what is the new treatments for 2013? My husband did the riba/pygs in 06 but didnt beat the dragon. When we went to the doctor before starting treatment he was geno 1b stage 1 grade 1 however, he has not seen a doctor since then ( I worry everyday if his conditions has changed) the only difference I can see is he goes to the bathroom and poops about 3 times a day is that normal? Yellowing in his eyes he seems not to worry about it because he said he was going to wait on a cure well I have been reading up on Hep c and i see where there are people saying they are cured. What is the percentage of slaying to dragon with new meds? Also we have no insurance is there a way we can get help with the new meds? I think after I give him the news of the cure rate I can get him to try the new drugs. Thanks for your help
Welcome to the forum! Your husband should have been having his condition monitored at least once per year to keep track of the functioning of his liver and to keep updated on what treatments are available. Triple drug treatments were approved in May of 2011 that have cured a pretty large percentage of people using them. I finished tx in September of 2012 and was pronounced cured as of March 2013. The triple tx is a fairly difficult one in terms of side effects, but the cure is most definitely worth it.
There are some options for uninsured people to treat too, including community or county clinics for the medical care and the drug manufacturers have programs to provide discounts or even free meds for those who can't afford tx. Options will vary somewhat depending on where you live and what your actual income is. Participation in drug trials (with free treatment) may also be an option. I don't know about frequent bowel movements bring related to hep c, but I'd be very worried about yellowing in his eyes or skin. He needs to get up to date with a good hepatologist ASAP! In the meantime he needs to totally avoid ANY alcohol consumption and to do the usual healthy things: eat well with lots if fresh fruits and veggies, and get regular exercise. Good luck!
The current available FDA approved treatment is Incivek and Victrelis.
You can find out information about these two triple treatments by go to
"hepatitis.va.gov". Also, you can find out about financial assistant on that site and by going to the Incivek.com. I don't know what financial assistance Victrelis offers.
Triple therapy for HCV genotype 1 infection: telaprevir or boceprevir?
Boceprevir and telaprevir are the first two protease inhibitors available for the treatment of patients infected with hepatitis C virus (HCV) genotype 1. A sustained virological response (SVR) of 70–80% is observed when either of these protease inhibitors is utilized with pegylated interferon (PEG-IFN) and ribavirin (RBV) in treatment naïve patients. Both agents are also highly effective in patients who failed to achieve a SVR during previous treatment with PEG-IFN/RBV. A rapid virological response (RVR) is observed in 56–60% of treatment naïve patients. Patients who achieve a RVR can be treated with a shorter course of therapy (24–28 weeks) and still achieve a SVR rate of 90% or higher. Patients who do not achieve a RVR, those with cirrhosis and certain prior non-responders should be treated for 48 weeks. Although the SVR rates observed with boceprevir and telaprevir are quite similar both globally and within sub-populations, the treatment algorithms for the two agents are unique. The decision of which protease inhibitor to use should assess several factors including the treatment scheme, duration of therapy, adverse event profile, cost and the likelihood of achieving a RVR. The latter is highly dependent upon IFN sensitivity and the IL28B genotype.
direct acting antivirals
hepatitis C virus
rapid virological response
standard of care
sustained virological response
Boceprevir and telaprevir were the first two and are currently the only protease inhibitors to be approved by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for the treatment of patients infected with hepatitis C virus (HCV) genotype 1. For the past decade, only 40–45% of these patients achieved a SVR when treated with PEG-IFN/RBV [1-4]. The duration of therapy was for a fixed 48 weeks. In contrast, when either of these two protease inhibitors is added to PEG-IFN/RBV, the SVR rate in treatment naïve patients increases to 70–80% [5-7]. Boceprevir and telaprevir are also highly effective in patients who fail to achieve a SVR during previous treatment with PEG-IFN/RBV [8, 9]. The availability of these two protease inhibitors has therefore revolutionized the treatment of chronic HCV. For the first time, physicians can tell their patients that it is much more likely they will be ‘cured’ of HCV following treatment.
It has been recognized in recent years that the likelihood of achieving a SVR during treatment with PEG-IFN/RBV was directly related to when the patient became HCV RNA undetectable during therapy . Patients with a RVR, who became HCV RNA undetectable within 4 weeks after initiating treatment, had SVR rates in the 85–90% range and several studies strongly suggested that these patients could receive only 24 weeks of PEG-IFN/RBV [11-14]. This observation forms the cornerstone of response guided therapy (RGT) [10, 15, 16]; a concept that was readily incorporated into the treatment schemes developed for boceprevir and telaprevir.
