Friday, November 25, 2022

Latest Treatment Of Hepatitis C

Assessment Of Treatment Efficacy

New Hepatitis C Treatment Boasts Over 90% Cure Rate

Recommendations

  • HCV RNA or HCV core antigen detection should be performed at week 12 or 24 post-treatment to assess whether treatment has been successful .
  • Given the high SVR12 rates expected with pangenotypic DAA-based regimens, checking SVR is dispensable, except in patients with high-risk behaviours and in patients at risk of reinfection .

Ombitasvir Paritaprevir And Ritonavir Tablets Co

This is a relatively new group of medicines that treat genotype 1 hepatitis.

Facts about the drug pack include:

  • Treatment time is 12 or 24 weeks.
  • Dosage is a pack of tablets containing 12.5 mg of ombitasvir, 75 mg of paritaprevir, and 50 mg ritonavir, taken once daily in the morning, and one 250 mg tablet of dasabuvir taken twice daily with a meal.
  • Common side effects of this group of drugs include nausea, itching, and trouble sleeping. If the person also takes ribavirin, side effects include tiredness, nausea, fatigue, and skin reactions.

The following medications may be effective for genotype 2:

Will Community Pharmacies Be Able To Dispense These New Hepatitis C Drugs

Community pharmacists will be able to dispense the drugs. However, because these are new drugs, it may take time for pharmacies to order in sufficient stock to meet demand.

This means that patients may need to wait a couple of days after providing their script for the drugs to be available from their local pharmacy.

Also Check: What Is Hepatitis C And What Causes It

Asunaprevir + Dcv + Bms

This BMS combo, soon to be commercialised, analysed non-cirrhotic naive and retreated patients in the UNITY-1 study. A SVR of around 90% was achieved, slightly lower in the genotype 1a patients, but similar in both naive and pretreated patients. The cirrhotic patients were analysed in the UNITY-2 study, receiving this combination with or without RBV. In this group of cirrhotic patients RBV increased the rates of SVR in both naive and pretreated patients.

The BMS combo obtained a SVR in 90% of cases, but cirrhotic patients require the addition of RBV.

The current recommendations for therapy in patients with genotype 1 HCV are summarised in Tables and .

Hcv Rna Or Hcv Core Antigen Detection/quantification

Hepatitis C and Treatment Barriers

Recommendations

  • The presence of viraemia, reflected by the presence of HCV RNA or HCV core antigen, must be demonstrated prior to initiating therapy .
  • HCV RNA detection and quantification in serum or plasma should be made by a sensitive assay with a lower limit of detection of 15 IU/ml .
  • HCV core antigen detection and quantification should be made by EIA .
  • HCV RNA detection can be made by a low-cost point-of-care test with a lower limit of detection 1,000 IU/ml where sensitive HCV RNA assays are not available and/or not affordable .

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General Principles Of Treatment Of Chronic Hepatitis C In Patients Without Cirrhosis And In Patients With Compensated Cirrhosis

Liver Int.

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J Clin Exp Hepatol.

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J Viral Hepat.

  • Madkour M.A.
  • Aboufarrag G.A.

Liver Int.Rev Recent Clin Trials.Int J Infect Dis.J Gastroenterol Hepatol.

  • Yang H.C.
  • et al.

Clin Infect Dis.

  • Sun H.Y.
  • et al.

Sci Rep.Nat Biotechnol.J Hepatol.

J Hepatol.J Hepatol.J Hepatol.J Hepatol.J Hepatol.

J Hepatol.Recommendations

  • Because of their virological efficacy, ease of use, safety and tolerability, IFN-free, ribavirin-free, pangenotypic DAA-based regimens are preferred in HCV-infected patients without cirrhosis or with compensated cirrhosis, including treatment-naïve patients and treatment-experienced patients .
  • The following pangenotypic regimens are recommended for the treatment of patients infected with HCV, according to the below recommendations :
  • the fixed-dose combination of sofosbuvir and velpatasvir in a single tablet administered once daily
  • the fixed-dose combination of glecaprevir and pibrentasvir in 3 tablets containing 100 mg of glecaprevir and 40 mg of pibrentasvir, administered once daily with food
  • the fixed-dose combination of sofosbuvir , velpatasvir and voxilaprevir in a single tablet administered once daily with food.
  • The non-pangenotypic fixed-dose combination of grazoprevir and elbasvir in a single tablet administered once daily can also be used in patients infected with HCV genotype 1b .
  • Generic drugs can be used, provided that quality controls are met and guaranteed by the provider .
  • Causes And Risk Factors Of Hep B

