We are now seeing more approval of new highly effective direct-acting antiviral therapies for hepatitis C, with more in the pipeline and due through 2017.
The advent of direct-acting antivirals (DAAs) used in interferon-free regimens has made hepatitis C treatment shorter, more convenient, and much more effective, but there is still room for better options for difficult-to-treat patients, including people with prior treatment experience, liver cirrhosis, and hepatitis C virus (HCV) genotypes other than 1.
Hepatitis C Medication Evolution
Previous to 1989, Hepatitis C had yet to be identified and was merely known as Non-A Non-B Hepatitis. Below is a general timeline for the more prominent medications used to fight the Hepatitis C virus and their effectiveness:
•1991 – Although this type of interferon had a low success rate, the Food & Drug Administration (FDA) approved Intron A (interferon alfa-2b), the first treatment for Hepatitis C.
•1998 – Used alongside interferon alfa-2b, ribavirin is approved by the FDA for treating Hepatitis C.
•2001 and 2002 – Slight improvements were made to interferon and ribavirin medications, but the treatment success rate remained at or below 50 percent. Side effects were often severe.
•2011 – To be added to pegylated interferon and ribavirin therapy, first generation triple therapies were approved by the FDA; namely boceprevir and telaprevir. Treatment success rates began to pass the 50 percent mark, but not without some challenging side effects.
•2013 – Also added to pegylated interferon and ribavirin therapy, second generation triple therapies were approved by the FDA: sofosbuvir and simeprevir. Treatment success rates climbed even higher (some groups achieved success rates in the 90th percentile), but the pegylated interferon and ribavirin side effects remained problematic.
•2014 – Finally getting rid of the pegylated interferon injection, all-oral treatment for Hepatitis C becomes FDA approved. The ledipasvir/sofosbuvir (Harvoni) was approved first and was soon followed by ombitasvir/paritaprevir/ritonavir and dasabuvir (Viekira Pak). Treatment success rates soar to 95 to 100 percent in certain populations.
•2015 – Maintaining a very high treatment success rate, the momentum of all-oral regimens builds with the approval of daclatasvir to be used with sofosbuvir and ombitasvir, paritaprevir and ritonavir (Technivie) with ribavirin for genotype 4 without scarring or cirrhosis.
•2016 – All oral Hepatitis C drugs released this year target harder to treat populations. Elbasvir/grazoprevir, with or without ribavirin earned FDA approval and boasts treatment success rates up to 97 percent for genotype 1 and up to 100 percent for genotype 4. Sofosbuvir/velpatasvir is approved for genotypes 1 through 6
Moving forward in 2017, Primary Care Providers Can Effectively Treat Patients with Hepatitis C
Primary care providers such as non-specialist physicians and nurse practitioners can be quickly trained to provide direct-acting antiviral (DAA) therapy for hepatitis C with a high level of treatment success and provider satisfaction.
The advent of direct-acting antivirals used in interferon-free regimens has made treatment for chronic hepatitis C much more effective. In addition, DAA treatment is shorter -- typically 8-12 weeks instead of 12-24 months -- and simpler because it does not require interferon injections and management of its many side effects.
Since 2014, the all-oral Hepatitis C treatment regimens are boasting very high success rates. However, the cost of these medications is staggering.
In addition to the cost of the new DAA drugs, another barrier to expanded access to treatment is that there are not enough liver disease specialists to treat everyone with hepatitis C. But specialized treatment may not be necessary for most patients with uncomplicated disease in the DAA era.
While primary care providers are often busy and even overburdened, they seldom have the opportunity to cure a serious disease themselves, and learning new skills to do so might improve job satisfaction.
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