Novel Treatments for HCV
Jul 8, 2008
Hi Dr McGovern,
First, thank you for maintaining such an informative and compassionate service here.
Second, I'm curious about experimental treatments for HCV. I'm a therapist at a psychiatric hospital, and many of our dual-diagnosis patients are HCV infected. I realize that some will never develop liver disease, and that slightly over 50% of those who do can be cured with current therapies.
Based on these facts, I typically tell treatment-naive patients that they have a great chance of beating HCV as long as they can stay sober, adhere to treatment for their psychiatric illness, and receive treatment for HCV when and if needed.
Unfortunately, I also encounter patients who have experienced treatment failure with the current gold standard therapy for HCV. As a therapist, I'm constantly looking for ways to encourage and inspire hope in those patients who see no hope for themselves.
So I'm wondering, what are the odds that experimental HCV drugs could cure patients who have already failed standard therapy? Of course I want to encourage hope, but I also don't want to be unrealistic.
What do you tell patients who have experience treatment failure, especially if they are still in relatively good health? Would it be inaccurate to suggest that they can hope for a cure?
Response from Dr. McGovern
First I want to say that I am gratified to hear that you are supporting patients through therapy since we also try to treat our patients with dual diagnoses. Our psychiatrist is central in helping us accomplish this.
As for those who do not respond, there is reason for hope. There are two protease inhibitors, named telaprevir and boceprevir, that are going into phase 3 trials. There are also polymerase inhibitors that are in Phase 2 trials. Most of these drugs will need to be given with pegylated interferon and ribavirin since studies show that triple therapy is much more potent and is also effective in reducing resistance. There is also some recent data with telaprevir suggesting a good response even in those with prior failed interferon responses.
We now hope that all goes smoothly so that we will have new therapies at hand in the next 3-5 years.
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