Interfern Y Ribavirina Para La Hepatitis C Crnica: Deben Ser Administrados En La Nueva Era De Tratamiento
Resumen
Palabras claves. Hepatitis C, farmacoterapia, interferón, ribavirina, tratamiento.
AbbreviationsETR: virologic response at end of treatment.Rel: relapse.
Hepatitis C is regarded as a public health problem, with an estimated 185 million people diagnosed with the virus, and a further 3 million who are unaware they are infected.1, 2 Approximately 80-85% of cases become chronic, with important clinical consequences such as increased risk of cirrhosis and hepatocellular carcinoma. Thus, adequate and uninterrupted treatment should be carefully administered.3
The aim of drug therapy is eliminate the virus and prevent disease progression. Currently, the best indicator of effective treatment is sustained virologic response , defined as the absence of detectable viral RNA in serum 1224 weeks after the end of treatment.4, 5
In recent years, drug therapy in patients with chronic Hepatitis C has achieved increasingly effective results due to improvements in medication and optimized treatment duration.
Drug therapy for Hepatitis C initially consisted of interferon monotherapy however, the rates of SVR achieved were lower than those with subsequent combination therapy with IFN and ribavirin : 6% versus 31% for a 24-week treatment period and 13% versus 38% for a 48-week treatment period, respectively.6 RBV monotherapy does not result in a satisfactory end of treatment response or SVR.4, 7-8
Materials and methods
Results
New Oral Hepatitis C Drugs: Faq
Dec. 9, 2013 â Experts call two new drugs for hepatitis Câgame changersâ that they expect will dramatically improve treatment for many of the 3 million Americans with a chronic infection. Hepatitis C can lead to liver failure.
Both new pills â Olysio and Sovaldi âwork better than the current treatment for hepatitis C. They cure it more often and in less time. They also have fewer side effects.
In a major advance, the drugs could eliminate the need for some patients to take interferon, which is injected and can have unpleasant, even intolerable side effects.
âMost hepatitis C patients and most physicians would like never to use interferon again,â says Henry Masur, MD, past president of the Infectious Diseases Society of America.
The FDA approved both new oral drugs in combination with other drugs, he says. âNeither can be taken alone.â The next question, he says, is âWhat is the best combination?â
Doctors hope â and predict â that the combinations deemed best will often exclude the need for interferon for more and more patients. But the new drugs are expected to be more expensive.
Here, three experts address questions they get from patients about the new options.
How do Olysio and Sovaldi work?
Both Olysio and Sovaldi prevent the virus from copying itself, Masur says.
What is each drug approved for?
Olysio is approved for people with genotype 1 infection in combination with the medicines ribavirin and interferon.
How effective is each drug?
A Promise Of A Cure With A Cost
These new medicines are expensive. Researchers believe that as more come to the marketplace, prices will drop to stay competitive. If you have life-threatening liver damage due to the hepatitis C virus, you might be eligible for “compassionate care” rates, which can greatly reduce your out-of-pocket cost. Ask your doctor or case manager or directly contact the drug manufacturers.
Remember, there is no one-size-fits all treatment for chronic hepatitis C. Which medication is best for you depends on many things, including:
- The amount of liver damage
- Your previous treatments
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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.
Are New Drugs For Hepatitis C Safe A Report Raises Concerns
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By Denise Grady
Drugs approved in recent years that can cure hepatitis C may have severe side effects, including liver failure, a new report suggests.
The number of adverse events appears relatively small, and the findings are not conclusive. But experts said the report was a warning that should not be ignored. It involves nine widely used antiviral drugs that were heralded as a huge advance because they greatly increased cure rates, seemingly with few side effects.
The report will be published online on Wednesday by the Institute for Safe Medication Practices, a nonprofit in Horsham, Pa., that studies drug safety. Its findings are based on the groups analysis of the Food and Drug Administrations database of reports from doctors around the world of adverse events that might be related to medications.
Dr. Robert S. Brown, the director of the Center for Liver Disease and Transplantation at NewYork-Presbyterian at Columbia and Weill Cornell, who was not involved in the study, said that there had been other, scattered accounts of problems with the new drugs and that they should be investigated further.
We dont want people to ignore it and lead to risks to patients, he said. We dont want people to overreact and not treat patients who should be treated. A lot of doctors are unclear about it, and if doctors are unclear, patients are, too.
There is no vaccine to prevent the infection, so treatments have long been eagerly sought.
