Hepatitis C

The March issue of Treatment Guidelines from The Medical Letter will review antiviral drugs: which ones to use, in which doses, for how long, their side effects, etc. One of the most important sections, in my view, is the one on hepatitis C. Earlier this year the CDC made the rather astonishing recommendation that everyone born between 1945 and 1965, an estimated 27% of the population of the US, should be tested for hepatitis C. The CDC estimates that 3.25% of people in this age range in the US have been infected, mainly, we can assume, as a result of intravenous drug abuse; in prison populations the estimate is much higher. Many of these people may have chronic hepatitis C without knowing it, and chronic hepatitis C is a major risk factor for cirrhosis and hepatic failure. It is the main reason for liver transplantation.

And we can cure it. Not easily, but more easily than we could just a few years ago. For many years, the standard treatment for hepatitis C was 48 weeks of treatment with subcutaneously injected interferon and oral ribavirin. That regimen produced sustained viral responses (undetectable hepatitis C virus RNA 24 weeks after stopping treatment) in 40-50% of patients. That wasn’t bad, but it left more patients than you would like still infected, and 48 weeks of treatment with interferon is hard to take. Interferon not only has to be injected every day, but it also has a laundry list of unpleasant side effects, starting with a flu-like illness and including severe depression, bone marrow suppression, increased susceptibility to bacterial infections, hearing loss, hair loss, and on and on.

In July of 2011, The Medical Letter published some good news. The FDA had approved 2 new drugs, both oral, for treatment of hepatitis C, and adding one of them to interferon and ribavirin increased the sustained viral response rate to as high as 70-80%. The new drugs have side effects too, mainly anemia, but nothing like interferon. Some patients who respond to the addition of one of the new drugs could take less interferon. One problem that remains is that these new drugs cost a fortune (both The Medical Letter and Treatment Guidelines from The Medical Letter publish the wholesale acquisition cost of the drugs they review; no comparable publication does that). Hopefully, the Affordable Care Act will find a way to make these drugs more affordable. In the meantime, look for all the names and numbers in the next issue of Treatment Guidelines from The Medical Letter.

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