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HCV 101: Hepatitis C Treatment: Combination Therapy

From Brown Medical School

April 2002

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!

Treatment (Trade Name, Manufacturer)

 Dosing Recommendations Cost*** Major Side Effects****
Ribavirin: oral antiviral agent (Rebetol, Schering Plough) Ribavirin** (200 mg capsule):1, 2

<75kg: 1,000 mg given as 400 mg PO Q AM + 600 mg PO Q PM

>75kg: 1,200 mg given as 600 mg PO BID

Ribavirin (as unbundled Rebetol):
$9.84 per 200 mg capsule
1,000 mg: $344.40/wk
1,200 mg: $413.28/wk

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Rebetron (ribavirin in combination therapy*):
1,000 mg: $402.16/wk
1,200 mg: $444.38/wk

Primary toxicity: hemolytic anemia 10%-21% (reductions of hemoglobin levels occurred within the first 1-2 weeks of therapy).

Rebetron (combination therapy*): cardiac and pulmonary events associated with anemia occurred in approximately 10% of patients. Psychiatric events in treatment naive: insomnia (39%), depression (34%), irritability (27%).

Interferon alfa-2a (Roferon A, Roche) 3 MIU 3x/week x 12 months subcutaneous or IM injection5 $30.60 per 3 MIU Interferon side effects:

Percentages given: pegylated/unpegylated

Depression:***** 29%/25%
Headache: 56%/63%
Fatigue: 52%/62%
Nausea: 26%/46%
Fevers: 22%/35%
Alopecia: 22%/27%

Interferon alfa-2b (Intron A, Schering) 3 MIU 3x/week x 12 months subcutaneous or IM injection3 $40.00 per 3 MIU
Peginterferon alfa 2b (PEG-Intron, Schering Plough)
Pegasys by Roche is expected later this year 		1.5 micrograms/kg/week x 12 months subcutaneous injection 100 mcg/vial: $247.87
160 mcg/vial: $260.27
240 mcg/vial: $273.28
300 mcg/vial: $286.93
Interferon alfacon-1 (Infergen, Amgen) consensus interferon 9 mcg/injection $38.76 per 9ug

Monotherapy is no longer the standard of care for initial treatment.

* Rebetron is interferon alfa-2b packaged with ribavirin (Schering Plough).

** Ribavirin is FDA approved for use in combination therapy as Rebetron or with PEG-Intron as Rebetol only.

*** All Schering prices are adjusted wholesale prices (AWP). All Roche Prices are wholesale acquisition cost (WAC). The pricing shown should be considered a maximum price. Substantially discounted pricing may be available based upon the type of pharmacy purchasing medications (ex. institutional, retail, government operated). In addition, quantity or market share rebates from the manufacturer may be available. Prices are subject to change at any time.

**** Most of the reported adverse reactions are considered mild to moderate and are manageable.

***** Note: In some larger studies, close to 70% of patients required some sort of psychiatric support while on therapy, including antidepressants. If patients begin experiencing depression while on HCV treatment, treatment with antidepressants should be initiated. Benzodiazepines should be avoided. Psychiatric support may also be appropriate in some cases.

Adapted from Chronic Hepatitis C: Current Disease Management. NIH Publication No. 99-4230, May 1999.

Additional Information from:

  1. Product insert, available at www.hepatitis innovations.com/pro/rebetol/rebetol_pi.html

  2. Product insert, available at www.rebetron.com/pro/rebetron/pi.html

  3. Product insert, available at www.hepatitisinnovations.com/pro/introna/pi.html

  4. Product insert, available at www.hepatitisinnovations.com/pro/pegintron/product_info.html

  5. Product insert, available at www.rocheusa.com/products/roferon/pi.html


Back to the HEPP News April 2002 contents page.

A note from TheBody.com: Since this article was written, the HIV pandemic has changed, as has our understanding of HIV/AIDS and its treatment. As a result, parts of this article may be outdated. Please keep this in mind, and be sure to visit other parts of our site for more recent information!




  
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This article was provided by Brown Medical School. It is a part of the publication HEPP News.
 
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