Hepatitis C (cont.)

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Newer drugs and therapeutic medications for hepatitis C

Scientific advances have led to the development of new drugs for hepatitis C, which may be more effective and better tolerated than existing therapies. There are few newer therapeutic medications in the market, which are approved by FDA, and many others are in process of development.

Telaprevir (Incivek) and boceprevir (Victrelis) are therapeutic drugs used in addition to interferon and ribavirin. These combinations are commonly known as triple therapy (comprising of three medications- interferon, ribavirin and a new agent). The response to triple therapy was better than with pegylated interferon and ribavirin, reaching approximately 80%. Telaprevir (Incivek) was withdrawn from the market in 2014 by the manufacturer due to the availability of better drugs.

Sofosbuvir (Sovaldi) and simeprevir (Olysio) are oral therapeutic drugs, which were approved by the FDA in 2013. These drugs can be used in combination with ribavirin and interferon, but with simeprevir it is possible to eliminate the interferon. The effectiveness of treatment with these combinations of medications is extremely high (greater than 90%), and it now provides an all oral treatment.

Some of these new medications are also are known as direct acting antivirals (DAA) because they:

  • Directly attack and help kill the hepatitis C virus in the body
  • Are highly effective with a rate of sustained responses of >90%.
  • Are taken as all oral regimens i.e. pill only form

Ledipasvir and sofosbuvir (Harvoni) is a combination that is taken as one pill once a day is the latest addition to the list of direct acting antivirals approved in 2014. With this therapy, the effectiveness is even greater with a rate of sustained responses of 94%-99% with fewer side effects. Duration of therapy also is reduced to 12 weeks (instead of the traditional 48 weeks with interferon and ribavirin).

Ombitasvir, paritaprevir and ritonavir co-packaged with dasabuvir tablets (Viekira Pak), another combination of oral direct acting antivirals was approved by the FDA in December 2014. The sustained response rate of this combination was 91%-100%. As these medications are very new, data is still limited, and more data is expected to be available in the near future.

Many other medications are under investigation but are not approved yet. The latest treatment guidelines by American Association for the Study of Liver Disease (AASLD) and Infectious Disease Society of America (IDSA) recommends use of these newer medications (direct acting antivirals) as the primary treatment for hepatitis C infection and no longer recommend treatment with pegylated interferon and ribavirin. The choice of direct acting antiviral 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 direct acting antivirals. Patients are encouraged to discuss these options with their physician on an individual basis.

Medically Reviewed by a Doctor on 5/26/2015

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