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Non-Compliance Lowers Hep C Treatment Success

June 14, 2017

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If you want to eliminate Hepatitis C, you MUST be strict about your medications’ dosing schedule.

A patient who commits to following their physician’s instructions exactly as given is a rarity. Granted, many consider their doctor to be the dispenser of God-like information. Nonetheless, a growing fear that our healthcare system over-prescribes frequently leads to a dismissal of medication directions. As such, a majority of consumers consider their prescription orders to be mere suggestions. Despite the prevalence of this mindset, there are several drugs that must be exempt from this laissez-faire attitude – including birth control pills, antibiotics, insulin and direct-acting antivirals for Hepatitis C.

Success Rates

Before the high success rates of direct-acting antivirals helped reduce the burden of Hepatitis C, the prevailing treatment regimen was pegylated interferon and ribavirin. The success rates of these medications rarely broke the 50 percent mark. The primary reason for the relatively low success rate of pegylated interferon and ribavirin was the severe side effects that interfered with patients’ ability to comply with the full dosage schedule.

Thankfully, direct-acting antiviral regimens that did not include interferon became approved in 2014. This leap forward – first with Harvoni and then with Viekira Pak – changed treatment success rates to 95 to 100% in certain populations. The new regimens that include Harvoni, Viekira Pak and several more in 2015 and 2016 have very low failure rates, yet are exceedingly costly. Thus, the additional cost of re-treatment is a substantial barrier for those with Hepatitis C who do not succeed initially.

Research at Mount Sinai Medical Center in New York

According to research carried out at Mount Sinai Medical Center in New York presented at the 2016 AASLD Liver Meeting in Boston, non-adherence was the strongest risk factor for treatment failure in people being treated for Hepatitis C.

The main reasons cited for non-adherence were:

  1. failing to take medications as prescribed
  2. and hospitalization.

The Mount Sinai study sought to explore motivational and educational barriers to adherence, such as lack of knowledge about pill-taking or the need for adherence. The researchers concluded that their findings underscore:

  • the need for providers to clearly communicate dosing information
  • assuring that patients have access to an uninterrupted supply of medication
  • the value of pre-treatment adherence counseling

The HepCure App

In addition, the research team suggested a pill bottle monitoring system to improve adherence, and thus boost treatment success rates. As a response to their findings, the Mount Sinai Hepatitis C team developed an application for patients to assess their own readiness for treatment. Called the HepCure app, adherence reminders can be set, and communication with healthcare providers about treatment adherence, side effects and lab test results are all aimed at improving Hepatitis C treatment outcome.

Dosing Schedules Are Crucial

The information gleaned from this recent study is that the dosing schedule for Hepatitis C medications is extremely important. Different from taking a drug for pain relief only when absolutely necessary, adhering to the medication regimen with direct-acting antivirals is crucial.

Those getting ready to begin Hepatitis C treatment will get the best result when prepared to follow their physician’s instructions exactly. Use modern technology to make sure you have your next dose available at the right time. If you easily forget or dismiss strict regimens, seek support to help you stick to your medication schedule. The high cost of Hepatitis C treatment aside, get the best result possible by committing to viral elimination via adhering strictly to your medications’ instructions.

http://hcvadvocate.org/hepatitis/factsheets_pdf/Adherence.pdf, Adherence to HCV Therapy, Retrieved December 18, 2016, Hepatitis C Support Project, 2016.

http://hivandhepatitis.com/hepatitis-c/hepatitis-c-topics/hcv-treatment/5942-aasld-2016-non-adherence-is-most-important-risk-factor-for-sofosbuvirledipasvir-failure, AASLD 2016: Non-Adherence Is Most Important Risk Factor for Sofosbuvir/Ledipasvir Failure, Keith Alcom, Retrieved December 18, 2016, hivandhepatitis.com, 2016.

http://www.infohep.org/page/3101064, Non-adherence most important risk factor for sofosbuvir/ledipasvir failure, Keith Alcorn, Retrieved December 18, 2016, NAM Publications, 2016.

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  • CoyoteJohnKerr

    Thankfully, the side effects are so minimal with the new anti-virals. I was treated unsuccessfully with 5 million units of Interferon, 3 X weekly for a whole year. It was truly a tough year. Today, with the new anti-virals, it makes treatment so much easier and the time factor (12 weeks for Epclusa) is a large part of the success. I have been viral free for 8 months and my Infectious Disease Specialist tells me I am effectively cured. Thank God!

  • kathy quinones

    I took 3 different types of hepatitis c treatment follow the dosage instructions to a T and still came back 6 months post treatment

    • bobben49

      So did I. However, my last treatment, Harvoni, worked. My Dr. had me take it for 6 month since I had failed various previous interferon based treatments. If your third treatment was Harvoni and your Dr. put you on only a 8 or 12 week course of treatment then he/she failed to follow the manufactures recommended course of treatment, 24 weeks, for patients who had previously failed the various interferon combo treatments.

      • Virginia Morrissey

        That’s not true. I had three previous treatment and only needed 12 weeks of Harvoni for cure..it depends on status / stage of liver. Not promoting Harvoni though. Thank god there are more choices now.

