New Drugs Promise to Transform the Treatment of Hepatitis C

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.

Dr. Michell Shiffman of Bon Secours' Liver Institute of Virginia

Dr. Michell Shiffman of Bon Secours' Liver Institute of Virginia

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.

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Source: The College of American Pathologists “HCV Superstars Spotlight Viral Load Testing

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About Dr.MLShiffman

Dr. Mitchell Shiffman is the Bon Secours expert on liver disease and liver treatments for Virginia. Prior to joining Bon Secours, Dr. Shiffman was a professor of Medicine at Virginia Commonwealth University (VCU) in Richmond, VA. He was the Chief of the Hepatology Section and Medical Director of the Liver Transplant Program at the VCU Medical Center from 1989 until 2009. During his 20 years at the VCU Medical Center Dr. Shiffman built and directed one of the most respected and productive hepatology programs in the United States. Dr. Shiffman is recognized as one of the world’s leaders in the field of Hepatology. His particular area of research is viral hepatitis. He has been involved with and/or directed numerous clinical trials to develop new and better treatments for viral hepatitis B and C. Dr. Shiffman is a regular speaker on the treatment of viral hepatitis, the management of various liver disorders, and issues related to liver transplantation at regional, national and international society meetings. He has published over 200 articles in medical journals related to the treatment of liver diseases and has edited two books on this topic. In addition, he has contributed to various HCV educational resources including an HCV educational kit. Dr. Shiffman is also a widely recognized expert consultant to pharmaceutical companies on the treatment of liver disease. Dr. Shiffman holds a Bachelor of Arts from State University of New York at Buffalo, a Master of Science in physiology from the University of New Mexico School of Medicine in Albuquerque, N.M. and his Doctor of Medicine from State University of New York Upstate Medical Center in Syracuse, N.Y. He completed his internship and residency in internal medicine and fellowship training in gastroenterology and hepatology at the Medical College of Virginia Hospitals in Richmond, VA. Dr. Shiffman is a member of many professional organizations including: the American College of Gastroenterology, American College of Physicians, the American Gastroenterological Association, American Society for the Study of Liver Diseases, American Society of Transplantation, European Association for the Study of the Liver, International Liver Transplantation Society, Richmond Academy of Medicine, Virginia Medical Society and the Virginia Gastrointestinal Society. He was a member of the Board of Trustees with the American College of Gastroenterology from 2003-2009.

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