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    3-Drug Combo May Treat Hepatitis C

    Studies Show Boceprevir or Telaprevir Help Patients When Added to Standard Treatment

    How the Drug Combo Works

    About 3 million Americans are infected with HCV, and the CDC says more than 12,000 people in the U.S. die each year of liver disease and liver cancer caused by the virus. It is also the leading cause of liver transplants.

    Most people show no symptoms of infection with hepatitis C for years, or even decades. Because of this, few people even know they are infected until they develop liver disease or have significant liver scarring, known as cirrhosis.

    The two new drugs directly attack and suppress the virus by inhibiting the HCV protease enzyme, in a similar way that other protease inhibitors inhibit the HIV virus.

    Because viruses quickly develop resistance to these drugs when given alone, they typically are not used alone.

    That is why the three-drug cocktail will be needed, even though patients often find the flu-like symptoms and other side effects associated with peginterferon difficult to tolerate.

    The two new drugs have proven to have a common side effect of their own: anemia.

    In the newly published boceprevir studies, more than 40% of patients required the costly drug erythropoietin to boost red blood cell production.

    “This is a very expensive drug, and I would imagine some insurance companies would not pay for it,” Hensen says. He says it remains to be seen if patients will stay on the three-drug regimen if they don’t have access to erythropoietin.

    Experimental Drugs on the Horizon

    The Holy Grail of HCV treatment is oral medications that clear the virus without major side effects.

    Hensen says early trials of several candidates appear promising and treatment without peginterferon may be a reality within two or three years.

    Bacon says the time frame may be closer to five or even 10 years.

    An FDA advisory committee is scheduled to meet April 27 to consider recommending approval of boceprevir. The panel will consider Vertex’s application for telaprevir the next day.

    Merck spokesman Robert Consalvo says the company hopes to have boceprevir on the market by this summer.

    “We are working actively to prepare for the launch of this drug, and will do so very quickly once it is approved by FDA,” he tells WebMD.

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