New hope for hepatitis C, an often hidden disease
Associated Press | 1/18/2011, 7:12 p.m.
Most people find out they’re infected like Brian Graham of Briarcliff Manor, N.Y., during a routine check-up that spotted elevated liver enzymes. He’d never heard of hepatitis C and had no obvious risk factors. But tests showed the virus had begun to scar his liver. So over the last decade he tried three rounds of traditional treatments, with increasingly tough side effects, to no avail.
“I didn’t want to die of liver disease or cancer or suffer the prospect of having to tee up for a liver transplant. Scary stuff,” says Graham, now 56.
Enter the new drugs. They work by blocking an enzyme named protease that’s key for the virus to reproduce. But they must be taken together with standard medications — ribavirin pills plus injections of interferon-alpha — that are thought to boost the immune system.
According to studies presented at a recent medical meeting, 67 percent to 75 percent of patients given treatment including either boceprevir or telaprevir, respectively, had what doctors call a cure. That’s defined as no sign of the hepatitis C virus six months after their last dose. Importantly, only about a quarter of black patients are helped by standard therapy but adding one of the new drugs more than doubled their cure rates.
People getting their first-ever treatment did best, but the studies also found improvements in hard-to-treat patients like Graham.
“The fourth time did the trick,” says Graham, who volunteered for an early telaprevir study and says he’s been hepatitis-free for three years.
The new drugs do add side effects to the flu-like symptoms and other complaints of existing treatment. Telaprevir’s main risk is a rash that is sometimes severe, and boceprevir’s is anemia.
“The future looks very bright beyond telaprevir and boceprevir,” notes Dr. Fred Poordad of Cedars-Sinai Medical Center in Los Angeles, who has studied both drugs and consults for several companies. He points to additional drugs in earlier-stage testing that promise to target more types of hepatitis C and perhaps eventually allow for pill-only, interferon-free treatment.
Manufacturers haven’t said how much the new drugs will add to the price of treatment that already can cost $30,000, albeit far cheaper than a liver transplant.
A stickier issue: Not everyone suffers serious liver damage and it’s hard to predict who will, raising questions about exactly who needs treatment even as drug companies help push for more screening.”
That’s a concern, acknowledges Jeff Levi of the nonprofit Trust for America’s Health, also a screening proponent. But when to treat is a doctor-patient decision, and “anyone with chronic infection you do want to be monitoring so you can intervene at the right moment,” he adds.
Plus, people with hepatitis C should avoid alcohol and consider other liver-protection steps — and know how to avoid infecting others, he stresses.
Stay tuned: The CDC has begun a study at four hospitals — in New York, Detroit, Houston and Birmingham, Ala. — to see if a one-time hepatitis C test for baby boomers makes sense. Among the boomers, black men in their 50s are at particular risk. CDC plans new guidelines next year.
Meanwhile, “start that conversation” at a routine doctor’s visit by asking about hepatitis C risks and testing, Ward advises boomers.