. The only downside is the high cost of these new drugs, which may put them beyond the reach of some patients. At $1,000 a pill for sofosbuvir, a 12-week course of treatment can cost between $84,000 and $168,000.
New Treatment Guidelines
Because the landscape of Hepatitis C treatment options is changing so dramatically, the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America in collaboration with the International Antiviral Society–USA have released new web-based guidelines. As the management of Hepatitis C continues to evolve, a panel of experts in hepatology and infectious diseases will post updated guidance on the website, using an evidence-based review of available information. The guidelines will evolve as more new medications are approved for the treatment of Hepatitis C.