COMMENTARY

Hepatitis C: The Pace of Progress

Digestive Disease Week (DDW) 2013

William F. Balistreri, MD

Disclosures

June 06, 2013

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In This Article

Progress in Treating Hepatitis C Infection

Hello. I am Dr. Bill Balistreri, Professor at Cincinnati Children's Hospital. I am here at Digestive Disease Week (DDW) in Orlando, reporting for Medscape.

A major focus of the research and the state-of-the-art summaries presented here at DDW has been the pace of progress in developing new treatment strategies for hepatitis C. Speakers highlighted the fact that the agents and approaches for treatment of hepatitis C virus (HCV) infection are in constant change and may, in fact, be in for an upgrade.

The standard of care for several years consisted of a combination of pegylated interferon and ribavirin. With advanced understanding of the biology of HCV came the identification of specific proteins involved in its replication and the understanding that these proteins can be targeted by protease and polymerase inhibitors.

Last year, the US Food and Drug Administration approved 2 NS3 protease inhibitors -- telaprevir and boceprevir -- for the treatment of HCV genotype 1 in combination with standard therapy. Clinical trials of the 2 agents showed significantly improved sustained virologic response (SVR) rates in treatment-naive patients. Therefore, the American Association for the Study of Liver Diseases guidelines were altered to recommend triple therapy consisting of a protease inhibitor (either telaprevir or boceprevir) plus peginterferon and ribavirin.

Side Effects Still Bothersome

In studies reported here, several investigators[1,2,3,4] have found high response rates with either triple-therapy regimen in treatment-naive patients or in previously treated patients who had relapsed. Triple therapy was generally well tolerated. However, troublesome side effects, including rashes, occurred in many patients. Although there was no difference in discontinuation rates between telaprevir and boceprevir, more patients withdrew because of side effects or intolerance than because of nonresponse to the drug.

These studies also underscored the point that patients must be closely followed to reinforce appropriate adherence to the complex algorithmic triple-therapy approach. Protease inhibitors have greatly enhanced SVR rates. However, these inhibitors are active only against the dominant viral genotype type (type 1) found in North America and Europe. Furthermore, 30%-35% of patients with genotype 1 infection will not have sustained viral repression, and there is the potential for resistance. Protease inhibitor-based triple therapy is also limited by the complex dosing regimens, which require intensive monitoring and side-effect management.

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