Home survival veterans prisoners new_drugs hcv_handout dr_cecil_cv hbv_info pegIntron cirrhosis pegasys resources infergen maint-inf Who has HCV?

 

email Dr. Cecil

 

I am excited about HCV protease inhibitors which are orally active drugs with great strength.  VX-950

from Vertex Pharmaceuticals  has been named telaprevir, and it drops the viral level by about 99.9% in

a week or two. The viral level then is about the same, and resistance comes into play. It has to be taken by

mouth every 8 hours without fail, which makes patient compliance a problem. When telaprevir is combined

with Pegasys plus ribavirin, it dropped the HCV-RNA to undetectable in 12 of 12 genotype one patients in 28

days. Phase 2 studies are underway and a big phase 3 study will start in 2008. I expect it will be a

big help in previously untreated genotype one patients, and could double success. The standard treatment

may fall from one year to only  6 months for genotype one patients.  I  hope it is tested alone without

interferon or ribavirin in patients with sarcoidosis, liver failure, ITP and others who cannot take

 interferon. It is possible that reducing the HCV-RNA by 3 or 4 logs will reduce liver damage even

without cure, but that must be proven. 


Oral drugs for HCV are being developed by pharmaceutical companies.  The hope is that oral drugs will

control  HCV without using interferon.  They would be taken by  mouth and will be similar to the drugs

taken for HIV or HBV. Those proven safe and effective would allow us to avoid the side effects and risks of

interferon based therapy. I do not think that these new drugs will cure HCV if not combined with interferon,

but  I expect they will control it. When combined with interferon plus ribavirin they will shorten treatment

 duration and will increase the number cured. HCV protease inhibitors and other oral drugs will be the

third major advance in treating HCV.  First was interferon approved in 1992, second was ribavirin approved

in 1998 and HCV protease inhibitors is number 3. Pegylated interferons were approved in 2001-2 and are

 convenient, but are not as big of a help as ribavirin. With strong protease inhibitors, we will cure many

 more patients.


If you are interested in participating in a clinical trial to test new drugs go to Clinical trials and

Center Watch.   Put "HCV" in the search field. It will tell you what clinical trials are available in the US.