Hepatitis C medications – while being the best game in town for treating this life-threatening disease – admittedly come with a significant burden in side effects for most patients. Medication combinations that can shorten treatment time and cure more cases of acute hepatitis C infections are welcome news to both patients and physicians. Dr. Daniel Fierer, from Mount Sinai Hospital in New York City, presented data about a quicker, better cure for hepatitis C at this year’s Conference on Retroviruses and Opportunistic Infections in Atlanta.
Hepatitis C infections are considered “acute” in the first six months after the initial infection. Acute hepatitis C is a short-term illness that causes jaundice, fatigue, and nausea in some people, while others have no symptoms at all. An estimated 15-25 percent of people will clear the virus on their own without any treatment, but most people (that is, 75-85 percent) go on to develop chronic hepatitis C infection.
Chronic hepatitis C can cause several long-term health problems, including cirrhosis, liver cancer, and liver failure. Chronic hepatitis C infection is the most common reason necessitating liver transplantation.
Protease Inhibitors Enter the Market
Hepatitis C treatment became more effective last year when protease inhibitors were added to treatment protocols. One of these protease inhibitors, Incivek (telaprevir) from Vertex, is used specifically for genotype 1 hepatitis C infections, in combination with peginterferon alpha and ribavirin. The addition of telaprevir has increased the viral cure rate for chronic hepatitis C.
Dr. Fierer’s oral presentation at the Conference on Retroviruses and Opportunistic Infections, offered data from his work with HIV+ men treated in his clinic with a novel treatment regimen. HIV+ patients generally get regular liver panels, as a result of the antiretroviral therapy. Thus, Dr. Fierer was able to identify a group of 18 patients in the early stages of genotype 1 hepatitis C infection; they were enrolled in his open label study. Five additional patients cleared the virus on their own before treatment was started.
Triple therapy with telaprevir, peginterferon alpha, and ribavirin shortened the treatment time and increased the sustained virological response (in essence, cured these patients). Specifically, 83 percent of these men (15 out of 18) were cured of hepatitis C infection and none relapsed. Without the telaprevir, 62 percent would have been cured, according to data gathered prior to the approval and use of telaprevir, and reaching that 62 percent took 24-48 weeks instead of the 12 weeks of this study.
The virus was undetectable by week four of treatment in these 83 percent, although treatment continued for a total of 12 weeks. Treating hepatitis C in the acute stage, as opposed to waiting for the infection to be chronic, leads to better cure rates. I’ll be looking forward to more and larger studies to confirm Dr. Fierer’s results in acute hepatitis C infection.
Stephen C Vogt, PharmD
President and CEO