Brown

New Treatment Options for Hepatitis C in 2014

by Columbia Surgery on February 10, 2014

Most people are aware of the implications of being diagnosed with HIV, but few have any notion how to live with Hepatitis C. Both viruses are spread through some similar means, but for reasons beyond this blog post, HIV is in our usual lexicon, and Hepatitis C (HCV) is not. This is about to change thanks to new research that has and will lead to breakthrough treatments for this disease.

Between four and five million Americans currently have HCV—most were infected in the 1960s through the 1980s. Fifty percent of these HCV infections are caused by intravenous or other drug use (even casual experimentation decades ago), the rest are from blood transfusions, body modifications such as tattoos and piercings, and sexual transmission.

Hepatitis C

Hepatitis C

Those with HCV have up to a 37% risk of mortality due to liver failure. Hepatitis C starts insidiously as inflammation and scarring (fibrosis) but then can progress to cirrhosis and liver cancer (hepatocellular carcinoma). Because HCV is asymptomatic, up to 75% of cases aren’t diagnosed until it is too late. Unfortunately our screening procedures don’t work well in targeting populations at risk, because the risks occurred so long ago and may not even be remembered.

But, we are close to a tipping point. Due to the development of new drugs HCV will soon be curable in the vast majority of patients. The decades old therapy of interferon and ribavirin work in some, but require lengthy treatment and have hard-to-tolerate side effects.

To help make more sense of these new drugs, and to better understand the changes that will be coming in the treatment of Hepatitis C, please join Dr. Robert S. Brown, Jr. of the Center of Liver Disease and Transplantation for his webinar New Treatment Options for Hepatitis C in 2014 to be held on February 27th at 1:00 PM/ET.

Topics discussed and questions to be answered include:

  • What is the timeline for DAA treatment therapies? What can HCV patients expect in the next few years?
  • What are the survival rates and treatment costs for HCV?
  • What sub-populations of HCV patients require special attention?
  • What are the results and updates for the latest Hepatitis C clinical trials?
  • What factors should be considered when developing a personal treatment regime for someone affected with HCV?

To register for this program and request a reminder please visits our New Treatment Options for Hepatitis C in 2014 webinar page. To submit a question for Dr. Brown to answer live on our show, visit our question submission form or send an @ reply to our @columbiasurgery Twitter account.


The common drugs used to treat HCV and the ways in which they are combined are:

Interferon
  • Interferon does not attack a cancer or virus directly, but boosts the immune systems response to these diseases.
  • There are different types (alpha, beta, lambda & gamma) used to treat different diseases.
  • Many patients cannot tolerate interferon due to side effects and co-morbidities.
Ribavirin
  • Ribavirin affects the reproductive capabilities of the virus through its RNA and DNA.
  • It is a synthetic chemical not found in nature.
  • Ribavirin does not have as many side effects as interferon but is a teratogen, which means it can cause birth defects in a fetus or embryo.
Interferon & Ribavirin
  • Interferon and ribavirin have been used to treat Hepatitis C for almost 20 years.
  • Interferon and ribavirin must be taken for at least 6 months usually up to a year.
  • This drug combination cures less than half of the patients with HCV genotype 1 and 70% of the patients with genotypes 2 & 3.
Boceprevir & Telprevir
  • Developed in May of 2011, boceprevir and telprevir were the first drugs to act directly on the HCV virus (DAA).
  • Boceprevir and teleprevir increased the cure rate for HCV genotype 1 to 70%. (This is the same cure rate for HCV genotypes 2 & 3 using interferon and ribavirin.)
  • A treatment regime with boceprevir or telprevir, with interferon and ribavirin lasts 24-48 weeks.
Sofosbuvir, Interferon & Ribavirin
  • Sofosbuvir was approved as first-in-class nucleotide drug in December 2013.
  • When combined with interferon and ribavirin, sofosbuvir can be used to treat HCV genotype 1 for 12 weeks with a cure rate of 90%.
  • When combined with interferon and ribavirin, sofosbuvir for 12 weeks can also treat some genotype 3 patients. (This is off-label.)
Sofosbuvir & Ribavirin
  • Sofosbuvir & ribavirin for 12-24 weeks cured HCV and allowed the elimination of interferon for the treatment for ~90% of HCV genotype 2 and for many HCV genotype 3 patients.
Sofosbuvir with Simeprevir or NS5A inhibitors
  • The combination of these drug classes together has not been approved for use by the FDA, but will be important since interferon and, likely, ribavirin will no longer be needed.

 

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New Treatments for Hepatitis C

by Columbia Surgery on December 18, 2013

Hep C Article Image (1)Hepatitis C (HCV) is an infection that primarily affects the liver. In the majority of persons, HCV infection becomes chronic and if left untreated can cause numerous outcomes, including cirrhosis and liver cancer. HCV-related end-stage liver disease is the leading cause of liver transplantation in the United States.

Chronic HCV affects nearly four million Americans, and it is estimated that 75 percent of people with chronic infection were born between 1945 and 1965. The risks of cirrhosis and cancer are higher in older individuals and those who have been infected for a longer period of time.

