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Holding Out for Better Hepatitis C Treatment

Nicole Cutler L.Ac. March 22, 2013

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Riddled with hard personal decisions and ethical quandaries, many people are opting to pass on current Hepatitis C therapy. Instead, they are waiting for the arrival of an interferon-free drug regimen that is still in development.
Holding Out for Better Hepatitis C Treatment

Receiving a diagnosis of a potentially fatal infection typically prompts immediate treatment. If that treatment doesn’t work, a newer, supposedly more potent treatment is likely pursued. However, being infected with chronic Hepatitis C does not necessarily follow this seemingly sound logic. An increasing number of patients and physicians are opting to skip the currently available Hepatitis C medications and wait for the next generation of drugs expected to arrive on the market within the next few years.

About Hepatitis C

Infecting about 170 million people worldwide, Hepatitis C is a viral infection that attacks the liver. About 85 percent of those infected with the virus battle a chronic liver infection, a problem that progresses slowly but can lead to devastating (and even fatal) liver damage. Although this common, blood-borne pathogen is getting more attention lately via improved health education efforts, there are many individuals who have yet to be diagnosed.

Symptoms of Hepatitis C may not surface until someone has been infected for one or more decades. Thus, there are a great number of people yet to learn they have Hepatitis C. Besides being a major problem for anyone who ever injected intravenous drugs, this virus was commonly spread through blood transfusions before screening the blood supply for Hepatitis C began in 1992. Those at the greatest risk of undetected Hepatitis C infection appear to be the baby boomer generation, a realization that prompted the U.S. Centers for Disease Control (CDC) to announce that everyone born between 1945 and 1965 should be tested for Hepatitis C.

Hepatitis C Treatment – Past, Present and Future

When it comes to its eradication, the Hepatitis C virus puts up an extraordinary fight. For many years, the standard treatment of interferon and ribavirin had a 50 percent success rate – odds that were not very encouraging considering the intense side effects these medications can cause. However, combining interferon and ribavirin with one of the two new drugs approved in 2011 (boceprevir or telaprevir) dramatically boosted the Hepatitis C treatment success rate. On this relatively new triple therapy regimen, between 66 and 79 percent of patients with the most common genotype of Hepatitis C who undergo drug therapy for the first time clear the virus. Unfortunately, the documented side effects of boceprevir or telaprevir plus interferon and ribavirin are so severe that a growing resistance to this new drug regimen has developed.

Consequently, a growing number of individuals who were deemed non-responsive to the interferon and ribavirin combination are choosing to skip trying the newer triple drug regimen in favor of what is believed to be heading down the drug pipeline. Additionally, some newly diagnosed patients who have never done Hepatitis C antiviral therapy before are also delaying treatment. This is because several drug companies are developing new drugs that promise to eliminate the need for interferon (the drug associated with the most severe side effects) with an improved rate of efficacy. Although not projected to be available until 2014 or 2015, the new class of Hepatitis C drugs has several advantages over the currently approved treatment. Besides eliminating the need for injecting interferon, studies of the all-oral drugs in development:

  • appear to show cure rates above 90 percent
  • appear to have a high rate of success in a shorter period of time (12 weeks vs. 24 or 48 weeks)
  • appear to have less severe side effects than interferon-based therapies

Waiting for the Future

The anticipated advantages of the next generation of Hepatitis C drugs explains why many people are opting to temporarily hold off on treatment. Even so, the choice between treating now and waiting to treat is complicated. According to Ira M. Jacobson, a physician specializing in Hepatitis C research and chief of the division of gastroenterology and hepatology at Weill Cornell Medical College in New York, “…it’s reasonable to defer treatment for certain patients with mild liver disease.” However, the decision to treat or wait is especially complex if patients are dealing with mid-stage liver disease.

An ethical dilemma is posed with deferring treatment because delaying comes with its own risks. Determining how far liver disease has progressed isn’t an exact science:

  1. The liver may be damaged more than clinicians have detected.
  2. Hepatitis C may worsen more quickly than expected.

Unfortunately, progressive liver damage or worsening of the virus can occur while a person is waiting for the next generation of drugs. Compounding this predicament is the evidence suggesting patients have a better chance of curing the disease the less time they’ve been infected. Those who choose to wait must also recognize that there is no guarantee that new medications will be approved anytime soon, as obstacles to pharmaceutical development are commonplace. These factors are echoed by Donald M. Jensen, director of the Center for Liver Diseases at the University of Chicago Medical Center who stated, “We’re constantly weighing whether to treat now to avoid problems downstream versus waiting for newer, easier and potentially better therapies a couple years from now.”

