Adding Third Drug May Improve Hepatitis C
MONDAY, Aug. 9 (HealthDay News) -- The current two-drug standard
treatment for the potentially lethal hepatitis C could be rendered
nearly twice as effective if doctors added in a third antiviral
medication called boceprevir, new research suggests.
The finding might help the estimated 170 million people
worldwide who are infected with this particular type of hepatitis C
(genotype 1), the study authors say, given that the liver infection
is difficult to treat.
The study, funded by Merck, the maker of boceprevir, was
reported online Aug. 8 in
According to the researchers, led by Dr. Paul Y. Kwo of Indiana
University School of Medicine in Indianapolis, the standard
two-drug treatment of pegylated interferon plus ribavirin prompts
the desired virological response in less than half of patients.
Searching for a way to improve these outcomes, the Indiana team
launched a two-phase trial involving 520 hepatitis C patients in 67
sites across the United States, Canada and Europe. Patients
received one of several drug cocktails of various strengths for
upwards of 48 weeks. Some of the drug combinations included
boceprevir, while some did not.
Irrespective of other factors -- including attempts to reduce
the length of treatment or the amount of standard medications given
to patients -- adding boceprevir to the mix appeared to
consistently boost viral response, Kwo and his colleagues
However, the effectiveness of the three-drug regimen was
undercut somewhat when the team lowered the amount of ribavirin the
In a news release from the journal, the team concluded that,
"boceprevir, in combination with pegylated interferon and
ribavirin, achieves high (virological response) rates with 28 weeks
of therapy in most patients, and is safe and effective for use up
to 48 weeks in the few patients who benefit from longer duration of
therapy." They also noted "increased response rates in
difficult-to-treat groups, including black participants and those
In a journal commentary, Drs. Laura Milazzo and Spinello
Antinori of the Universita degli Studi de Milano in Milan, said
that the addition of the third drug "substantially improved the
proportion of sustained virological responses, although not to the
They also noted that about a quarter of blood samples taken from
the patients showed signs of viral resistance against boceprevir.
Milazzo and Antinori say that a number of questions, including
drug-drug interactions and the role of genetics in predicting
patient outcomes, also need to be considered.
Dr. Eugene Schiff, director of the center for liver disease at
the University of Miami School of Medicine, was enthusiastic about
the current effort to improve hepatitis C treatment, and said that
he expects more to come.
"Boceprevir is one of two protease inhibitors that we are anticipating will be licensed within the next year," he said. "And when coupled with the standard-of-care right now, these drugs should double the success rate in terms of the sustained viral response rate, which equates with cure in patients who have never been treated before."
Schiff added that even some patients who have undergone and
failed to improve following a standard treatment regimen may be
able to benefit from a second round of treatment with such protease
"So there is no question this a major advance in our current treatment of Hep C," Schiff said. "And it's the first of what we can anticipate in terms of the use of what we call direct antivirals. There are many studies ongoing regarding this, but the point to make is that this field is really advancing."
Find out more about hepatitis C infection at the
U.S. National Institute of Diabetes and Digestive ...
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