What Medications are Used to Treat Hepatitis C?

Recent advances in the number and types of medications available to treat Hepatitis C give you and your doctor more options to consider when deciding on a treatment plan.  For some people with a particular strain or genotype of HCV, these advances make the treatment regimen shorter in duration, less difficult to tolerate and more effective.

What follows is a general outline of the main indications for each drug approved by the U.S. Food and Drug Administration (FDA) to treat Hepatitis C.  Use this information as a starting point to talk with your healthcare provider about developing an individualized treatment plan that best suits your specific circumstances.

Until a few years ago, there were only two drugs approved by the FDA for treating Hepatitis C. These are:

  • Pegylated interferon: Interferon is similar to a protein your body makes to fight off infection. Pegylated interferon is a long acting form of interferon. It can be used alone, but is almost always used with ribavirin.
  • Ribavirin: This is used only in combination with interferon. It can never be used alone to treat Hepatitis C.

Combination therapy with pegylated interferon and ribavirin – often referred to as PEG/riba therapy – increases the chances of getting rid of the virus from your body.

In May 2011, the FDA approved two new medications that are part of a drug group called protease inhibitors.  They are:

  • Boceprevir (brand name Victrelis)
  • Telaprevir (brand name Incivek)

These drugs directly attack the Hepatitis C virus to stop it from growing and are sometimes referred to as direct-acting antivirals (DAAs).  The protease inhibitors are approved to be used in people with HCV genotypye 1 in combination with PEG/riba therapy.  They cannot be used alone; using PEG/riba plus one of the protease inhibitors is called triple therapy.

In November 2013, the FDA approved the first once-daily protease inhibitor called:

  • Simeprevir (brand name Olysio)

It too must be used in combination with PEG/riba therapy and is considered a first line therapy over the older protease inhibitors, shortening treatment duration and increasing cure rates.

Simeprevir is active against HCV subtypes 1a and 1b, but it does not work well for people with 1a and something called a Q80 K polymorphism, a strain commonly found in the United States.  Talk to your doctor about screening for genotype 1a Q80K before beginning therapy with simeprevir and discuss using an alternative therapy if the strain is detected.

In December 2013, the FDA approved a new medication that is a part of a drug group called polymerase inhibitors.  It works by blocking a specific protein the Hepatitis C virus needs to grow.  It is called:

  • Sofosbuvir (brand name Sovaldi)

Sofosbuvir, a once-daily pill, is approved to treat HCV genotypes 1, 2, 3 and 4.  It cannot be used alone; it must be used as part of a combination antiviral treatment regimen.  Depending on the strain of HCV infection you have, your treatment regimen could include:

  • Sofosbuvir, ribavirin and peg-interferon: Genotypes 1 and 4
  • Sofosbuvir and ribavirin: Genotypes 2 and 3

This is the first drug that will allow some people (genotypes 2 and 3) to be treated with pills only, eliminating the need for weekly injections of interferon.  In addition, many people with genotype 1, 2 or 4 will be eligible for a shorter 12-week course of therapy (versus 24 weeks).

A longer course of sofosbuvir and ribavirin can be considered for those people who:

  • Cannot tolerate or take an interferon-based treatment
  • Are awaiting liver transplantation, including those with liver cancer, to prevent HCV recurrence

It’s a very exciting and hopeful time for people with HCV as treatment is rapidly changing for the better.  There are currently many new drugs in the pipeline with several of them expected to come to market within the next year or two.  We are seeing increasing cure rates, shorter treatment regimens and anticipate an all-oral regimen for most people sometime in 2015.