Choosing to Wait – In the Interim

Those in the earlier stages of liver disease who have made the decision (with their physician) to hold out for better Hepatitis C treatment are strongly advised to do all they can to preserve their liver’s health. This means strictly adhering to a liver wellness program. Such a program typically includes a combination of the following:

  • Completely abstaining from alcohol.
  • Cutting inflammatory foods (like saturated fat, sugar and preservatives) out of the diet.
  • Taking high quality liver protective supplements (like milk thistle, N-acetyl cysteine and alpha R-lipoic acid).
  • Avoiding exposure to known toxins.
  • Exercising regularly.
  • Consuming a nutritious diet of lean protein, complex carbohydrates and lots of fresh fruit and vegetables.
  • Prioritizing stress relief and relaxation.

There are many factors to consider when debating whether or not to begin triple antiviral therapy. Obviously, there are no guarantees that an improved Hepatitis C drug regimen will be available next year – or that your liver will be shielded from incurring further damage. Additionally, the odds of successful treatment with interferon and ribavirin plus boceprevir or telaprevir are much greater than ever before. However, some people would rather succumb to advanced liver disease than persevere through a first, second or third round of interferon-based treatment. Individuals who make an educated decision to hold off on Hepatitis C treatment should be adamant about their liver wellness, so that delaying treatment for the next generation of medications is worth their wait.

References:

http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1288&pageaction=displayproduct, Treating Chronic Hepatitis C: A Review of the Research for Adults, Retrieved March 14, 2013, Agency for Healthcare Research and Quality, 2013.

http://online.wsj.com/article/SB10001424127887323293704578330712442353712.html, Patient Dilemma: Treat Hepatitis C Now or Hold Out?, Peter Loftus, Retrieved March 14, 2013, Dow Jones & Company, Inc., 2013.

http://www.hepatitis.va.gov/patient/treat/decisions-single-page.asp, Treatment Decisions: Entire Lesson, Retrieved March 14, 2013, US Department of Veteran Affairs, 2013.

http://www.mayoclinic.com/health/hepatitis-c/DS00097/DSECTION=treatments-and-drugs, Hepatitis C, Retrieved March 15, 2013, Mayo Foundation for Medical Education and Research, 2013.

http://www.npr.org/blogs/health/2013/01/14/167258972/as-hepatitis-c-sneaks-up-on-baby-boomers-treatment-options-grow, As Hepatitis C Sneaks Up On Baby Boomers, Treatment Options Grow, Richard Knox, Retrieved March 14, 2013, NPR, 2013.

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13 Comments

  • bbb says:

    I am among those who are holding out for a better treatment. My best advice is to DEFINITELY DO NOT drink alcohol… Sugar and Alcohol both create the best environment for the virus to duplicate and make you feel like hell and eat your liver alive…. you CAN make it to your “cure day” if you give nutrition and no booze a priority,
    Give your liver some love… it has carried you through the toughest of viruses !

  • Patti says:

    When documenting new information, I wish there were more information posted for children who have acquired Hepatitis C at birth.

  • ncm says:

    I am currently enrolled in a study which has shown some very positive results and I am not taking interferon or ribariviran (?) 1 pill a day and no side effects. I am all too happy to try this new study med and hopefully play some small part in helping to find a cure

    • EV Chickie says:

      Thanx for your contribution !!!

    • [email protected] says:

      What wonder medication is this with no side effects what so ever?

    • Copster says:

      Can you share the name of this medication? Please?

  • jo says:

    I took tylenol for some muscle pain and i became very ill.Severe feelings of heart burn only to find out i had satruated my liver, so my gall bladder tried to help rid my body of the toxins. I have Hep with 4 stage chriossis. Be careful. I tell every doctor now NO tylenol.

    • Dickey says:

      The same exact thing happen to me recently!!! Did you recover back to where you were? I have Dr appointment but I know I did damage!