Historically, the backbone of treatment has been a combination of two drugs.

  • Interferon is a drug that activates the immune system to interfere, through different pathways, with production of the virus in infected cells.
  • Ribavirin is a drug that changes the genetic material of the virus and blocks reproduction in cells. Also, it is thought to activate the immune system in order to destroy infected cells.

Prior to 2011, treatment with the combination of these two drugs for 48 weeks cured approximately 40 percent of patients with genotype 1 infection, the most difficult-to-treat form of HCV. However, treatment produced significant side effects (flu-like symptoms, fatigue, depression, anemia, rash), and could complicate other conditions, such as diabetes and thyroid disease.

Poor tolerability forced many patients to discontinue treatment early and lowered their chances of cure. The need for more effective and better tolerated therapies has led researchers and doctors to develop and study classes of drugs that target HCV directly (Direct Acting Antivirals, or DAAs).

  • Protease inhibitors (PIs) include agents like telaprevir, boceprevir and the recently approved simeprevir. Any one of these drugs combined with interferon and ribavirin (triple therapy) improves cure rates and, in some cases, can shorten treatment duration from 48 weeks to 24-28 weeks. Cure rates with triple therapy can be as high as 70 to 80 percent in patients with genotype 1 chronic HCV. However, because the PIs are indicated with interferon and ribavirin, actual cure rates depend on factors such as race/ethnicity and stage of disease. Finally, the PIs have unique side effect profiles and can interact with numerous drugs, causing unwanted side effects.
  • Recent FDA-approval of sofosbuvir, a nucleotide analog, supports treatment for patients with genotype 1 and non-genotype 1 chronic HCV. It will shorten treatment duration to 12 weeks when combined with interferon and ribavirin. Furthermore, for some patients, it will allow for an all oral, non-interferon regimen. Sofosbuvir-containing regimens improve cure rates up to approximately 90 percent.

Clinical trials conducted at Columbia University’s Center for Liver Disease and Transplantation currently study the effectiveness and safety of different interferon-free combinations. These combinations include potent agents that are well tolerated and have fewer interactions with other drugs. When these treatments become available, providers will be able to offer effective and well tolerated therapies to a greater number of patients. The long-term goal of treatment, which is HCV eradication with effective and safe drug combinations, will help to reduce complications from HCV-related liver disease, including cirrhosis and liver cancer, as well as the need for liver transplantation.

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New Release: Common Liver Diseases and Transplantation, an Algorithmic Approach to Work-Up and Management

February 1, 2013

Tweetby Robert S. Brown, Jr, MD, MPH Frank Cardile Professor of Medicine Chief Center for Liver Disease and Transplantation NewYork-Presbyterian Hospital/Columbia University College of Physicians and Surgeons Common Liver Diseases and Transplantation, an Algorithmic Approach to Work-Up and Management is now available to gastroenterologists, internists, and students of gastroenterology, hepatology, and surgery. Edited by Robert […]

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New Hepatitis C Treatment Therapies at the Center for Liver Disease and Transplantation

November 1, 2012

TweetMore than 3 million Americans suffer from chronic infection with the hepatitis C virus. Often considered a “silent killer, ” an infected individual may go for years without symptoms before liver damage even becomes apparent. As the disease progresses, it can cause long-term damage to the liver and may lead to liver dysfunction or failure. […]

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U.S. News & World Report Recognizes 33 Top Doctors at NYP/Columbia Department of Surgery

September 21, 2012

TweetCongratulations to the thirty three surgeons at the Department of Surgeon for being recognized by U.S. News & World Report in their 2012 list of Top Doctors. Of these top-ranked surgeons, U.S. News further identified seventeen physicians as being in the top one percent in the nation in their specialties. U.S. News & World Report’s […]

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Reflections of a Living Liver Donor

April 30, 2012

TweetIn July 2009, I was a liver donor to my 21 year old daughter, Jen, whose liver failed due to autoimmune hepatitis. I first wrote about the experience in December 2009. Though I accurately captured the emotion and the gratitude I felt at the time, I glossed over many aspects of the journey. Our lives […]

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From the City of Brotherly Love, A Brother’s Liver Saves Sister

April 23, 2012

TweetWhen 46-year-old Sharon Lupo started having stomach pains before Christmas, she brushed it off as a case of too much pre-holiday indulgence. But the pain persisted even after the holidays ended, landing her in the local emergency room. Many tests, scans, and biopsies later, she was shocked to learn the source of her pain: malignant […]

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Challenges in Liver Transplantation: Allocation of Donor Organs

November 16, 2011

TweetThe November 10, 2011 issue of the New England Journal of Medicine features an editorial by Robert S. Brown, Jr., MD, MPH, Director of the Center for Liver Disease and Transplantation, titled Transplantation for Alcoholic Hepatitis — Time to Rethink the 6-Month “Rule.” In this editorial, Dr. Brown addresses the difficult questions surrounding how to […]

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