New Hepatitis C Drugs Looking Better
April 18, 2002 -- The odds of beating the killer hepatitis C virus are getting better. A new study shows that basing treatment on the specific type of virus improves the odds of becoming virus free.
Those odds now stand at three chances in five overall. People infected with easier-to-treat types of the virus have almost a four-in-five chance of success. Even the hard-to-treat subtype called genotype 1 -- which accounts for 70% of U.S. infections -- responds more than half the time.
Doctors call this kind of success a "sustained viral response." It means that no virus can be found in the blood or the liver for at least six months after treatment. In patients who have had this kind of response, the virus nearly always goes away and stays gone for at least 10 years. Some say it's a cure.
"We are now over 60% sustained viral response for first time in history," says Donald M. Jensen, MD, director of the liver unit at Rush-Presbyterian-St. Luke's Medical Center, Chicago. "Cure is a word we doctors shy away from using. But if there is no virus in the blood or liver and the liver returns to normal, maybe that is the next best thing."
Jensen's report came at the annual meeting of the European Association for the Study of Liver, held this week in Madrid. He led an international study of a new brand of long-lasting interferon -- Pegasys -- given in combination with the hepatitis C drug ribavirin. Pegasys isn't available yet -- U.S. approval is expected this fall -- but a similar drug called PEG-Intron is already on the market.
Jensen's claim that the Pegasys results are the best ever is technically correct. But earlier PEG-Intron studies show similar results if one looks only at patients who got the right ribavirin dosage for their body weight.
The big news from the new study is that not everybody has to suffer through the grueling 48 weeks of full-dose combination treatment. Most people suffer flu-like symptoms from the interferon, and ribavirin -- in addition to other side effects -- is very toxic to blood cells.
The international trial showed that people infected with the hard-to-treat type should be encouraged to stick with high-dose ribavirin for the full 48 weeks of combination treatment. People with easier-to-treat types of the hepatitis C virus get excellent results when they shorten treatment to 24 weeks, even if they take a lower dose of ribavirin as part of the combination therapy. And some of these patients may need only 12 weeks of treatment.
"We are getting close, at least, to the ability to have early predictors of response," Jensen says. "In patients who are having a good response, we don't have to continue. We can stop at 12 weeks and only continue in patients in whom the likelihood of sustained viral response is not as high."