Hepatitis C is a devastating virus that affects over 150 million people around the world every year. The virus causes inflammation of the liver and the disease can be deadly if it is not treated in a timely and efficient manner. A blood-borne virus, the hepatitis C virus (HCV), can permanently damage the liver along with other systems of the body. Many patients having hepatitis C do not require any treatment, and in the starting stages of the disease itself, the immune system is able to fight off the infection. However, once the disease progresses to its chronic, or more advanced, stage, then it requires treatment and medical intervention.
How Hepatitis is Cured or Treated?
On an average, hepatitis C is generally treated with a combination of antiviral drugs. The course of treatment lasts for several weeks, and can even go up to a year. These antiviral medications go inside the body and have the following effect:
- They help the immune system get rid of the virus
- They prevent inflammation or at least slow down the inflammation process and damage caused to the liver
- They lower the chances of developing cirrhosis or even liver cancer. In some cases, these drugs are able to prevent this from happening altogether.
- The most common medications used for treating hepatitis C include ribavirin and interferon.
Ribavirin: Also known as tribavirin, the drug is used in combination with other antiviral drugs for treating chronic hepatitis C. There are several side effects associated with ribavirin. Some of the most commonly occurring side effects from consuming ribavirin include:
- Nausea and/or vomiting
- Stomach upset or diarrhea
- A headache
- Blurry vision
- A cough
- Weight gain or weight loss
- Loss of appetite
- Dry or itchy skin
- Changes in taste
- Changes in hearing
- Chest pain or irregular heartbeat
- Yellowing of the skin/eyes
Interferon: Interferon is a naturally occurring protein that is manufactured by the body itself as a response to invasion by bacteria and viruses. The drawback of using interferon is that causes several unpleasant side effects. In some cases these side effects can be severe, causing the patient to eventually refuse or stop the treatment.
Some of the common side effects of taking interferon include:
- Fatigue or generalized weakness
- Nausea and/or vomiting
- Diarrhea or stomach upset
- Flu-like symptoms including muscle pain, headaches, low-grade fever.
The Launch of Direct-acting Antivirals (DAAs)
Due to the toxic side effects of interferon and ribavirin, the researchers have been working for years to find a drug that would be effective in treating hepatitis C, but without these severe side effects. Finally, there has been a breakthrough in this process. Known as Direct-acting Antivirals, or DAAs, these drugs have been developed in recent times, starting from 2013. The newer ones are lepidasvir or sofosbuvir (brand name Harvoni and Sovaldi), paritaprevir/ombitasvir/ritonavir/dasabuvir (brand name Viekira Pak), and these drugs are known to have a 90% rate of effectiveness and they only need to be taken for 8 to 12 weeks. Earlier, interferon or ribavirin needed to be taken for a course of 24 to 48 weeks.
DAAs work by directly targeting the hepatitis C virus in each stage of its lifecycle. Interferon on the other hand worked by activating the immune system to fight against the virus.
In December 2013, the US Food and Drug Administration (FDA) approved the use of sofosbuvir (brand name Sovaldi) as one of the first non-interferon based combination treatment for hepatitis C. The drug works only on certain genotypes of the virus, not across all of them. It has been approved for treating the genotypes 1-4 of HCV. The drug is still a major milestone in the history of hepatitis C treatment, as genotypes 1-4 are what causes the majority of hepatitis C infections in most countries. The drawback to Sovaldi is that it was launched at a very high price point, making it difficult for many hepatitis C patients to afford. Nevertheless, studies have shown that the drug is highly effective in treating the disease.
If HCV causes irreversible and end-stage liver damage, then the only treatment option left is a liver transplant. However, the problem is that it is not necessary that a transplant will ensure that you do not become infected with HCV again. Studies have shown that the recurrence of HCV after a transplant is universal as of today. The patient will again need to be on antiviral medications after the transplant, as the virus will come back in the transplanted liver as well.
Making Pan-Genotype Medications and Addressing the High Price Point
As of today, there European Association for the Study of the Liver (EASL) has only recommended two treatments that are pan-genotypic, meaning they are effective across all genotypes of the Hepatitis C virus. Out of these two, though, one has some of the same side effects as that of interferon. The second one is a combination of daclatasvir and sofosbuvir (brand name Daklinza). Daklinza has been found to be effective across genotypes, but in people who are also infected with the HIV virus.
The issue with all these new treatments is the sky-high cost. Such high price points make it difficult to have access to these newer medications, particularly in settings that have limited resources. A lot of effort has to be made by governments around the world to lower the price point so that such HCV therapies can be rolled out successfully to combat hepatitis C.
Development of New Drugs
Several new research studies are going on to discover new and effective treatments for hepatitis C, particularly treatments that do not have so many side effects. There are also many drugs that are under development for treating HCV. These novel medications are aiming to target the different parts of the virus’ lifecycle. Experts are hoping that by combining several drugs together, they will be able to find a cure for all the genotypes of the hepatitis C virus, without having to use interferon.
The pharmaceutical company AbbVie, Inc. is in the process of making a new drug combination that is still undergoing clinical trials. This drug is composed of an NS5A inhibitor and a protease inhibitor, and it works by stopping the replication process of the hepatitis C virus.
Several version of the ASTRAL study has been testing various combinations of drugs to find an effective pan-genotypic treatment for hepatitis C. One version of the study, ASTRAL-1, has been testing a combination of sofosbuvir/velpatasvir (SOF/VEL, brand name Epclusa), in a double-blind clinical trial. The trial has so far found that SOF/VEL is nearly 100% effective against all the genotypes of the HCV, except for genotype 3.
ASTRAL-2, meanwhile, is comparing this drug against a combination drug of ribavirin and sofosbuvir upon patients. This study has shown a 99% effectiveness of this new drug across all genotypes.
Similar, other versions of the ASTRAL study is also going on to try and find a treatment that will be effective all the genotypes of the virus.
Due to the sky-high cost of most HCV treatments, a company based in Egypt has recently developed a new, low-cost HCV treatment known as ravidasvir. This is an oral drug, which is being hailed as being effective against all the genotypes of HCV. The medication has also shown a good safety profile during the clinical trials, not having toxic side effects such as interferon. There is also a lesser chance for interactions with other drugs. The drug has already been tested in several Egyptian patients suffering from genotype 4 of HCV, and it proved to be 100% effective in patients who did not have cirrhosis. In patients who had cirrhosis, the drug showed an efficacy rate of 94%. The company is now gearing up to conduct clinical trials across other countries and is conducting studies to compares ravidasvir with sofosbuvir. It is expected that a 12-week course of treatment with ravidasvir will only cost around USD 300.
Novel and effective treatment options that are also financially feasible will only become feasible with the entry of generic medications in the industry. Until then, there is hope that the numerous research studies going on world over for curing hepatitis C will find a way of bettering DAAs and making them effective against all the genotypes of the virus.
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