This manuscript will review data from the phase 3 clinical trials performed with boceprevir and telaprevir in the treatment naïve population [5-7] and in patients who previously failed to achieve a SVR with PEG-IFN/RBV [8, 9]. We conclude by discussing issues that may lead to the selection of a specific protease inhibitor. Throughout this discussion, the reader must keep in mind that the phase 2 and 3 clinical trials that led to the approval of boceprevir and telaprevir were each performed against a placebo control (with PEG-IFN/RBV) and that these two protease inhibitors have never been directly compared. It is therefore impossible to conclude that either protease inhibitor is universally superior for the treatment of patients with chronic HCV genotype 1.
Three phase 3 clinical trials led to the approval of telaprevir, PEG-IFN/RBV for the treatment of patients with chronic HCV genotype 1 [6, 7, 9]. The ADVANCE study was a randomized placebo controlled trial designed to compare 8 weeks vs 12 weeks of telaprevir triple therapy (with PEG-IFN/RBV). Patients who achieved a RVR and remained HCV RNA undetectable throughout the first 24 weeks of treatment were referred to as having an extended RVR (eRVR). These patients were treated for a total of 24 weeks: 8 or 12 weeks of telaprevir-based triple therapy followed by an additional 16 or 12 weeks of PEG-IFN/RBV respectively. Patients who failed to achieve an eRVR received a total of 48 weeks of treatment (8 or 12 weeks of telaprevir-based triple therapy followed by 36 weeks of PEG-IFN/RBV). Patients who received 12 weeks of telaprevir had about a 5% higher SVR rate compared to patients who received only 8 weeks whether they achieved an eRVR and received 24 weeks of treatment (89 vs 83%) or they failed to achieve an eRVR and received 48 weeks of treatment (54% vs 50%). The conclusion of ADVANCE was that 12 weeks of telaprevir was superior and preferable to 8 weeks.
The ILLUMINATE study was a randomized controlled trial designed to compare 24 vs 48 weeks of treatment in patients with an eRVR. All patients were treated with telaprevir-based triple therapy for 12 weeks and then continued PEG-IFN/RBV. Patients who achieved an eRVR were randomized to receive a total of 24 weeks of treatment (12 weeks of telaprevir-based triple therapy plus 12 weeks of PEG-IFN/RBV) or a total of 48 weeks of treatment (an additional 36 weeks of PEG-IFN/RBV). The SVR rates in these two groups were identical (92 vs 90% respectively). Patients who did not achieve an eRVR but did become HCV RNA undetectable by treatment week 24 were treated for a total of 48 weeks. The SVR rate in these patients was 64%. The conclusion of ILLUMINATE was that patients with an eRVR should be treated for only 24 weeks. In both ADVANCE and ILLUMINATE, about 60% of patients treated with telaprevir-based triple therapy achieved an eRVR.
The REALIZE study was a randomized, placebo-controlled trial designed to document the impact of telaprevir-based triple therapy in patients who had failed to achieve a SVR during previous treatment with PEG-IFN/RBV and to determine if 4 weeks of lead-in therapy with PEG-IFN/RBV affected SVR. Patients were randomized to receive ether 12 weeks of telaprevir-based triple therapy followed by 36 weeks of PEG-IFN/RBV or 4 weeks of PEG-IFN/RBV lead-in followed by 12 weeks of telaprevir-based triple therapy, followed by an additional 30 weeks of PEG-IFN/RBV. Both groups were treated for a total of 48 weeks. Overall, the SVR rates in patients with prior relapse, partial response and non-response were 86, 58 and 32% respectively. No significant difference in SVR was apparent between the two treatment arms in any of the three non-responder categories. The conclusion of REALIZE was that 4 weeks of a PEG-IFN/RBV lead-in prior to adding telaprevir did not influence SVR.
