Need-To-Know News on Hepatitis C Treatment
Hepatitis C treatment continues to develop at a rapid pace, so we’ve updated our information to bring you all the latest breakthroughs and help you make well-informed decisions about your treatment plan.
Please bear in mind, the information and comments we’ve presented here are not intended as a substitute for professional medical advice. Always refer to your GP, liver specialist or hepatology (liver) nurse for expert advice on the type of treatment that is best suited to your individual situation.
Hepatitis C Treatment: An overview
For many years, hepatitis C has been treated with pegylated interferon and ribavirin, both of which cause significant side-effects. But with groundbreaking new treatments becoming available, we anticipate that by 2020 at least 9 out of 10 people will be cured of hepatitis C by taking a short course of tablets with very few side effects.
We’ve already seen improvements in treatment since the first direct acting antiviral medicines (DAAs) were subsidised by the government in April 2013, through the Pharmaceutical Benefits Scheme (PBS) for people with hepatitis C genotype 1. The improvements are going to keep on coming.
With more clinical trials in the pipeline, we expect new, affordable medicines to be subsidised through the PBS. Initially, these are likely to be shorter treatments, using a combination of pegylated interferon and DAAs to treat most people and drive the cure rate higher.
Eventually, we’ll see combinations of interferon-free oral medicines become available. These will have far fewer side-effects than current treatments and result in a high cure rate for most people. We also anticipate that these treatments will substantially improve the cure rate for people living with compensated cirrhosis, co-infections and other health problems.
What’s the current treatment for hepatitis C in Australia?
Treatment is tailored according to the particular genotype or strain of hepatitis C that you have. In Australia, the most common are genotype 1 (54%) and genotype 3 (37%). Collectively, genotypes 2, 4, 5 and 6 have less than 5% prevalence in Australia.
Treating hepatitis C genotype 1
In April 2013, the treatment for genotype 1 changed to include weekly interferon injections, with daily ribavirin tablets, and either a course of daily boceprevir or telaprevir tablets. This improved the average cure rate and reduced the duration of treatment for many people. However, side-effects remain a significant issue.
If your treatment regimen includes boceprevir, this requires you to take pegylated interferon and ribavirin for the first four weeks only, followed by pegylated interferon, ribavirin and boceprevir for 24 to 44 weeks.
With telaprevir, your treatment regimen will include pegylated interferon, ribavirin and telaprevir for the first 12 weeks, reducing this to pegylated interferon and ribavirin only, for an additional 12 to 36 weeks.
The time it takes to complete treatment will depend on your treatment history and how well you respond to treatment in the initial stages.
Treating hepatitis C genotypes 2 and 3
For hepatitis C genotypes 2 and 3, treatment has remained unchanged for many years and includes a combination of weekly pegylated interferon injections and daily ribavirin tablets over a period of 26 weeks.
What are the side-effects of current treatments?
The side-effects can be significant, which is one reason why treatment rates remain so low in Australia. Side-effects from pegylated interferon and ribavirin include:
- Mild to severe mood disturbances
- Slow blood-clotting
- Flu-like symptoms
- Dry skin
- Decreased appetite
- Weight loss
- Hair loss.
Additional side-effects related to boceprevir include:
- Anaemia (which can be severe)
- Change in taste.
Additional side-effects related to telaprevir include:
- Rashes (which can be severe)
- Anal pain/itching.
Often, the body’s tolerance of treatment is reduced the longer the treatment lasts. Therefore, for most people, shortening the duration of treatment can result in higher tolerance and fewer/lesser side-effects.
If you experience side-effects, the earlier you seek advice from your doctor, the better. Early intervention and careful monitoring can often minimise side-effects.
In rare cases of advanced liver disease, treatment may be stopped to avoid progression of significant life-threatening side-effects.
Mixing other medicines with hepatitis C treatments
Mixing your medications can be dangerous. If you need to take additional prescription or over-the counter medicines during your treatment, always check with your specialist before taking anything.
What are my chances of being cured with current treatments?
The success of your treatment will depend largely on your commitment to taking your prescribed medicines regularly, so be sure to follow your doctor’s instructions consistently.