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Hepatitis C Cure Health Canada Approves New Drug
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TORONTO Health Canada has approved a drug being touted as a cure for hepatitis C, a disease believed to have infected hundreds of thousands of Canadians, many of whom are unaware they harbour the virus.
The drug, sold under the brand name Epclusa, is a once-daily pill taken for 12 weeks that can rid the body of all six strains of hepatitis C, a blood-borne virus that can lead to severe liver damage and liver cancer if left untreated.
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This is really a cure, Dr. Jordan Feld, a liver specialist at Toronto Western Hospital, said of the medication, also known by its generic chemical designation sofosbuvir-velpatasvir.
In a pre-approval clinical trial conducted by researchers led by Feld and published last November, 99 per cent of 624 patients given the drug were virus-free after three months.
The study looked at patients infected with one of five strains, or genotypes, of hepatitis C 1,2,4,5 and 6. A second study of genotype 3 an aggressive form most commonly found in people of South Asian descent found the drug was effective in at least 90 per cent of cases, Feld said.
Feld said because the combination of sofosbuvir-velpatasvir has been shown to work on all strains of the virus, it eliminates the need for such testing, which often delayed treatment and can be difficult to access for those living in rural or remote regions of the country.
Treatment Of Hepatitis C In The Future New Models Of Care
Treatment of hepatitis C currently occurs in specialist liver clinics, typically within tertiary hospitals. This system is very effective and necessary to manage the complexities of interferon-based treatment. However, capacity is limited. Patients with advanced fibrosis and cirrhosis will need to remain in the tertiary system for management of their liver disease. However, patients who do not have cirrhosis may not need to be managed in a specialist clinic if they can be treated with simple interferon-free regimens. This will allow new models of care involving GPs, nurse practitioners, opioid-substitution therapy clinics and the custodial system. The PBAC has recommended that newer hepatitis C therapies are listed on the general schedule to promote treatment in primary care.
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A New Way To Beat The Disease
So far, hepatitis C drugs target the virus itself, but research is under way to create new drugs that target the cells that host the virus.
âThere are two ways to prevent a virus from growing: You target the virus or target the cell,â Polyak says. âHepatitis C is capable of mutating, which can lead to resistance to drugs that target the virus. In theory, development of drug-resistant viruses is less of an issue with drugs that target the cell.â
Will The Drugs Be Available By 1 March 2016
Although the drugs will be available for prescribing through the Pharmaceutical Benefits Scheme, it may be that not all GPs or pharmacists are fully aware of the new treatments by that date. This means there may be some delay in some areas in accessing the drugs from your local GP. However, the Victorian Government is working with doctors, services and hospitals to ensure these delays are minimised as much as possible.
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Price Remains An Obstacle
In an era of safe, highly effective antivirals and a treatment time that may shrink to 8 weeks with tolerable side effects, many barriers to HCV treatment are falling.
Except for one: cost. Currently the cost of oral therapy tops $80,000. The irony is that we have solved the scientific challenge of HCV, but now the bottleneck lies in getting those pills into the patient, Dr. Chung says. Thats where cost enters the room.
With even more oral drugs expected to be approved by the end of 2014, Dr. Chung says, there is hope that competition for a growing pool of HCV-infected people will help to drive costs down.
Now that we have a treatment that would succeed in vast majority of people with few side effects and a shorter treatment time, it would be a shame to miss out on curing someone who might later present with advanced disease, Dr. Chung says.
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Nonstructural 5b Polymerase Inhibitors
The RdRp is vital to HCV replication, acting to catalyze RNA synthesis and genome replication. Nucleoside inhibitors arrest RNA synthesis, while nonnucleoside inhibitors bind and disrupt the RdRp function.
The nucleoside inhibitors are analogues that are incorporated into the viral RNA genome by the RdRp, causing termination of further replication, and competitively bind the active polymerase site. Single mutations can lead to resistance however, there is some evidence that mutations also seem to decrease viral fitness. This class of NS5B polymerase inhibitors has a high barrier to resistance and works broadly against genotypes with intermediate potency. Sofosbuvir was the first available NS5B nucleoside inhibitor .
Nonnucleoside inhibitors inhibit the RdRp by binding an allosteric site in a noncompetitive fashion, which changes the biochemical activity of the polymerase. They have a low barrier of resistance. Beclabuvir, an indole derivative, binds the thumb I subdomain on the RdRp with potent activity but has reduced activity against HCV genotypes 2 and 6 infections. Dasabuvir, a benzothiadiazine derivative, binds the palm I site on the RdRp, causing changes to the active site and preventing transcription., Deleobuvir and radalbuvir are additional nonnucleoside inhibitors .