    Like several other viruses, HBV is transferred through person-to-person contact. Some common causes include sexual contact with an infected person, sharing of needles , accidental needle sticks, which is one of the major threats to people working in healthcare settings, and from mother to child . Some possible risk factors associated with hepatitis infections are men having sex with men and travelling to regions with high infection rates of HBV like Asia, the Pacific Islands, Africa, and Eastern Europe.

    Recommended Reading: Hepatitis A B C Symptoms

    Where Can I Go If I Have Further Questions Or Need More Information

    • Your local GP and pharmacist can provide you with more information on the new treatments, including if they are right for you. To find a GP, please click here
    • The Victorian Government funds a range of community organisations to provide information, care and support to people living with hepatitis C, and on the new treatments. For more information, please visit:
    • Hepatitis Victoria’s website or their Hepatitis Infoline on 1800 703 003or refer to the Hepatitis Victoria, PBS factsheets

    What Are The Names Of The Medications For Treating Hepatitis C

    New Hepatitis C Treatment

    Since 2014, multiple different antiviral treatments for hepatitis C have been developed. With the many options now available, often there is more than one good choice for a patient. Some of the treatments are recommended as first-line options, some are second-line options, and others are used less commonly in light of all the available choices.

    • Elbasvir/Grazoprevir

    Second line hepatitis C medications:

    • Sofosbuvir/Velpatasvir/Voxelaprevir

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    Is Hep C Curable

    The latest drugs available for hepatitis C have high success rates when it comes to curing the condition.

    In conversations with your doctor, you can discuss the full range of treatment options. Some of these are combination drugs.

    But its important to note that not every medication may be effective for you, even if its for the right genotype.

    Endpoint Of Hcv Therapy

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    • et al.

    Hepatology.

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    • et al.

    Antivir Ther.J Clin Virol.

    • Cohn J.
    • et al.

    Ann Intern Med.

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    Clin Gastroenterol Hepatol.

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    Br J Biomed Sci.

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    Clin Infect Dis.

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    • et al.

    Gastroenterology.

    • et al.

    Gastroenterology.Recommendations

    • The endpoint of therapy is undetectable HCV RNA in serum or plasma by an assay with a lower limit of detection 15 IU/ml, 12 weeks or 24 weeks after the end of treatment .
    • Undetectable HCV core antigen in serum or plasma 12 weeks or 24 weeks after the end of treatment can be used as an alternative endpoint of therapy in patients with detectable HCV core antigen prior to therapy .
    • Undetectable HCV RNA in serum or plasma 12 weeks or 24 weeks after the end of treatment, using a qualitative HCV RNA assay with a lower limit of detection 1,000 IU/ml , can be used as an alternative endpoint of therapy where sensitive HCV RNA assays are not available and/or not affordable .
    • In patients with advanced fibrosis and cirrhosis , surveillance for HCC must be continued because an SVR will reduce, but not abolish, the risk of HCC .

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    How Hepatitis C Used To Be Treated

    Along with abstinence from alcohol , the standard treatment for chronic hepatitis C used to be a combination antiviral therapy consisting of a pegylated interferon and ribavirin, sometimes called PEG/riba therapy.

    A pegylated interferon is a long-acting form of an interferon, a synthetic copy of an infection-fighting protein secreted by immune system cells in response to pathogens. Ribavirin is a drug that interferes with HCV’s ability to replicate. In some cases, pegylated interferon was used without ribavirin, but ribavirin alone isn’t effective against hepatitis C.

    To treat hepatitis C, doctors prescribed weekly injections of the pegylated interferons along with twice-daily oral doses of ribavirin. PEG/riba therapy was not a cure-all.

    Interferon is not an option for people with liver failure, autoimmune diseases, and psychiatric illness. It can also cause a range of life-threatening complications that prevent many people from completing their therapy.

    Newer drug regimens that can cure hepatitis C have forced a change in the standard treatment for the disease, and in the United States, these medications have largely replaced interferon. But pegylated interferon and ribavirin together or separately may still be used in combination with newer antiviral drugs.

