Treating hepatitis C (HCV) presents challenges for those taking medications, but it looks like that’s going to change dramatically over the next few years, thanks to new treatments on the horizon. Being tested in clinical trials right now, they aim to increase the cure rate, shorten the treatment time, decrease side effects and cut the number of doses taken per day – good news for the approximate quarter of a million Canadians with HCV.
What is treatment like today?
Currently, HCV treatment is a combination of two drugs, peg-interferon and ribavirin. Peg-interferon is taken as a weekly injection for six months to a year and can cause fatigue, depression and other side effects. This treatment results in a cure 45 to 80 per cent of the time, depending on the strain of the virus. Dual therapy was the only treatment available until 2011, when two new drugs were approved: telaprevir (Incivek) and boceprevir (Victrelis). Both are called direct-acting antiviral (DAA) medications, which means they act to disrupt how copies of HCV are made. These treatments are also known as ‘triple therapies’ because each is taken in combination with peg-interferon and ribavirin. They increase the cure rate from 45 percent to 75 per cent for people with genotype 1, the most common strain of the virus in Canada. However, telaprevir can cause rashes and both drugs cause an increase in anemia (low red blood cells and iron in blood) and other side effects. They need to be taken two or three times per day with food, which can be difficult to manage.
Interferon: here to stay for a little while
Some new treatments will also need to be taken, at least initially, with peg-interferon and ribavirin, but will improve the experience of treatment. Remember these drug names; you’ll soon be hearing more about them: daclatasvir, faldaprevir, simeprevir and sofosbuvir. These new triple therapies, which may be available as soon as 2014, will mean shorter treatment times, fewer pills and side effects, and a higher cure rate. However, side effects such as depression and fatigue from peg-interferon will still be hard for some people to manage.
It’s been a long wait for treatments without interferon. These promising medications, now in the pipeline, are drug combinations that act on different parts of the viral life cycle. Some treatments will be as short as 12 weeks, with only one to two doses per day. For most strains of the virus, they may have cure rates of up to 90 per cent, even for people who did not previously respond to treatment.
“The side effects will be much fewer, the treatment will be shorter, it will be easier for people who find it difficult to take medication and for people who have mental health issues” says Sandra Trifa, Hep C Outreach Nurse, CLSC métro, Montreal, QC.
The first interferon-free treatment may be available in 2014, and by 2015 or 2016 there could be multiple options for interferon-free treatment on the market for people with different strains of the virus.
New treatments, but will people be able to access them?
While these emerging treatments are good news, some troubling questions remain that could affect access to them. Their cost is unknown, but they are likely to be expensive, and cost could affect their being added to provincial/territorial drug formularies.
- Will treatments be tested and approved for people with severe liver damage (cirrhosis) or co-infected with HIV? These people are often excluded from initial clinical trials, but need treatment the most.
- Will there be enough trained doctors and nurses to accommodate all those wanting treatment? Many HCV-positive people have substance-use and mental health issues, and research shows that with the support of multi-disciplinary teams that include doctors, nurses, social workers and peers, they can complete treatment.
- HCV also affects some immigrant and newcomer communities that experience difficulties accessing testing and health care because of cultural and linguistic barriers. Will more be done to reach and support these groups?
It remains to be seen whether key barriers affecting access to treatment will be removed. If these new treatments succeed in reaching enough people, it will lead to a better quality of life for people living with HCV, and a dramatic reduction in the burden of HCV on the healthcare system in Canada.
“I think HCV is a disease we can eradicate in the long-term,” says Dr. Jordan Feld, Hepatologist at the Toronto Western Hospital Francis Family Liver Clinic, “The progress has happened so fast with hepatitis C. To go from discovering the virus in 1989 to eliminating it from the blood supply, to developing therapy that cures people, and now getting to the point where we’ll be able to cure almost everybody. It’s a pretty remarkable feat.”