DOCTOR'S VIEWS ARCHIVE


Topic: Hepatitis C, June 2000

Dr. Lee:
What treatments are available to date for Hepatitis C?

Dr. Edward Block:
Well, there are now several treatments available. The initial medication that was first released for treatment of hepatitis C was interferon. Interferon is an injectable agent that was initially recommended to use for Hepatitis C patients. Unfortunately, the success rate was somewhat limited.

Fortunately, over the last several years we have been able to introduce a second drug, which is known as ribavirin (an antiviral drug). We have found that this drug used alone was actually not terribly beneficial, but when given in combination with interferon the two together seemed to have better efficacy than interferon alone in eradicating the Hepatitis C virus.

Dr. Lee:
So now we have two treatments, one is interferon, alone. And, the other treatment is interferon in combination with oral ribavirin, correct?

Dr. Edward Block:
Yes.

Dr. Lee:
Let's have a discussion on what constitutes treatment success?

Dr. Edward Block:
Well, what we would like to see is complete eradication of the Hepatitis C virus. We use the Hepatitis C RNA test to detect the virus in the blood of an individual. Failure to detect Hepatitis C RNA in a patient six months after stopping treatment likely indicates virus eradication. So, 6 months following treatment, Hepatitis C RNA test is repeated. Treatment success would be defined as the disappearance of the Hepatitis C RNA in the blood of the treated individual.

Dr. Lee:
Also, in that patient other liver tests such as SGOT (ALT) and SGPT (AST) will also have returned to normal with successful treatment, am I correct?

Dr. Edward Block:
Yes that is correct. Although we would prefer to use the disappearance of Hepatitis C RNA from the blood as the 'gold standard' of determining treatment success. Because in some individuals, SGOT and SGPT can go up and down, independent of the presence or absence of the virus.

Some patients may actually have normalization of these liver tests (SGOT and SGPT) with treatment. But when you look a little further by measuring Hepatitis C RNA, you can still detect the presence of the virus. So the best way to determine the success of treatment is by the measurement of the Hepatitis C RNA at six months after completing treatment.

Dr. Lee:
By this treatment success definition, what is our success rate with interferon alone as compared to interferon combined with ribavirin?

Dr. Edward Block:
Unfortunately, we still have some work to do here. The initial interferon treatment trials were with injection under the skin three times a week with 3 million units. These were continued for six months. The long term successful response rate as measured by the failure to detect the virus at six months following treatment was only somewhere between 8% and 10%.

When we lengthened the interferon treatment duration to one year, we were actually able to double success rate to 20%---still not very good.

Now, when we combine interferon and ribavirin together, we are getting up to a 40% sustained overall response rate.

I might add that successful response rates vary depending on the virus genotype. In some of the favorable genotypes, the ability to eradicate the virus is as high as 60% or 80%!

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Last Editorial Review: 8/16/2000 3:52:00 PM



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