March 3, 2004 -- A landmark new study offers the best news yet about hepatitis C treatment.
Among patients with the most common -- and most difficult to treat -- type, more than half of all patients were cured with the combination regimen of Pegasys and Copegus. Cure rates are approaching 100% for patients with easier-to-treat forms of the disease. The drugs' manufacturer, Hoffmann-La Roche Inc., funded the study. Hoffmann-La Roche is a WebMD sponsor.
And there is even more good news about hepatitis C treatment. Researchers found that those with the easier-to-treat variety do just fine when they are given half as much treatment as other patients. The findings were convincing enough to prompt two of the nation's top liver disease health groups to change their treatment guidelines.
"For this (subset) of patients with hepatitis C virus, we are now talking about a largely curable disease," says hepatitis expert Leonard Seeff, MD, who co-authored the revised treatment guidelines. "And for all patients, the good news is that we have progressed from a cure rate of about 6% just a decade ago to over 50% today."
A Matter of Genotype
Roughly three out of four hepatitis C-infected people in the U.S., however, have the more difficult-to-treat forms of the virus, known as genotypes 1a and 1b. In the international study, which involved 1,284 patients, just over 50% of these patients had complete and sustained eradication of hepatitis C virus with a standard 48-week course of Pegasys and Copegus.
The cure rate for all patients in the study, including those with the easier-to-treat hepatitis C genotypes 2 and 3, was 63%. Cure rates for hepatitis C genotype 2 and 3 patients treated for just 24 weeks with Pegasys and a lower-than-normal dosage of Copegus approached 80%.
"This is the first study to confirm that for certain patients, we can use a lower dose of therapy and cut the treatment duration by half without sacrificing efficacy," says study researcher Paul J. Pockros, MD, of Scripps Clinic in La Jolla, Calif. "Potentially, this can save some patients nearly six months of unnecessary treatment."
In an interview with WebMD, Pockros says most liver specialists are already treating genotype 2 and 3 patients with shorter and less intensive courses of the combination hepatitis C treatment, but he adds that general practitioners may not be aware of the latest research. That is one reason, he says, that the study was published in the general medical journal Annals of Internal Medicine.
More than 4 million Americans, and 170 million people worldwide, are infected with hepatitis C virus.
While some people eliminate the virus on their own, many others develop chronic infection, which can lead to cirrhosis of the liver, liver failure, and liver cancer. Hepatitis C is the leading cause of liver transplants.
Seeff tells WebMD that while hepatitis C treatment has come a long way over the past decade, a large percentage of genotype 1a and 1b patients do not respond to the combination treatment. African Americans tend to have a poorer response to treatment than other patients, as do people who are also infected with HIV, those who are obese, and those with kidney failure. Seeff is a senior scientist for hepatitis research with the National Institute for Diabetes, Digestive and Kidney Diseases (NIDDK).
"We are learning that these patients can be treated effectively, but we have a long way to go," he says. "The good news is that overall nearly half of patients respond to treatment, but the bad news is that nearly half don't."