  • SCK says:

    I was diagnosised with hcv in 2008 went on the interferon treatment . but after 5mths had to be taken off because of sever side affects, lost over
    20% of my eyesight in my left eye at first it was 50% but after getting off the treatment my eyesight improved. It damaged the optic nerve. The treatment was working my viral load went down. I’m glade their finely developing treatment with out the posion. My viral load has not increased but I take care of myself no alcohol take ultra thistle eat right. only pain reliver I take is asperin, at 55 I have alot of aches and pains. my last blood test just a few months ago doc said my liver is in good shape. But I will be so glade when the new meds come out and be cured of this once and for all.

    • Trotter says:

      The treatments are pretty much horrible from start to finish. I hope you can wait and take an easier treatment down the road. But, sorry to say you will never “be cured” of Hep C, remission is most we can hope for. We have to monitor it our life long, keep tabs on it, get biopsies, get our blood tested, etc. Let’s hope for better medicine, a vaccine and permanent cure for us in the future.

  • B.j. Marra says:

    I am 56 yr old female; diagnosed a little over 8 yrs ago. I have always shown a high viral load topping off at 12 million, an avg of around 4.5 million & a low of 100. The low was during my 1st attempt at
    treatment with ribiviran & interferon, which failed due to side effect
    complications. Fortunately, in spite of a consistently high viral load my bloodwork has been good & my liver function panel always in the norm. In 2011 I tried treatment again with Telaprevir added to the Interferon/Ribiviran regime. Altho it did drop my viral load to 100 after about 1.5 weeks I had to stop again due to side effects. My Dr seems to believe the Interferon is the culprit & I simply can’t handle it. (Who decided to come up with a drug that has to be taken with food/fat in order to work when you are so sick that the last thing you want to do is eat? I’d love to see the things folks came up with to force down the required grams of fat you had to take with telaprevir!)

    Luckily I had stopped drinking about a year before being diagnosed with Hep-C . I wasn’t an alcoholic, just a party animal who often drank too much & the hangovers & endless trips to the john to puke simply weren’t worth it. I really think that has helped save my butt (or in this case; liver!) Had I continued to drink I am pretty sure the results would be less favorable. Once I found out I was infected with Hep C, Genotype 1; I researched how best to take care of myself. I was already a vegetarian, a non- smoker, a non-drinker & maintained my
    weight at 100# or so. I continue to exercise as much as I can although the fatigue is taking its toll on that. I luve to hike in the Adirondack’s , canoe, mountain bike, rollerblade, snowshoe,
    & hit the gym after work as much as possible. I think I’m doing pretty good on my own, I’m sure there’s room for improvement. So for now I wait for a treatment that I can tolerate & also one that doesn’t put the rest of my body in jeopardy for long term complications from side effects.My liver Dr. has me getting ultrasounds every 6 months now to watch for signs of cancer in my liver & surrounding organs. I take
    vitamin/supplements like “Ultra” milk thistle, SST, R-lipolic acid,
    L-carnetine, Krill Oil & a few others to help maintain liver health.
    But I can’t lie, the waiting scares me! I worry that one day those
    blood-work results will come back & they won’t be so great. I’m tired of fighting the daily fatigue – some days it’s so bad I can’t get off the couch or I’m falling asleep at my desk as my coworkers give me strange looks. Hep C has taken its toll on my quality of life & has affected my relationship. I silently freak out if I get a pain under my rib cage or just feel especially out of it. I’m nervous as I await the results from my ultrasounds. It’s a waiting game now & I’m hoping it pays off with a new cure I can start, and finish & be healthy again. So let’s all
    hope & pray these drug companies continue to work on a cure: I don’t even care if their only motivation is money – just hurry up & get it done & get it done right! PLEASE

  • Ric says:

    I’m in the last 10 weeks of triple therapy, and It’s been horrible, but tolerable…. and I’m virus clear to this point. Diagnosed in beg of 2012, contracted the virus while I was in the Army in 1972, working as a Flight Evac Medic. Don’t know why I didn’t wait for longer to be treated… just didn’t have the patience and wanted to get the 1st wave of the assault in on my terms !

    Ric in MIch
    [email protected]

  • Copster says:

    WOW! Very interesting article!

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