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Combination of direct antivirals may be key to curing hepatitis C

Science Centric | 6 May 2010 13:29 GMT — Comments (8)
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A combination of antiviral drugs may be needed to combat the drug resistance that rapidly develops in potentially deadly hepatitis C infections, a new study using sophisticated computer and mathematical modelling has shown.

Using probabilistic and viral dynamic models, researchers at the University of Illinois at Chicago, Oakland University and Los Alamos National Laboratory predict why rapid resistance emerges in hepatitis C virus and show that a combination of drugs that can fight three or more mutated strains may be needed to eradicate the virus from the body. They compared their model with data from a clinical trial of the new direct-acting antiviral medication telaprevir.

The findings are published in Science Translational Medicine.

Hepatitis C is a progressive liver disease that can lead to cirrhosis and liver cancer. Current standard treatment is a combination of the antiviral drugs interferon and ribavirin for a period of 24 to 48 weeks - a regimen that is long and expensive, carries side effects, and is successful only in about half of patients.

Intensive effort has focused on developing direct antiviral drugs. But the virus is genetically diverse, and so may be particularly prone to develop resistance, said Harel Dahari, research assistant professor of hepatology in the UIC College of Medicine and one of the paper's co-authors.

One way to combat resistance would be to administer multiple drugs, each with a different mechanism of inhibiting the virus.

'We found that rapid emergence of resistance to these types of drugs is due to a population of viruses already present, allowing the resistant virus to become the dominant strain,' said Dahari.

The researchers suggest that a combination of new antiviral drugs will be needed to fight all of the resistant virus strains and achieve better cure rates for the disease.

'We are moving to a new era where we can treat these patients with direct-acting agents against the virus, in which we specifically target the life-cycle of the virus,' Dahari said.

To replace the standard treatment, four or more different types of direct drugs may be needed, Dahari said. However, some patients may need fewer drugs. It depends on the level of the virus in their blood, among other factors.

It is frustrating for patients to go through a long, difficult treatment and know that they might not be cured, said Dr Scott Cotler, associate professor of medicine at UIC and a hepatologist who treats patients at the University of Illinois Medical Centre's Walter Payton Liver Centre.

'Patients are looking forward to a day when they don't have to take interferon and ribavirin,' said Cotler. 'But as we are learning with this study, if we are going to need four different direct drugs, it is going to be awhile before we get there. Now at least we know where the goal line is.'

Dahari suggests that future treatment that includes the standard treatment and direct antivirals, such as telaprevir or boceprevir, will be tailored to each patient and that using direct antivirals may also shorten the duration of treatment.

Source: University of Illinois at Chicago

I participated in a clinical study last year for Hep C at Northwestern Memorial. Took ribavirin and interferon, along with another antiviral and an experimental drug. I took all doses of all meds as told, very tough, no way I could work. Had trouble with my haemoglobin dropping and had to add Procrit shots once a week, also had to decrease the ribavirin dose for about 3 weeks. Had weekly labs and the virus completely cleared from my blood very quickly. I didn't achieve a long term viral response and the virus was back after 6-8 weeks. After 4 months of treatments and being told I was 'cured' I was very disappointed and started the follow up phase of the study. Now, almost a year later, I've learned to LIVE with Hep C. Don't think I could do that again.
Posted by Nancy, 04 Jun 2010 04:47 GMT
I've had Hep-C geno type 1a or 1b depend on what lab does my test. I just know there is no treatment for it and it makes me mad as H. That the GENO type is not talked about much at all. To many different types of Hep-C but all I ever hear is Hep-C. Knowen since the 80's that I had Hep-C it was in 2000's that I found out it was Geno type 1A or 1B. As of right now there is no treatment for either one. Think I will try Milk Thistle and see if that helps hear it is great for the liver. Will let you all know in a few months how it works.
Posted by Ken, 02 Jun 2010 12:00 GMT
What is the hold up with telaprevir. I'm wating for aproval and development to get treated.
Posted by Zoraida Castro, 23 May 2010 03:25 GMT
I've had hep C since 1982... before they even knew it was hep C. Back then it was non A non B Hep... I was 21 years old at the time. Got it from a blood trans. when I had Hodgkin's disease. Years ago I did interferon and ribavirin for a year which was horrible. Almost worse than chemotherapy... Didn't work of course... I don't even bother seeing my liver Dr anymore... Waste of time and money. Maybe when this new stuff is out there for us all I might try it.

I agree with Helen... I'm sick & tired of being SICK & TIRED.
Posted by Terri, 20 May 2010 13:18 GMT
I was diagnosed with this disease 15 years ago, and have carried it with only count elevations, and then back to normal, now in the last six months my count is getting higher and does not show signs of coming down, tomorrow of to see liver specialist and think biopsy is imminent, I hope that there will be a guaranteed cure found, as this disease is running ramped.
Posted by mike kowalchuk, 19 May 2010 20:39 GMT
What is the hold up with telapravir? They were expected to apply for fast track approval a year ago. The trials keep coming in better than expected, and they keep delaying submitting their application.
Posted by James, 19 May 2010 09:29 GMT
The percentage of infected people around the world is scaring which needs better attention from the various concerned bodies. As patients we like to know the approx. date of the approval of the new medication.
Posted by magda, 18 May 2010 22:35 GMT
Thank you for working so hard to help hep c patients out! We need it! I for one am sick & tired of being SICK & TIRED.
Posted by Helen, 12 May 2010 03:26 GMT

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