On average, there is a 70% to 80% success rate with current treatments. However, there are many personal factors that influence treatment outcomes for individuals. To get a better understanding of how well you’re likely to respond to current treatments, make an appointment with your doctor.
How will my response to treatment be monitored?
Your response to treatment is monitored by taking blood tests at intervals to measure the amount of virus in your blood. What your doctor will be looking for is a Sustained Virological Response (SVR). This means that the virus drops to undetectable levels while you are undergoing treatment and remains undetectable six months after you complete the treatment. In a word, it means you’re cured.
What if treatment doesn’t work for me?
If your treatment doesn’t result in a cure this time, remember there is hope in the form of new medicines that might be suitable for you. Stay in touch with your doctor for regular liver health checks and updates on the release of new treatments offering higher cure rates.
What’s the next wave of hepatitis C treatment?
Two new hepatitis C treatments are currently being assessed for use in Australia, but we don’t know when they’ll be made available.
For those with genotype 1 infection, simeprevir is a new direct-acting antiviral hepatitis C treatment (a second generation protease inhibitor), which would replace existing treatments with boceprevir and telaprevir (first generation protease inhibitors). Simeprevir would be combined with pegylated interferon and ribavirin.
The advantages of using simeprevir over existing treatment plans for genotype 1 infection include:
- Safer treatment with fewer complications
- Easier to take – one tablet once a day and no fatty food requirements
- Better tolerated with fewer side effects
- Shorter duration of treatment (for most people).
Simeprevir is not recommended for use if you have previously been treated with pegylated interferon and ribavirin and either boceprevir or telaprevir, as there is no data to suggest that there would be a clinical benefit.
Sofosbuvir is another new, direct-acting antiviral treatment (nucleotide polymerase inhibitor) that can be used to treat all genotypes of the hepatitis C virus. This once-a-day tablet is combined with other medicines.
The benefits of treatment with sofosbuvir include:
- The use of pegylated interferon (which has significant side-effects) can be considerably reduced and, in some cases, eliminated
- For most people, the chance of achieving a cure is 90%
- The chance of achieving a cure also significantly improves for people with cirrhosis
- Better tolerated with fewer side effects
- The safety profile in clinical trials is good and drug interactions are unlikely to be a significant issue.
When will the new treatments be available?
The new hepatitis C medicines are very expensive and will be subject to a rigorous process of expert assessment to establish safety and cost-effectiveness. Once assessment is complete, the Federal Cabinet will need to approve the funds to subsidise the medicines before they can be added to the Pharmaceutical Benefits Scheme and made available at an affordable cost.
This process can be complex and subject to delays. What’s more, the criteria to access the new government-subsidised hepatitis C treatments are unknown at this stage. As a general rule, you need to be eligible for Medicare to access medicines subsidised by the government on the PBS; however, there are some exceptions.
Consequently, no one can tell with any certainty when you might have access to the next wave of hepatitis C medicines or other new medicines.
Also, if you’re researching online, make sure the information you’re reading relates to Australia, and be aware that new hepatitis C medicines become available in different countries at different times.
Don’t put your health at risk by waiting too long
It’s easy to understand why you might prefer to wait for interferon-free treatments to become available. However, by waiting, you could be putting your health at risk.
If you’re 40 years of age or over, you’re likely to experience an accelerated rate of liver damage, which increases your risk of developing cirrhosis, liver cancer or liver failure. This is called the ‘Liver Danger Zone’.
You should also bear in mind that symptoms of liver disease may not be felt until the liver is significantly scarred.
Don’t put your health at risk by waiting too long for treatment. Make an appointment with your doctor to have a liver health assessment at least once a year.
What does a liver health assessment involve?
Your doctor will give you a clinical examination and blood tests. They may also use a Fibroscan® – a quick, non-invasive test (similar to an ultrasound) that measures the level of liver scarring to determine the severity of liver disease.
If you have chronic hepatitis C and particularly if you are in the ‘Liver Danger Zone’, ask your doctor about having a regular liver health check-up today.
A liver check-up is nothing to worry about, it is simple, easy and it could save your life.
Page Updated: 27 July 2013