The most common adverse events in patients who received telaprevir-based triple therapy compared to PEG-IFN/RBV in these phase 3 clinical trials included anaemia, nausea, diarrhoea, anal-rectal discomfort, rash and pruritus. The average decline in haemoglobin during telaprevir-based triple therapy was approximately 1 g/dl more than that observed with PEG-IFN/RBV; and nearly 40% of patients had a decline in haemoglobin to below 10 g/dl. Over half the patients receiving telaprevir developed a rash and once this occurred it generally worsened over time. In most cases, this was mild-moderate in severity and could be managed symptomatically. Severe rash requiring premature discontinuation of telaprevir occurred in 7% of patients.
The recommended treatment paradigm for telaprevir is illustrated in Fig. 1. Telaprevir is initiated along with PEG-IFN/RBV for the first 12 weeks of treatment. Patients then continue PEG-IFN/RBV for a total of either 24 or 48 weeks based upon the concepts of RGT [14, 15]. Patients who are treatment naïve or with prior relapse to PEG-IFN/RBV can be treated for only 24 weeks if they achieve eRVR. These patients achieve SVR rates that exceed 90%. In contrast, patients who become HCV RNA undetectable after week 4 should be treated for a total of 48 weeks (12 weeks of telaprevir-based triple therapy and 36 weeks of PEG-IFN/RBV). These patients achieve SVR rates of about 64%. It is recommended that all patients with cirrhosis also be treated for 48 weeks. Treatment should be discontinued in any patient with an HCV RNA level of >1000 IU/ml at treatment weeks 4 or 12 and any detectable HCV RNA at treatment week 24.
Two phase 3 clinical trials led to the approval of boceprevir, PEG-IFN/RBV for the treatment of patients with chronic HCV genotype 1 [5, 8]. The SPRINT-2 study was a randomized placebo-controlled trial performed in treatment naïve patients and designed to compare RGT to a fixed 48 weeks of treatment. Patients randomized to the 48 week treatment arm received a 4 week lead-in with PEG-IFN/RBV followed by 44 weeks of boceprevir-based triple therapy (48 weeks of total treatment). Patients randomized to the RGT arm received the 4 week PEG-IFN/RBV lead-in followed by 24 weeks of boceprevir-based triple therapy. Patients who achieved RVR (HCV RNA undetectable 4 weeks after the addition of boceprevir; 8 weeks after the start of treatment) and remained HCV RNA undetectable through week 24 received a total of 28 weeks of treatment (4 weeks of PEG-IFN/RBV and 24 weeks of boceprevir-based triple therapy). Patients who became HCV RNA undetectable more than 4 weeks after the addition of boceprevir and before treatment week 24 received an additional 20 weeks of PEG-IFN/RBV for a total treatment duration of 48 weeks (4 weeks of PEG-IFN/RBV, 24 weeks of boceprevir triple therapy and 20 weeks of PEG-IFN/RBV). The SVR rate achieved with the RGT approach was identical to that observed in patients who received 48 weeks of therapy (70 vs 71%). Patients who achieved a RVR had SVR rates of 96% with 28 weeks of total treatment. Patients who did not achieve a RVR but became HCV RNA undetectable after treatment week 8 (4 weeks after the start of boceprevir) had SVR rates of about 70% when treated for 48 weeks. The conclusion of SPRINT-2 was that the duration of HCV treatment should be determined according to the principles of RGT. Approximately 60% of patients achieved a RVR and could be treated for the shorter duration.
The RESPOND-2 study was a randomized placebo-controlled trial conducted in patients with a prior partial virological response or relapse to PEG-IFN/RBV. The study was designed to document the SVR rate with boceprevir triple therapy retreatment and like SPRINT-2 to compare RGT to a fixed 48 weeks of treatment. Although patients with documented prior non-response were not enrolled in this study a significant proportion of the patients had less than a 1 log10 decline in HCV RNA during the 4 week lead-in and thus behaved biologically as non-responders. Patients were randomized to receive either 48 weeks of treatment (4 weeks PEG-IFN/RBV lead-in and 44 weeks of boceprevir-based triple therapy) or RGT. Patients randomized to the RGT arm received the 4-week PEG-IFN/RBV lead-in followed by 32 weeks of boceprevir-based triple therapy. Patients who achieved RVR (HCV RNA undetectable 4 weeks after the addition of boceprevir; 8 weeks after the start of treatment) and remained HCV RNA undetectable through week 24 received a total of 36 weeks of boceprevir-based triple therapy (4 weeks of PEG-IFN/RBV and 32 weeks of boceprevir-based triple therapy). Patients who became HCV RNA undetectable more than 4 weeks after the addition of boceprevir and before treatment week 24 received an additional 12 weeks of PEG-IFN/RBV for a total treatment duration of 48 weeks (4 weeks of PEG-IFN/RBV, 32 weeks of boceprevir triple therapy and 12 weeks of PEG-IFN/RBV).
