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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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