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Hepatitis C (cont.)

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What medications cure hepatitis C infection?

Interferons and pegylated interferons such as Peg-Intron A, Pegasys, Roferon, and Infergen, were mainstays of treatment for years and produced sustained viral response (SVR, or cure) of up to 50%-80%. These drugs were injected, had many adverse effects, required frequent monitoring, and were often combined with oral ribavirin, which caused anemia. Treatment durations ranged up to 48 weeks.

Direct-acting agents (DAA) are antiviral drugs that act directly on hepatitis C multiplication.

  • They are taken by mouth, are well-tolerated, and cure over 90% of patients.
  • Treatment time is much shorter.
  • The earliest options were sofosbuvir (Sovaldi) and simeprevir (Olysio). These were approved by the Food and Drug Administration (FDA) in 2013.
  • Ledipasvir and sofosbuvir (Harvoni) followed as a once-a-day combination pill, in 2014.
  • With this combination of DAAs, about 94%-99% of people achieve an SVR (cure) in 12 weeks with few side effects.
  • Ombitasvir, paritaprevir and ritonavir co-packaged with dasabuvir tablets (Viekira Pak), is a combination approved in 2014. SVR with this combination is 91%-100%. The combination of elbasvir and grazoprevir (Zepatier) was approved in 2016. SVR with this combination depends on the HCV genotype and whether individual patient factors require the addition of ribavirin. Genotype 1 has a 94%-97% SVR, and SVR is 97%-100% in genotype 4.

What are the treatment guidelines for hepatitis C?

The treatment of hepatitis C is best discussed with a doctor or specialist familiar with current and developing options as this field is changing, and even major guidelines may become outdated quickly.

The latest treatment guidelines by the American Association for the Study of Liver Disease (AASLD) and Infectious Disease Society of America (IDSA) recommends use of DAAs as first-line treatment for hepatitis C infection. The choice of DAA varies by specific virus genotype, and the presence or absence of cirrhosis. In the U.S., specific insurance providers also might influence the choice due to the high cost of DAAs. Patients are encouraged to discuss options with their health-care professional.

Treatment is recommended in all patients with chronic hepatitis C unless they have a short life expectancy that is not related to liver disease. Severe life-threatening liver disease may require liver transplantation. Newer therapies with DAAs have allowed more and more patients to be treated.

What are the goals of therapy for hepatitis C infection?

The ultimate goals of antiviral therapy are to

  • prevent transmission of hepatitis C,
  • normalize liver tests,
  • reduce inflammation and scarring,
  • prevent progression to cirrhosis and liver cancer, and
  • improve survival and quality of life.
Medically Reviewed by a Doctor on 4/12/2016


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