The SVR rate in patients with prior relapse was 72%. Patients who were sensitive to interferon and had more than a 1 log10 decline in HCV RNA during the 4 week lead-in had an SVR rate of 76%. Patients who were insensitive to interferon and had less than a 1 log10 decline in HCV RNA during the 4 week lead-in had a SVR of 32%. No significant differences in SVR rates were evident between a fixed 48 week treatment and the RGT approach. Patients who achieved RVR (HCV RNA undetectable 4 weeks after the addition of boceprevir) had SVR rates of 88% with the shorter duration of therapy. Patients who did not achieve RVR but became HCV RNA undetectable after treatment week 8 (4 weeks after the start of boceprevir) had SVR rates of about 75% when treated for 48 weeks. The conclusion of RESPOND-2 was that the duration of HCV treatment should be determined by the principles of RGT even in patients with prior non-response to PEG-IFN/RBV.
The most common adverse events in patients who received boceprevir-based triple therapy compared to PEG-IFN/RBV in these phase 3 clinical trials included anaemia and dysgusea. The average decline in haemoglobin during treatment with boceprevir-based triple therapy was approximately 1 g/dl greater than that observed with PEG-IFN/RBV; nearly half had a decline in haemoglobin to below 10 g/dl. Although 43% of patients in these two phase 3 clinical studies received epoetin alfa to treat anaemia, no significant difference in SVR rates was observed between patients who received epotin alfa and those patients whose anaemia was managed by ribavirin dose reduction.
The recommended treatment paradigm for boceprevir is illustrated in Fig. 2. Boceprevir is initiated after 4 weeks of lead-in therapy with PEG-IFN/RBV. After the 4 week lead-in, patients are treated with boceprevir triple therapy. Patients who are HCV RNA undetectable at treatment week 8 (an RVR 4 weeks after adding boceprevir) and remain HCV RNA undetectable at treatment weeks 12 and 24 can be treated for a total of 28 weeks (4 weeks of PEG-IFN/RBV lead-in and 24 weeks of boceprevir-based triple therapy). These patients have SVR rates which exceed 90%. In contrast, patients who become HCV RNA undetectable more than 4 weeks after the addition of boceprevir (after treatment week 8) should be treated for a total of 48 weeks. This consists of 4 weeks of PEG-IFN/RBV lead-in, 32 weeks of boceprevir triple therapy and another 12 weeks of PEG-IFN/RBV. These patients achieve SVR rates of about 70%. It is recommended that patients who are interferon resistant (less than a 1 log10 decline in HCV RNA during the lead-in), prior non-responders and patients with cirrhosis receive 44 weeks of boceprevir-based triple therapy following the 4 week PEG-IFN/RBV lead-in. Treatment should be discontinued in patients with an HCV RNA level of >100 IU/ml at treatment week 12 and any detectable HCV RNA at treatment weeks 24.
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I am genotype 1 w/stage 4 cirrohsis and did 16 mos of Pegasus/ ribivarin and lost the fight late in tx. I have been waiting, while being monitored, for 2&1/2 yrs for something my Dr could get excited about. I knew it was coming soon and got a call in Nov. about a new treatment by Bristol Myers Squibb that is interferon free. The drugs are Daclatasvir, Asunaprevir and BMS 7025 or something close. These three are a one pill combination that have been tried overseas with great result 75-85% svr. They have just brought it to the east coast and are introducing Ribivarin along with the 3 part. It is a 12 wk tx and only in clinical trials at this point. My advice is to get your husband back in the system so your Drs can keep you current and image your husbands liver every 6 mos. The imaging is crucial to monitor liver function and overall health of the liver. This trial I am in begins Wed. Jan 15 ,2014 and will compensate for mileage and misc. expenses. Gilead Pharm. has hit a home run with their SBV tx but at $1000 a pill for 84 days and Geno 1 may include interferon.makes it tough for many. I hope this helps and your husband will consider getting back in the system for his and your good. Good luck!!
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