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Strong Differences Between Regions
But the Regions are now on the starting grid with strong unevenness. The figure that catches the eye is a strong delay compared to the roadmap drawn, which should see the screening activities be completed for this first phase by 2022.
We are faced with the possibility of being able to eliminate Hepatitis C, but the confusion that arises in the implementation of the decree is singular. This is a serious delay, certainly the result of the COVID-19 pandemic which continues to absorb resources and energy, but which is also explained by a series of other critical issues.
There are difficulties in coordinating the various regional figures involved in the planning and organization of screening. It is difficult to manage, in times suited to the objectives, to define and implement a plan that knows how to find regional resources to be used for training, information, reporting, and to combine with the methods of using the funds made available by the State for screening test.
Hepatitis C, the battle to knock it out in over 50s
What Are The New Hepatitis C Treatments And When Will They Be Available
Recent advances in antiviral treatment have led to the development of new highly effective drugs for the treatment of all types of hepatitis C.
The new hepatitis C treatments are sofosbuvir with ledipasvir sofosbuvir daclatasvir and ribavirin .
These new treatments will be available on the Pharmaceuticals Benefits Scheme from 1 March 2016.
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What Are The Side Effects Of Treatment
Some people stop therapy because of side effects. Since hepatitis C can lead to liver damage, cirrhosis, and liver cancer if not treated, its vital to stick with a treatment plan.
Newer drugs have fewer severe side effects than pegylated interferon and ribavirin. Nevertheless, you may feel some effects while taking hepatitis C medication. Side effects can include:
- nausea, vomiting, or diarrhea
- appetite loss or weight loss
Serious side effects can occur with pegylated interferon and ribavirin treatment. If youre taking these medications, you should be monitored for these serious side effects:
- anemia
- thrombocytopenia
- light sensitivity in the eyes
- trouble breathing because of lung tissue inflammation
- suicidal thoughts, depression, or irritability
- thyroid disease
- elevated liver enzymes
- autoimmune disease flares
Some medications arent recommended if theres evidence of liver damage, like cirrhosis . A co-infection with HIV also affects medication options.
More Pills On The Way
Within the next year, the FDA should approve three or four drugs that can cure hepatitis C by mouth, not needle. And even more are expected in the next 2 years. Like Harvoni, all will combine two or more types of medicine in each pill.
âIt’s a cocktail therapy – a number of drugs that target different viral proteins,â says virologist Stephen J. Polyak, PhD. He’s a research professor in the department of laboratory medicine at the University of Washington in Seattle. âThe harder that you can hit a virus and knock it down, hit it in multiple places, the more you can keep it suppressed.â
Because the hepatitis C virus can mutate, one type of medicine can’t cure the disease on its own — two or more are needed.
âThey all attack the virus in different sites,â Boyer says. âYou can’t give a single drug for hepatitis C it will just mutate and become resistant.â
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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.
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New Drugs Offer Easier More Effective Hepatitis C Treatment
- By Daniel Pendick, Former Executive Editor, Harvard Men’s Health Watch
If you are a baby boomer, the U.S. Centers for Disease Control and Prevention recommends that you be tested for infection with the hepatitis C virus. The virus can live in the liver for decades, often causing silent damage that leads to liver failure or liver cancer.
But wide-scale testing has proved to be a hard sell. One reason is that treatments to eliminate HCV infection have required weekly injections of one drug and oral doses of others. Treatment could take up to a year. Typical side effects of the injected drug required to clear the virus, called peginterferon, include depression, anxiety, irritability, anemia, and fatigue.
The existing therapies were almost as feared as the disease itself, says Dr. Raymond Chung, a hepatitis expert at Massachusetts General Hospital and an associate professor of medicine at Harvard Medical School.
Two drug studies published today in The New England Journal of Medicine mark the latest advance in making treatment for HCV easier and more effective. Researchers report that combining several oral antiviralsdrugs taken in pill form, not as injectionsclear the virus from the liver in more than 95% of people in just 12 weeks.
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Ombitasvir Paritaprevir And Ritonavir Tablets Co
This is a relatively new group of medications to 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 of ritonavir, once daily. One 250 mg tablet of dasabuvir is taken twice daily with a meal.
- Common side effects of this group of drugs include nausea, itching, and trouble sleeping. If the person takes ribavirin, side effects include tiredness, nausea, fatigue, and skin reactions.
The following medications may be effective for genotype 2.