Impressive new oral therapies are now available to combat hepatitis C infections, a growing problem for the baby boomer generation.
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New oral medications will hit the market over the next 12 to 24 months to join a growing list of available therapies. In some cases, taking once-a-day pills for as little as eight weeks will be enough to cure patients with the virus, with minimal side effects.
“The amount of progress in a single generation is absolutely phenomenal,” says William Carey, MD, Director of the Hepatology (Liver) Center in the Department of Gastroenterology at Cleveland Clinic.
He says the development of oral medications is a big leap forward from current interferon injection treatments, which cause severe side effects, including depression, nausea, and lethargy.
Infection trends show progress
Hepatitis C is transmitted through infected blood from sharing needles to inject drugs or accidental needle sticks. Before 1992, people also could become infected from blood transfusions and organ transplants. Then widespread screening of the blood supply began in the United States.
Of all the people currently infected with hepatitis C in the U.S., about two-thirds are baby boomers.
“Most people infected with hepatitis C have no symptoms, or very mild ones,” Dr. Carey says.
This is why the U.S. Centers for Disease Control recommends that baby boomers born between 1945 and 1966 get screened.
Dr. Carey says patients who learn they have the infection are often very anxious, but he stresses that great strides have been made in treatment.
“Patients ask, ‘Am I going to give it to somebody else? What about my partner? What about my kids?’ These are common concerns,” he says.
“I spend the first 30 minutes with patients trying to bring them down from the notion that hep C is a death sentence. Making sure the rhetoric doesn’t get spun up too high is a very important step. Treatment has become so much better.”
The cure rate has spiked to more than 90 percent, and the overall rate of infections has fallen dramatically since the 1980s — from about 200,000 per year to only 25,000 today.
While all this is good news, Dr. Carey says, “We also need to keep in mind that 25,000 new cases is not a small number, and the effects of this infection can show up years later.”
Serious liver problems
A risk associated with hepatitis C is that people may develop cirrhosis of the liver, or a scarred liver. This happens to one out of every five people infected with hepatitis C and is the most common reason they come forward needing a liver transplant.
It’s also one of the most common reasons people get primary liver cancer.
“The rate of liver cancer in the United States is going up fairly dramatically, related to all those hep C infections people acquired in the ‘70s and ‘80s,” Dr. Carey says.
Treatment progress ‘phenomenal’
Dr. Carey was one of the authors of a New England Journal of Medicine study in the 1980s that led to the use of interferon injections in the first place.
“The amount of progress in a single generation is absolutely phenomenal,” he says. “The basis for most therapy involves the use of injections of interferon that have all kinds of side effects.”
That’s where the oral therapy comes in: In November and December 2013, the FDA approved two drugs that can be used with oral therapy for certain types of Hep C — including Genotype 1, the most common type in the U.S.
Studies published in January in the New England Journal of Medicine showed promise for yet another pill combination that had a 90 percent plus cure rate for Genotype 1. And those pills could, in addition, be combined into a single pill.
“We expect all oral therapy will become the norm over the next 12 or 24 months,” Dr. Carey says.
Effective, but expensive
The drug combination is not inexpensive, he says. “They’re highly effective, and they’re relatively free of side effects,” he says.
“But few people can afford them unless they have insurance that covers medications. As more of these highly effective oral drugs come to market, the large cost hurdle that currently exists may become less of a barrier.”