Combined Drug Therapy May Be Required to Treat Hepatitis C

From the WebMD Archives

Jan. 9, 2001 -- Treating infection with the hepatitis C virus is a major challenge of the medical community. Often, one round of therapy is not enough to rid the body of the virus. A recent medical review now demonstrates that those who did not respond to a first round of treatment in the past may be best off being treated the second time around with a combination of medications.

The hepatitis C virus attacks the liver and is the leading cause of chronic liver disease in the U.S. According to one of the authors of the review, Mark Sulkowski, MD, "Hepatitis C affects about 1.9% of the U.S. population. That translates to 3.5-4 million people. It's a big problem in the U.S. today."

Sulkowski says that most of those infected with the hepatitis C virus will go on to develop chronic hepatitis, and a small number will progress to cirrhosis. Both of these are serious liver diseases that place people at risk for developing life-threatening liver failure and liver cancer. Sulkowski is an assistant professor of medicine at Johns Hopkins University School of Medicine in Baltimore.

The standard therapy for hepatitis C in the U.S. is a man-made version of interferon, a protein that is produced naturally by the body. This protein helps boost the immune system to fight viruses. Unfortunately, it is not strong enough to destroy the hepatitis C virus in all cases; thus, antiviral drugs such as ribavirin are sometimes added to interferon to enhance the body's response.

Sulkowski's team set out to determine whether adding ribavirin to interferon therapy in people with hepatitis C who had not responded previously to interferon alone would be more beneficial than using interferon alone a second time. They found that as long as the doses of ribavirin used were high enough, individuals given the combination therapy of interferon and ribavirin responded somewhat better to their therapy than those given interferon alone. However, overall response rates were still fairly low no matter what kind of treatment was used.

Raymond S. Koff, MD, from the division of digestive diseases and nutrition at the University of Massachusetts department of medicine, is the author of an editorial accompanying the study. In it, he writes that the benefits of retreating individuals for hepatitis C when they had not responded to previous interferon therapy will remain unclear until better treatments are discovered. In the meantime, however, patients who are given a second treatment are probably best off if they are given interferon in combination with ribavirin. The study and editorial are published in the Jan. 10 issue of the Journal of the American Medical Association.

Liver expert Michael Cox, MD, FACP, FACG, tells WebMD that the decision about whether to treat hepatitis C viral infections is not always clear-cut because therapy is extremely expensive, and those with only mild cases of the disease are less likely to have severe liver problems and to respond well to treatment. However, Cox believes emphatically that everyone with hepatitis C should be treated.

"If I had this virus, I would try to get rid of it, even if I had very mild disease," he says. "[E]ven if we don't cure [patients,] we give them what we think is a significant advantage. [Treatment] slows down the virus and can even reverse some of the damage done to the liver already." Cox is assistant chief of gastroenterology at Mercy Medical Center in Baltimore.

All the experts agree that response rates with currently available medications for the treatment of hepatitis C are not adequate and that the clearest message offered from this study is that more research into the development of new and better therapies is essential.