March 23, 2011
While about 250,000 Australians have hepatitis C virus, just 5 percent choose to initiate therapy. Standard interferon and ribavirin treatment creates a sustained virologic response in up to 50 percent of patients with HCV genotype 1. Many choose a conservative approach due to the side effects of standard therapy, which can include depression, insomnia, muscle pain, and psychotic episodes.
The Alfred Hospital in Melbourne recently was one of six hospitals in Australia and New Zealand to trial an experimental HCV treatment combination that did not include interferon. The all-oral treatment combined the nucleoside polymerase inhibitor RG7128 with danoprevir, an NS3/4A protease inhibitor. The trial, funded by drugmaker Roche, randomly assigned 88 chronic HCV patients to the combination treatment or placebo.
Results of the dose-escalation trial showed the promise of more effective treatment, with some patients clearing the virus within two weeks.
One of the trial's investigators, the Alfred's director of gastroenterology, said the new therapy could be up to 80 percent effective. "The interferon-free treatment ... will see a lot more people taking up treatment because of the lack of major side effects," said associate professor Stuart Roberts. "It may also open up opportunities to increase treatment outside specialist centers in the hospitals because there is less requirement for intensive care and monitoring of patients."
"Introducing this treatment as standard practice is a few years off, but this study provides a proof-of-concept that it can be effective," Roberts said. "Treatment, when successful, can not only arrest the progression of the disease but often it will reduce in severity as the liver remodels itself."
The study, "Oral Combination Therapy with a Nucleoside Polymerase Inhibitor (RG7128) and Danoprevir for Chronic Hepatitis C Genotype 1 Infection (INFORM-1): A Randomized, Double-Blind, Placebo-Controlled Dose-Escalation Trial," was published in the Lancet (2010;376(9751):1467-1475).