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Hepatitis C: Meet the Meds

August 28, 2015

Hepatitis C treatment used to have a terrible reputation. Until very recently, it consisted of weekly injections with pegylated interferon and daily tablets of ribavirin.

Not everyone did badly, but a significant number of people had debilitating side effects from the injections, including fever, tiredness and depression. Treatment usually lasted six months to one year. Worse, it didn't get rid of hepatitis C in everyone.

The new generation of hepatitis C treatments are different. You only need to take pills, and often just for 12 weeks (three months).

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Side effects cause fewer problems, with the result that 99% of people usually complete their course of treatment.

And most important of all, the new drugs are more effective. The aim of treatment is to see hepatitis C viral load drop to such a low level that the diagnostic tests used can't detect any virus. This is called a sustained virological response.

Studies show that the drugs used for people with hepatitis C genotype 1 (the most common genotype in the U.S.) are all able to achieve this in at least 95% of people.

The new hepatitis C drugs work in a similar way to HIV drugs. Each one interferes with a different stage of the life cycle of hepatitis C to prevent the virus from infecting new cells and replicating.

There are three types of new drugs: protease inhibitors, polymerase inhibitors and NS5A inhibitors. A combination of drugs with different modes of action gives a strong attack against hepatitis C.


Harvoni

Manufactured by Gilead and approved by the U.S. Food and Drug Administration (FDA) in October 2014, Harvoni is a combination pill that contains two drugs:

  • sofosbuvir, a polymerase inhibitor (this is also sold separately as Sovaldi), and
  • ledipasvir, an NS5A inhibitor.

Harvoni is a single pill to be taken once a day. Unlike most of the other medications, it doesn't need to be taken with food (but can be).

It works well for people with hepatitis C genotype 1 (either 1a or 1b). Most people take it for 12 weeks.

Some people with more advanced liver disease may be asked to take it for 24 weeks, or to supplement it with ribavirin tablets.

Harvoni is safe and generally well tolerated. The most common side effects are fatigue, headache, nausea and insomnia.


Viekira Pak

Produced by AbbVie, Viekira Pak was approved by the FDA in December 2014. It consists of two different types of pills, containing between them four drugs.

The pink pill contains:

  • ombitasvir, an NS5A inhibitor,
  • paritaprevir, a protease inhibitor, and
  • ritonavir, a booster that increases blood levels of the protease inhibitor.

The beige pill contains one drug:

  • dasabuvir, a polymerase inhibitor.

Viekira Pak needs to be taken twice a day, each time with food. At the same time each morning, you need to take two pink pills and one beige pill. At the same time each evening, you need to take one beige pill.

It works well for people with hepatitis C genotype 1 (either 1a or 1b). Most people take it for 12 weeks.

Again, people with harder to treat hepatitis may get better results if they supplement it with ribavirin tablets or take it for 24 weeks.

Side effects are limited, with fatigue and headache being the most commonly reported.


Sovaldi + Olysio

These are two separate pills, produced by different companies. Guidelines generally recommend that they be taken together.

  • Sovaldi is a polymerase inhibitor. It's also known as sofosbuvir and is also a component in Harvoni. The FDA approved this Gilead product for sale in December 2013.
  • Olysio is a protease inhibitor, also referred to as simeprevir. Manufactured by Janssen, the FDA approved it in November 2013.

Both pills need to be taken once a day, with food.

This is also a combination for people with hepatitis C genotype 1 (either 1a or 1b). The usual course lasts 12 weeks.

In harder-to-treat cases, adding ribavirin or taking the treatment for 24 weeks are options.

This combination is safe and generally well tolerated. The most common side effects are fatigue, headache, nausea, insomnia, diarrhea and dizziness.


Sovaldi + Ribavirin

Whereas the drugs we've covered above are for people with genotype 1, this combination is recommended for people with genotypes 2 and 3. Around one in five Americans living with hepatitis C has one of these genotypes.

These are two separate pills, manufactured by different companies:

  • Sovaldi is a polymerase inhibitor, approved by the FDA in 2013.
  • Ribavirin was approved by the FDA in 1998. It is sold under a number of brand names including Copegus, Rebetol and Ribasphere.

Both pills need to be taken with food. Sovaldi should be taken once a day and ribavirin twice a day.

An important warning: Ribavirin must not be taken during pregnancy, or by a man while he and his partner are trying to conceive. The drug can harm the unborn baby.

The course of treatment may last 12, 16 or 24 weeks, depending on your medical history.

Using the drugs currently available, hepatitis C genotypes 2 and 3 are harder to cure than genotype 1. If your hepatitis is hard to treat -- if previous treatment hasn't worked or if you have cirrhosis -- your doctor may suggest also adding pegylated interferon injections to this pair of drugs.

The most common side effects reported are headache, fatigue, itching, muscle weakness, nausea and insomnia.


Copyright © 2015 Remedy Health Media, LLC. All rights reserved.


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