Two protease inhibitors approved by the FDA in May—are true game changers in the treatment of liver disease. Experts are saying that they will transform the treatment of hepatitis C, the most common chronic bloodborne viral infection in the US.
In clinical studies, boceprevir and telaprevir, known as direct-acting antiviral therapies (DAAs), proved to be startlingly effective at curing many hepatitis C patients by blocking a key enzyme that the hepatitis C virus needs to replicate and spread. “For the first time in 20 years, we’ll be able to cure more hepatitis C patients than we’re not curing,” says Mitchell L. Shiffman, MD, medical director of the Liver Institute of Virginia.
For hepatitis C patients who had never been treated, the studies showed that combined therapy with the new drugs brought about a 30% increase in the number of cures. Without protease inhibitors, re-treated patients are only cured 20 percent of the time. The new trials show success rates of 60 to 65 percent.
Many patients choose to opt out of treatment for hepatitis C because of its unpleasant side effects, including nausea and flu-like symptoms. Dr. Shiffman hopes that the much higher cure rate now possible with the DAAs will bring people who have known they had hepatitis C for many years off the sidelines and into treatment, despite the drugs’ side effects. “In the past the nonresponders were the majority,” Dr. Shiffman says. “That’s the minority of patients now.”
Looking towards the future, some experts, like Dr. Shiffman, believe that personalized medicine will be a growing component of HCV therapy: “I like to think you can personalize treatment for many different diseases, including HCV, by tailoring your treatment and treatment durations to the specific genetic profile of the patient. And I think as we start to identify more genes that have significant impact, we’ll be able to tailor and personalize treatment, so that patients who have favorable genetics don’t require additional medications or have potential side effects—or, for example, can receive different medications that are much more effective.”
Unlike patients with hepatitis B and HIV, hepatitis C patients do have the chance to be cured for life. Hepatitis C does not integrate into human genomes as HIV does, and it does not establish a stable, nuclear, covalently closed DNA copy the way hepatitis B does. And experts hope that these drugs will, in fact, usher in “a new era” in the treatment and eradication of hepatitis C.
Source: The College of American Pathologists “HCV Superstars Spotlight Viral Load Testing“