When you have hepatitis C, you're no stranger to fatigue. It's a top challenge for people living with this liver disease. A number of things can cause you to be tired, so it can be hard to pinpoint one reason. The hepatitis virus itself may be to blame. Liver damage causes fatigue, as do some of the treatments.
Olysio and Sovaldi are combined with the older drugs interferon and ribavirin. This combination is quickly becoming the new standard for treating hepatitis C.
Before Olysio and Sovaldi became available in 2013, the typical treatment for hepatitis C was a combination of interferon and ribavirin with two antiviral drugs:
Incivek and Victrelis were introduced in 2011. "These drugs interfere with the virus's ability to grow and replicate in the body," says Jonathan M. Fenkel, MD. He's the director of the Jefferson Hepatitis C Center at Jefferson University Hospitals in Philadelphia.
Taking one of these two medications in combination with interferon and ribavirin increased cure rates for people with type 1 hepatitis C (the most common form in the U.S.) from less than 50% to between 68% and 75%.
It also reduced treatment time for many patients. Those who had the virus disappear from their blood quickly enough could stop taking medications after 24 weeks.
But combining Incivek and Victrelis with interferon and ribavirin comes with some serious side effects.
The side effects of interferon and ribavirin include:
Anxiety and depression
Interferon can also cause a lowered white blood cell count, reducing the ability to fight infection.
Incivek and Victrelis "tend to make the anemia caused by interferon and ribavirin even worse," says Ira Jacobson, MD. He is chief of the division of gastroenterology and hepatology at the Joan and Sanford I. Weill Medical College of Cornell University.
"Some patients have ended up taking 12 to 18 pills a day, plus a shot once a week, plus other medications to help control side effects, and sometimes shots for blood count abnormalities," Fenkel says. "It's arduous, but the cure rates have definitely been improved."
The 'New' Standard
Olysio and Sovaldi are now starting to replace Incivek and Victrelis as the combination "partners" with interferon and ribavirin. Both were approved by the FDA at the end of 2013. Sovaldi was also approved to be used without interferon for some types of hepatitis C.
Olysio and Sovaldi have fewer and milder side effects than Incivek and Victrelis. And they can wipe out the hepatitis C virus in a large percentage of patients in a much shorter period of time.
Sovaldi is very powerful, Jacobson says, because of the way it attacks the virus.
"It tricks the virus into incorporating the drug molecule into the growing chain that forms its DNA," he says. "It's extremely hard for the virus to become resistant to this drug."
With these new treatments available, and more on the horizon, experts say it's more important than ever to follow new recommendations for hepatitis C screening tests. In 2013, the U.S. Preventive Services Task Force recommended that all adults born between 1945 and 1965 get a one-time screening test for hepatitis C.
"More than two-thirds of the people in the U.S. who have Hepatitis C are baby boomers, and most of them don't know they're infected," Fenkel says. "Now that we have more effective therapies, we can treat patients much more easily before there's a lot of damage done to the liver."