Hepatitis C Combination Drug Therapy

Combination drug therapy is complex discuss any concerns with a health professional.

side effects here

The combination of Pegylated Interferon plus Ribavirin is now considered the standard of care for treating HCV Hepatitis C.

Standard Interferon, Pegylated Interferon, and Ribavirin are the pharmac funded medications for treating hepatitis C.

{UPDATE 2011 NEW ZEALAND DRUG TRIALS There are new treatments available for hepatitis C but these are not publically available in new Zealand yet.

There are extensive drug trials for new hepatitis C drugs being carried out in New Zealand

You may find information about current drug including trials ,locations and contacts at

http://clinicaltrials.gov/ct2/results?term=hepatitis+c+New+zealand&recr=Open }

Interferon, given by injection, is a genetically engineered product based on a set of natural immune system proteins found in the body.

Pegylated interferon (PEG) is a long-acting form of interferon that can be injected once a week. PEG maintains a more constant level of interferon in the blood and better reduces the ability of HCV Hepatitis C Virus to replicate.

Ribavirin is an oral antiviral medication used in combination with interferon to treat HCV infection. Ribavirin alone is not effective against HCV Hepatitis C.

Ribavirin (Copegus, Roche; Rebetol, Schering-Plough) is a nucleoside analogue with a broad spectrum of antiviral activity against RNA viruses.

Ribavirin is administered orally, usually in divided doses (200 mg per capsule or tablet). The dosage varies according to the patient’s weight. Regular monitoring of full blood count to detect haemolytic anaemia is needed in order to judge whether to reduce or cease ribavirin treatment.

HAEMOLYTIC ANAEMIA: is a rare form of anaemia in which red blood cells are destroyed (haemolysed) and removed from the bloodstream before their usual lifespan is up.Common signs and symptoms of haemolytic anaemia are feeling weak and fatigued (very tired) and having shortness of breath. People with haemolytic anaemia may be jaundiced (have a yellow discoloration of the skin or eyes), have dark urine, or have an enlarged spleen.

Successful combination therapy with pegylated interferon and ribavirin result in sustained virologic response (defined as undetectable HCV RNA in the patient's blood 24 weeks after the end of treatment)

{ UPDATE 2011 A new genetic test to predict your response to treatment has been introduced.
You can expect a gene test 1L28B before treatment is considered to predict your response to treatment.

gene test 1L28B -- They are looking for a gene that predicts a treatment response, If you have a ceratin combination of this gene your much more likely to respond rapidly and clear the virus.

"Patients with either the rs12979860 SNP or the 8099917 SNP were the most likely to achieve a sustained virologic response, with rates of over 80%"

"Patients with treatment-naive chronic hepatitis C virus infection who carry the rs12979860 C/C or rs8099917 T/T polymorphisms in the region of the IL28B gene are more likely than are noncarriers to show an early virologic response, as well as a sustained virologic response, to interferon-based therapy"

http://www.internalmedicinenews.com/new ... rks=711889

If you don't have the gene they may encourage you to wait for new treatments such as protease inhibitor drugs which also increase the odds of successfully clearing the virus.

If you don't have a favourable 1L28B test result you may be encouraged to wait f until the new hepatitis C drugs such as protease inhibitor drugs which also increase the odds of successfully clearing the virus become available in NZ . }

SVR sustained virologic response ( clear the virus )

Succesful treatment (SVR) up to 50% for patients infected with genotype 1, the most common genotype found in the New Zealand ,

Succesful treatment (SVR) up to 80% for patients infected with genotypes 2 or 3.

* Patients with genotypes 2 and 3 are almost three times more likely than patients with genotype 1 to respond to therapy with alpha interferon or the combination of alpha interferon and ribavirin

* When using combination therapy, the recommended duration of treatment depends on the genotype. For patients with genotypes 2 and 3, a 24-week course of combination treatment is adequate, whereas for patients with genotype 1, a 48-week course is recommended.

Once the genotype is identified, it need not be tested again; genotypes do not change during the course of infection.

Can superinfection with more than one genotype of HCV Hepatitis C Virus occur?

Superinfection is possible if risk behaviors (e.g., injection drug use) for HCV Hepatitis C Virus infection continue, but it is believed to be very uncommon.

Source Center for Diseaease Control CDC http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm#d4

People infected with more than one genotype that includes one or more of genotypes 1, 4, 5, or 6 should be treated as for genotype 1.

 

The following factors affect the efficacy (success) of treatment.

Genotype of the virus. This is the most important determinant of efficacy of treatment.

High viral load. The higher the viral load, the lower the proportion of people with HCV Hepatitis C who have a sustained virological response (SVR), all other things being equal. High viral load is the second most important determinant of efficacy of treatment.

Age. Younger people fare better than older people. This may be because older people tend to have been infected for longer, although there appears to be an independent factor beyond that.

The period between infection and treatment. Longer delays appear to adversely affect the efficacy of treatment.

Weight. People who weigh more than the average have a lower response rate to treatment than those who weigh less than the average, when the dosages of interferon alfa (and ribavirin for combination therapy) are fixed.

Fibrosis and cirrhosis of the liver (which act as markers for the damage done by the virus). The greater the damage, the less likely it is that the body can rid itself of the virus.

The pre-treatment ALT level. The higher the pre-treatment ALT level, the lower the probability of treatment success.

Racial group. Studies in the USA have shown that black people had a poorer response to treatment than white people, but there is no evidence of the impact of ethnicity in a UK setting.

Gender. Women respond somewhat better than men to fixed doses (though evidence suggests that this may be due to women’s lower average weight, and hence to the effective dose per kilogram).

source http://www.nice.org.uk/nicemedia/pdf/TA075guidance.pdf

National Institute for Clinical Excellence (england)

 

Measuring Treatment Response

People receiving HCV treatment should be tested on a regular basis to monitor side effects and to make sure that they are responding to therapy.

If someone has not responded after three months of treatment, further therapy is unlikely to clear the virus. Many physicians recommend stopping the medications at this time.

However, some evidence suggests that interferon can decrease scarring and inflammation and improve liver health even if it does not clear the virus.

Treatment Outcomes and Terminology

• Rapid Viral Response: viral clearance at week four of treatment.

• Early Viral Response (complete): viral clearance at week 12 of treatment.

• Early Viral Response (partial): Significant drop in viral load at week 12 of treatment, ie. two log drop in viral load, eg. from 60,000 down to 600.

• Non-Response: no significant drop in viral load after twelve weeks of treatment. This means you probably won’t be cured.

• End-of-Treatment Response: whether or not the virus is detectable in your blood at the end of treatment (either six months or twelve months). This is good but it
doesn’t mean you are cured.

• Sustained Viral Response: viral clearance as proved by a negative PCR result six months or more after treatment finishes. This is the result that people hope
for and is what doctors refer to when someone is successfully cured

http://www.hepc.org.au/documents/2009WYNTKweb-2MB.pdf

this info is from the new hep c council of NSW website  http://www.hepc.org.au/index.php?article=content/home

well worth a look.

Combination drug therapy is complex discuss any concerns with a health professional.

For detailed medicine and side effects information about Hepatitis C medications the (government) Med safe website is the most comprehensive New Zealand Source

Medsafe

A alphabetical list of all Consumer Medicine Information here

Medsafe PEGASYS (consumer information)

Medsafe PEGATRON COMBINATION THERAPY (consumer information)