In the United States alone, there are up to 3.9 million people living with chronic hepatitis C. Another 75 to 85 percent of people with acute hepatitis C eventually develop chronic hepatitis C during their lifetime. Those who will develop this disease may take some comfort in knowing that today’s hepatitis C treatments differ extremely from what was available when it was first discovered in 1989.
Here’s an overview of the past, present, and future treatments for hepatitis C, starting where it all began.
The early 1990s
The first treatment for hepatitis C came in the 1980s, by way of a series of protein-based injections called recombinant interferon-alfa (IFNa). Interferons are naturally occurring proteins in the body; recombinant IFNa is the protein-based generic drug that works to mobilize the body’s natural immune system to fight disease.
When used alone, response rates for IFNa were relatively low, helping only one-third of those with hepatitis C, and the relapse rate was very high.
Those taking IFNa also reported side effects such as:
- hair loss
- severe depression
- gum disease
- nausea or vomiting
- suicidal thoughts
- liver damage
In the end, only 6 to 16 percent of the population was effectively treated with IFNa, so other combination treatments for hepatitis C were sought.
The late 1990s
In 1995, scientists discovered that if you mixed the injectable IFNa with the antiviral drug ribavirin (RBV), results improved. For instance, hepatitis C patients saw a long-term, disease-free success rate of 33 to 41 percent. Doctors still don’t know a lot about how RBV works to combat hepatitis C, but RBV is still used today.
Still, RBV has been known to cause side effects, such as:
- thyroid issues
The early 2000s
In 2002, a breakthrough treatment came by way of pegylated interferon alpha (PegINFa). Comparatively, INFa was the bathwater to PegINFa’s jet-powered Jacuzzi. In trials, PegINFa had a higher permanent response rate than INFas (39 percent), which became even higher when PegINFa was combined with RBV (54 to 56 percent).
PegINFa also needed to be injected fewer times than INFa to be successful, which lessened side effects.
Researchers began homing in on treatments that were specific to hepatitis C itself in 2011. The results were two protease inhibitors (PIs) called boceprevir (Victrelis) and telaprevir (Incivek). With precision, these drugs directly targeted hepatitis C and worked to stop the virus from spreading. Adding RBV and PegINFa to PIs increased their effectiveness even more, with recovery rates jumping between 68 to 84 percent depending on the type of hepatitis C being treated.
The only problem? For many people, the side effects and negative interactions with other drugs outweighed the benefits.
Some of the more serious side effects were:
- Stevens-Johnson Syndrome (SJS)
- exfoliative dermatitis
- birth defects
- lowered white blood cell counts
- rectal pain
Both drugs were discontinued, and newer, less harmful PIs were formulated.
2014 and 2015
In 2014 and 2015, hepatitis C genotype-specific drugs were created that could target particular types of hepatitis C. These included:
- Sofosbuvir/ledipasvir (Harvoni). This antiviral pill fights hepatitis C genotypes 1 and 3 at different stages during its life cycle by blocking proteins that cause the virus. Because it’s interferon- and RBV-free, the side effects are much milder.
- Ombitasvir/paritaprevir/ritonavir (Viekira Pak). This combination medication is also interferon-free and doesn’t need an RBV to work. In clinical trials, it had a 97 percent cure rate for people with hepatitis C genotype 1.
- Daclatasvir (Daklinza). An antiviral drug meant to treat hepatitis C genotype 3, this drug is considered the first non-combination drug treatment to safely and efficiently work without requiring an interferon or RBV.
In 2016, sofosbuvir/velpatasvir (Epclusa) was developed as the first drug therapy to treat all hepatitis C genotypes in tablet form. The side effects are considered low (headache and fatigue). The cure rate is as high as 98 percent in those without severe liver scarring (cirrhosis) and 86 percent in those with cirrhosis.
In July 2017, sofosbuvir/velpatasvir/voxilaprevir (Vosevi) was approved by the U.S. Food and Drug Administration (FDA) to treat chronic hepatitis C of all genotypes. This fixed-dose combination pill prohibits the development of the specific protein NS5A. In recent research, this troublesome protein has been associated with growth and progression of hepatitis C. In its earliest drug trials, this combination drug had a 96 to 97 percent cure rate, and hopes are high for it today.
Most recently, glecaprevir/pibrentasvir (Mavyret) was approved in August 2017. This treatment is for adults with chronic hepatitis C genotypes 1 through 6, and treatment duration can be as little as eight weeks. Results from early trials showed that 92 to 100 percent had no evidence of infection after treatment.
When it comes to hepatitis C, the future is looking bright. Regardless of your genotype, there are now more treatment options than ever. More exciting is the possibility that eventually most genotypes of hepatitis C will be 100 percent curable.