      • Virginia Morrissey

        Not true. My doc is head of BI Boston. I had three previous interferon tx. 12 weeks is plenty if under or at 6 million vl. Hi is monitoring this site – theres alit of bs flying. As i person whi took Harvoni -I would never ever tell someone to tse 24 weeks.

        • Virginia Morrissey

          I obviously cant spell when miffed. I feel bad if you were misled led to take a horrid med twice as long.

  • James Glen Tartaro

    Although like many article’s the majority is on point, however… It really angers me to see that the failures of Hep C treatment are being placed on the patient. I’ve been battling my HEP C with treatment over the past 12 years (diagnosed in 1992). Like many others my “experts” convinced me to place these terribly toxic drugs in my system with a huge probability of cure and better quality of life. To those that were in my world then I say B.S.! Daily injections of interferon and a pole of Ribavirin for 6 months at a time then stopping for 2 months and restarting. The damage has been so much worse.

    Harvoni….congrats to those of you that have achieved a cure. Unfortunately, I’m the few that can’t take that as my body won’t absorb it (unofficially thanks to the crap the shoved in my body for all these years). As a last ditch I am given Zepitier, the get me all excited because I’m undetectable. Then 4 months later….whoops no cure.

    After I hired nurses to come daily to give my meds, spent thousands of my own money to ensure my success… I am a HUMAN BEING…not a non compliant patient… So when reading this article and the masses consider the failure of treatment to be how’d the word it “laissez-faire attitude” is insulting, inaccurate, and should be the shame the author goes to sleep with nightly.

    Perhaps success would be better if Dr.’s across the Nation stop treating humans as a number and as a human being. Perhaps the study should outline the very “laissez-faire attitude” if our medical communities Dr.s that fail them.

    Perhaps if the Dr.s would’ve taken the time to consider patients as more than a number and cash cow they would’ve ensure the drugs they gave us weren’t infected with such terrible diseases to begin with. Just a thought.

    • Virginia Morrissey

      Though cured I do not reccommend Harvoni due to health damage from it and unethical company. There will or is better meds. But i hear you bro – after 4 txs the meds did more harm then the disease. For thise just starting out… do yr research. Easy to say when you hsve somuch misinfo out there snd insurance companies threats looming. Just know your own numbers and status and resistences which takes scans and bld work often not offered.

      • James Glen Tartaro

        Thank you Virgina for your support. It means a lot to know I’m not alone in this failing medical system ran by big box pharmacy and insurance companies who together have removed the Dr.’s ability to prescribe the right medication for you.

  • bobben49

    I successfully cleared HCV with Harvoni in 2015. My doctor and her staff very clearly explained with great emphasis the importance of taking the pill at the same time everyday and never missing a dose in order to be successful with my treatment. My doctors PA also called me every week to monitor side effects and compliance and to discuss any questions I had.

    I set my cell phone alarm to go off at 6:00PM every day. I missed taking my pill on time by two hours one day and by three hours on another, all other pills were taken within 15 minutes of 6:00PM. I even changed my alarm to 7:00PM to accommodate for daylight saving time.

    I think it is very important that physicians and their staff take the time to educate their patients on the absolute necessity for compliance to dosage schedule.

  • Virginia Morrissey

    Another bullshit article. Interferon and combos never cured Hep c 1a which is what most people in US had for last 3-4 decades. Blame the patients – how perfect. Truth is most comply with what isn’t killing them. My third tx with Interferon/riba I had to quit at 43-44 week because I was in thyroid storm and could have had a heart attack. But what is written in my chart is – non compliant with inishing treatment.

    • Kelly Collett

      You are correct on your statement interferon and combos never cured help. C , There is no cure for a virus hep c or any other. But genotype-1a I was told by the endocrinologist that treated me genotype 1A is the hardest form of hep c treat and that there was only a 48% chance that it would even touch hepatitis C I took six pills a day one shot every Friday plus I had every side effect except for losing my hair after 24 weeks there was no viral load that they can detect my blood so they took me off that I was retested and it was back but I went through 48 weeks of treatment again 6 pills a day and 1 shot a week, Yes the interferon and ribavirin is hard it’s hard on your body, for me it was like I had the worst case of the flu and felt I would have to get better to die, I was lucky I didn’t have any liver damage I consider myself to be one of the lucky ones and I was really blessed with great doctors and family that was there to help me when I was so sick I could barely raise my head. I get my RNA test every 6 months just for my own piece of mind I have been viral load below 5 since 2005 . Had a scare at the first of the year because an unknowable about hep c Dr called me to tell me my help was active he checked my antibody not my RNA after a 2 day panic attack I got the test results to see his mistake. Interferon combo worked for me , I am sorry it did not work for you but you and I are not others with geno 1 a

  • Virginia Morrissey

    Dosing schedules are critical what about dosing amts. Chemo usually is not one size fits all. They now give riba according to weight..only took 15 years. This whole article is so mindless. Like a first yr med student cranking a late night paper out with sweeping generalizations. Is it suppose to teach the adults here anything like they wouldn’t already know?