    Are There Ways To Cure Hepatitis C Other Than With Medications

    Traditional Treatments Still in Use for Hep C

    Patients sometimes ask whether there are ways to treat hepatitis C other than taking medicines. Currently, there are no vaccines to prevent hepatitis C. Once a person is infected, the only way to treat it is with prescribed antiviral medications.

    Some patients worry that having hepatitis C means they will need a liver transplant. Only a very small fraction of people with hepatitis C require a liver transplant. By far, most people with hepatitis C never need a liver transplant. A transplant is performedonlywhen damage to the liver is extremely advanced and the liver is unable to perform its basic functions. A transplant provides a new working liver, but a transplant does not get rid of the hepatitis C virus in the patient. Patients with a liver transplant still need antiviral medication to cure their virus.

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    A Researcher Reflects On Progress Fighting Hepatitis C And A Path Forward

    The hepatitis C virus was discovered in 1989 research thats now earned a Nobel Prize.

    When I began my medical career in Hong Kong in the early 1980s, I chose to focus on hepatitis B, in part because it was very common and because the hepatitis C virus had not yet been discovered. I witnessed the devastation that this virus caused cirrhosis, liver failure and liver cancer and the lack of treatments we could offer to patients.

    Back then, scientists knew there was another type of hepatitis, but no one could identify it, so we called it non-A, non-B hepatitis. I would never have imagined that during the course of my career I would witness the discovery of what came to be known as hep C and the development of a cure for nearly all patients with chronic hepatitis C in 2014.

    Underscoring the importance of these discoveries for global human health, this years Nobel Prize in Physiology or Medicine was awarded jointly to Harvey J. Alter, Michael Houghton and Charles M. Rice for the discovery of the hepatitis C virus.

    Effective treatment for hepatitis C has become even more relevant today in light of the recent surge in new cases of hepatitis C due to rising opioid use.

    Interferons And Pegylated Interferons

    The two most frequently used recombinant interferon preparations in clinical trials have been IFN alfa-2b and IFN alfa-2a , which differ from each other by only a single amino acid residue. IFN alfacon-1 , or consensus IFN, is a genetically engineered compound synthesized by combining the most common amino acid sequences from all 12 naturally occurring IFNs. Roferon-A was discontinued from the market in 2007 and Infergen was discontinued from the market in 2013.

    The addition of propylene glycol molecules to IFN has led to the development of long-lasting IFNs that have better sustained absorption, a slower rate of clearance, and a longer half-life than unmodified IFN, which permits more convenient once-weekly dosing. The FDA has approved PEG-IFNs for the treatment of chronic hepatitis C.

    Two PEG-IFN preparations are available for the treatment of chronic hepatitis C. PEG-IFN alfa-2b consists of IFN alfa-2b attached to a single 12-kd PEG chain it is excreted by the kidneys. PEG-IFN alfa-2a consists of IFN alfa-2a attached to a 40-kd branched PEG molecule it is metabolized predominantly by the liver.

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    Pregnancy And Hepatitis C

    The new hepatitis C medicines have not been tested in pregnancy.

    You should not become pregnant while taking treatment as it could be harmful to unborn babies.

    If you’re pregnant, you must delay treatment until after your baby is born.

    Speak to your doctor before starting hepatitis C treatment if you’re planning to become pregnant in the near future.

    You’ll need to wait several weeks after treatment has ended before trying to get pregnant.

    Women taking ribavirin should use contraception during treatment and for another 4 months after the end of treatment.

    Men taking ribavirin should use a condom during treatment and for another 7 months after the end of treatment. This is because semen can contain ribavirin.

    If you become pregnant during treatment, speak to your doctor as soon as possible to discuss your treatment options.

    Can Hepatitis C Be Treated

    New Breakthrough in Hepatitis C Treatment

    Yes, since 2010 enormous progress has been made in the treatment of chronic hepatitis C. New therapies called direct-acting antivirals are pills that act on the virus itself to eradicate it from the body, unlike older medicines like interferon injections which work by stimulating an immune response. These new treatments are very effective and can achieve cure rates of over 90%. In most situations now, there is no need for interferon, which was responsible for many of the side effects previously associated with HCV treatment. The new treatment combinations require shorter treatment durations , have reduced side effects and appear to be effective at all stages of the disease.

