The Latest in Hepatitis C Treatments

Hepatitis C is the No. 1 cause of liver cancer and liver transplants. It's brought on by a virus you can catch if you come into contact with contaminated blood. You could get it from an unclean tattoo needle, for example. Sometimes, it spreads during sex.

It's curable. But curing it hasn't always been easy or comfortable. For decades, you needed painful shots of a medicine called interferon and a pill called ribavirin. These drugs didn't target the virus that made you sick. Instead, they amped up your immune system so you'd fight it the way you do when you get the flu.

But the treatment didn't always get the virus out of your body. Cure rates hovered around 50%. And people who stuck with the yearlong treatment -- not all did -- had to live with chemo-like side effects.

These days, more and more people can get rid of the virus by simply taking a pill, at home, for just a few weeks. There are several ways to do it without having to get shots.

Here's a closer look at some of the drugs and a peek at those on the horizon.

How They Work

There's no one-size-fits-all option. There are many different types, or "genotypes," of hepatitis C. Type 1 is the most common. This is important to understand when you talk to your doctor. Not all meds work on all types. Which medicine is best for you also depends on how much liver scarring (cirrhosis) you have.

Your doctor might call these new drugs direct-acting antivirals. They zoom in on the virus that's making you sick. Each drug works in a slightly different way. But in general, the medicine interferes with proteins that help the virus grow or spread.

Most of the time, these meds remove all traces of the virus from your blood within 12 weeks. This is called sustained virologic response (SVR), and it’s what doctors look for to tell if you’re cured. How long you'll need treatment can vary. It may range from 8 to 24 weeks.

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Meet the New Meds

Research is moving rapidly on treatments for hep C. As a result, what doctors will recommend for each case may change. Researchers may continue to come up with new treatments, and some of the combinations of medications below may change as they make new discoveries.

As always, it's best to discuss your treatment options with your medical team.

Daclatasvir (Daklinza): Approval of this drug meant no more shots for the 1 in 10 people infected with hepatitis C virus (HCV) types 1 and 3. You take this pill once a day with sofosbuvir (Sovaldi). You might get a headache or feel a little tired. Tell your doctor if you feel super-sluggish. The FDA warns it can sometimes seriously slow your heart rate, which may require you to get a pacemaker.

Elbasvir and grazoprevir (Zepatier): This once-a-day pill treats HCV types 1 and 4. It may also offer new hope for people with hep C who also have cirrhosis, HIV, late-stage kidney disease, and other hard-to-treat conditions. Like the other antivirals, the side effects are mild. You might have a slight headache or bellyache, or you might feel tired.

Glecaprevir and pibrentasvir (Mavyret): Three pills daily can treat all types of hep C. Side effects are mild and can include headache, fatigue, diarrhea, and nausea.

Ledipasvir and sofosbuvir (Harvoni): This once-a-day pill launched a revolution in hep C treatment. It was the first interferon-free med for people with type 1. A year later, the FDA also gave the thumbs up for people with HCV types 4, 5, and 6 to use it. Side effects are mild. You might feel tired or have a slight headache. Some people have a bellyache, diarrhea, and trouble sleeping.

Ombitasvir, paritaprevir, and ritonavir, with dasabuvir (Viekira Pak): Doctors say this treatment works well for people with HCV type 1. You can even take it if you have some liver scarring, as long as your liver still can do its job. Your doctor might call this compensated cirrhosis. You take two pills once a day and another pill twice a day.

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Some people find this clunky, but others say it beats getting shots. Side effects include feeling itchy, weak, tired, or having trouble sleeping. This medicine might cause severe liver damage in people with advanced cirrhosis.

Simeprevir (Olysio) and sofosbuvir (Sovaldi): The FDA said these two drugs could be given together to treat people with HCV type 1. Before that, you had to take the pills with interferon or ribavirin. Sofosbuvir can cause fatigue, headache, and tummy troubles and make it hard for you to sleep. Simeprevir may cause dry skin and a rash and make you more sensitive to sunlight.

Sofosbuvir and velpatasvir (Epclusa): This can treat all types of hep C with a single tablet. Common side effects are headache and fatigue. There are certain drugs that shouldn't be taken with it, as the combination can slow your heartbeat. As always, check with your doctor.

Sofosbuvir, velpatasvir, and voxilaprevir (Vosevi): This can also treat all types of hep C with one tablet that you take each day. Typically, your doctor will only prescribe this if you don't have cirrhosis and after other treatments have not worked. The most common side effects are headache, tiredness, diarrhea, and nausea.

WebMD Medical Reference Reviewed by Laura J. Martin, MD on October 14, 2018

Sources

SOURCES:

Ryan Ford, MD, assistant professor of medicine, Division of Digestive Diseases, Emory University School of Medicine.

William D. Carey, MD, senior hepatologist, Department of Gastroenterology, Cleveland Clinic, Cleveland, Ohio.

HCV Advocate: “A Brief History of Hepatitis C.”

CDC: "Hepatitis C FAQs for Consumers."

Curry, M.P. New England Journal of Medicine, Dec. 31, 2015.

FDA: "FDA Drug Safety Communication: FDA warns of serious liver injury risk with hepatitis C treatments Viekira Pak and Technivie," "FDA approves Viekira Pak to treat hepatitis C,"  "Drug Trials Snapshots: VOSEVI," "FDA approves Epclusa for treatment of chronic Hepatitis C virus infection."

Feld, J. NEJM, Nov. 23, 2015.

HCV Advocate. "What is Cirrhosis?"

HCV New Drug Research: “ZEPATIER - Recommended Dosage and Durations, Drug Interactions, Side Effects, Clinical Studies.”

News Release, Gilead.

News Release, Merck.

Up-To-Date: “Direct-acting antivirals for the treatment of hepatitis C virus infection.”

U.S. Department of Veterans Affairs: "Hepatitis C Virus Genotypes and Quasispecies."

University of Washington: "Sofosbuvir (Sovaldi)."

Zeuzem, S. Annals of Internal Medicine, July 7, 2015.

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