There are around 2.7 to 3.9 million people in the United States who have chronic Hepatitis C while an estimated 30,500 people have acute infections as of 2014.1 Worldwide, approximately 130 to 150 million are living with chronic Hep C. 2
This condition is caused by the virus with the same name or more commonly referred to as HCV. In several cases, patients with Hepatitis C recover from the disease even when they do not receive treatment. In the U.S., this happens in around 15 to 25 percent of cases.3
In most patients, however, acute Hep C doesn’t go away on its own. When left untreated, it can turn into chronic infections and even other complications like cirrhosis, liver cancer and liver failure.3 In fact, around 700,000 patients die every year because of liver diseases that are related to Hepatitis C infections.4
Because of these, it’s important for patients to seek treatment as soon as possible when they get diagnosed with Hep C. Antiviral drugs can cure around 90 percent of patients with the infection and can help reduce the risk of developing complications.2 Many Hepatitis C drugs do have side effects and adverse effects, but the benefits outweigh the drawbacks in most cases.
DRUGS FOR HEPATITIS C TREATMENT
There are at least six genotypes of the Hepatitis C virus and over 50 subtypes.1 Because of this, patients need to go through the appropriate diagnostic tests to know exactly which genotype they have. This information is greatly useful since the medications that are given to patients depend on the HCV genotype and subtype they have. The efficacy of medications is measured by their sustained viral response (SVR), which is the absence of the Hep C virus RNA in the bloodstream.5
For Genotypes 1a and 1b
The drug combination elbasvir/grazoprevir is an effective treatment for HCV genotype 1a patients without cirrhosis. It’s also recommended for those who have compensated cirrhosis (i.e. they don’t exhibit symptoms related to cirrhosis, such as jaundice).6 Phase III C-EDGE trials7 showed that the combination had an SVR of up to 92 percent in genotype 1a patients who took it for 12 weeks.
Elbasvir/grazoprevir is also recommended for patients with HCV genotype 1b who don’t have cirrhosis as well as those who have compensated cirrhosis. 7 In fact, in Phase III C-EDGE trials, the drug combination had an SVR of up to 99 percent in genotype 1b patients who took it for 12 weeks.
Ledipasvir/sofosbuvir is another drug combination that’s recommended for patients who have HCV genotype 1a or 1b. 7 It can be taken by patients who don’t have cirrhosis as well as those who have compensated cirrhosis. Controlled trials have shown that this drug combination has success rates of up to 99 percent.8
For Genotype 2
HCV genotype 2 patients who either have compensated cirrhosis or are free from cirrhosis can take the drug combination sofosbuvir/velpatasvir for 12 weeks. 7 Those who have decompensated cirrhosis will need to take this combination with ribavirin for 12 weeks.9 ASTRAL phase 3 trials show that sofosbuvir/velpatasvir has an SVR rate of up to 100 percent.
For Genotype 3
A 12-week treatment consisting of sofosbuvir/velpatasvir can be recommended to patients who have HCV genotype 3 and who either are free from cirrhosis or who have compensated cirrhosis. ASTRAL-3 trials show that this drug combination has an SVR of 98 percent in genotype 3 patients without cirrhosis and an SVR of 93 percent in patients with compensated cirrhosis. 7
They can also take daclatasvir along with sofosbuvir. Daclatasvir10 inhibits the replication of viral RNA, and trials show that the daclatasvir and sofusbuvir combination has an SVR of 90 percent. Patients without cirrhosis can take this drug combination for 12 weeks, while those who have compensated cirrhosis need to the take the combination for 24 weeks, either with or without ribavirin. 7
For Genotype 4
Patents who have HCV genotype 4 can take the drug combination of paritaprevir/ritonavir/ombitasvir along with ribavirin for 12 weeks, whether they’reeither free from cirrhosis or have compensated cirrhosis. A phase IIB study showed that the drug combination had an SVR of 100 percent in patients whotook it with ribavirin and 90.9 percent in patients who did not take the combination with ribavirin. 7
Aside from paritaprevir/ritonavir/ombitasvir, genotype 4 patients can also take other drug combinations like sofosbuvir/velpatasvir, elbasvir/grazoprevir,and ledipasvir/sofosbuvir.
For Genotypes 5 and 6
The same treatments are used to cure people with HCV genotypes 5 and 6. Patients are usually given the drug combination sofosbuvir/velpatasvir for 12 weeks, whether they have cirrhosis or not. Trials show that this combination has an SVR of 96 percent in patients with genotype 5 and 100 percent in patients with genotype 6. 7
Another treatment option is the ledipasvir/sofobuvir drug combination, which can be taken for 12 weeks by genotype 5 and 6 patients regardless of their cirrhosis status.7 There is limited data about the efficacy of this combination, but several trials show that the SVR is above 90 percent in both genotype 5 and 6 patients.
Patients with HCV genotype 6 can also be given a drug combination of pegylated interferon and ribavirin, which has an SVR of 60 to 90 percent.11
GETTING YOUR HCV TREATMENT DRUGS
The drugs mentioned above are effective in treating Hepatitis C, but they can be expensive especially when taken the entire treatment course is taken into account. Because of these, Hep C patients should look for specialty pharmacies that work closely with physicians and insurance providers to ensure that high costs will not prohibit people from accessing the best possible treatments. With the help of these pharmacies, patients can obtain the treatment they need and be on the road to recovery as soon as possible.
- Lozano, R. et al. (2012) ‘Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the global burden of disease study 2010’, The Lancet, 380(9859), pp. 2095–2128. doi: 10.1016/s0140-6736(12)61728-0.
- Pearlman, B.L. and Traub, N. (2011) ‘Sustained Virologic response to antiviral therapy for chronic hepatitis C virus infection: A cure and so much more’, Clinical Infectious Diseases, 52(7), pp. 889–900. doi: 10.1093/cid/cir076.
- The American Association for the Study of Liver Diseases and the Infectious Diseases Society of America (2016) Initial treatment of HCV infection.
- Hoofnagle, J.H. and Sherker, A.H. (2014) ‘Therapy for Hepatitis C — The Costs of Success’, New England Journal of Medicine, 370(16), pp. 1552–1553. doi: 10.1056/nejme1401508.
- Bunchorntavakul, C. (2013) ‘Hepatitis C genotype 6: A concise review and response-guided therapy proposal’, World Journal of Hepatology, 5(9), p. 496. doi: 10.4254/wjh.v5.i9.496.