    Because these new therapies are very new, they remain very expensive. As such, drug coverage from both government and private companies may require that your liver disease has progressed to a certain stage before they are willing to cover the cost of these drugs.

    Your primary care physician may refer you to a specialist to determine whether you are eligible for treatment. A specialist will help you decide which drug therapy is best for you based on the severity of your liver disease, your virus genotype and whether or not you have been treated in the past.

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    Opioid Epidemic Homeless Lead To Rise In Hepatitis B And C Infections

    In the United States, the number of new hepatitis B virus and hepatitis C virus infections has been decreasing for many years, but this trend has been reversed during recent years due to the opioid epidemic as more people use injection drugs, share needles or other paraphernalia and practice high-risk sexual behavior. This is particularly true for hepatitis C, where the number of new cases in the past 10 years has more than doubled, highlighting the need for a preventive vaccine, which is a vital tool to eliminate hepatitis C. The increase in number of new cases of hepatitis B is smaller and mainly seen in adults in their 30s because most younger persons have benefited from hepatitis B virus vaccination.

    When we talk about viral hepatitis, the focus is on hepatitis B and C because they can cause chronic infection, while hepatitis A causes only acute infection and will not lead to cirrhosis or liver cancer. However, since 2016, many states in the U.S. have witnessed outbreaks of hepatitis A. The Centers for Disease Control and Prevention received more than 2,500 reports of hepatitis A between January 2017 and April 2018 associated with person-to-person transmission, with risk factors in two-thirds of these cases being drug use or homelessness or both. In Michigan, where I live, 859 cases of hepatitis A, including 27 deaths, were reported between July 2016 and June 2018. We can prevent hepatitis A through vaccination and improved hygienic conditions.

    Assessment Of Liver Disease Severity

    vs.J Hepatol.

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    Ann Intern Med.

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    Liver Int.

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    J Hepatol.

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    • et al.

    Gastroenterology.Recommendations

    • Liver disease severity must be assessed prior to therapy .
    • Cirrhosis must be identified, as some treatment regimens must be adjusted and post-treatment surveillance for HCC is mandatory .
    • Post-treatment surveillance for HCC must also be performed in patients with advanced fibrosis .
    • Fibrosis stage must initially be assessed by non-invasive methods, including liver stiffness measurement or serum biomarkers, including APRI and FIB-4 that are inexpensive and reliable biomarker panels .
    • Liver biopsy should be reserved for cases where there is uncertainty or potential additional aetiologies .
    • Non-invasive methods should not be used to assess fibrosis stage after therapy, as they are unreliable in this setting .

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    Will A Specialist Need To Be Involved

    In order to prescribe, general practitioners including physicians with expertise in viral hepatitis, will be required to first consult with a gastroenterologist, hepatologist or infectious diseases physician to ensure patients with liver disease or other complex needs are appropriately referred to specialist care. A face to face consult with the specialist is not required and patients with complex needs will likely be referred to specialist care where appropriate.

    Patients affected by hepatitis C with severe or advanced liver disease may still need to access the treatments under the care of a specialist – such as a gastroenterologist, hepatologist, or an infectious disease physician with experience in treating chronic hepatitis C infection.

    Available Drugs In Europe

    New Treatment for Hepatitis C
    Product
    Tablets containing 400 mg of sofosbuvir One tablet once daily
    Tablets containing 400 mg of sofosbuvir and 100 mg of velpatasvir One tablet once daily
    Three or four granules once daily, according to body weight
    Sofosbuvir/velpatasvir/voxilaprevir Tablets containing 400 mg of sofosbuvir, 100 mg of velpatasvir and 100 mg of voxilaprevir One tablet once daily with food
    Glecaprevir/pibrentasvir Tablets containing 100 mg of glecaprevir and 40 mg of pibrentasvir Three tablets once daily with food
    Film-coated granules of glecaprevir and pibrentasvir in sachets containing 50 mg of glecaprevir and 20 mg of pibrentasvir mixed together in a small amount of food Three to five sachets once daily, according to body weight
    Grazoprevir/elbasvir Tablets containing 100 mg of grazoprevir and 50 mg of elbasvir One tablet once daily

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