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New Treatment Combo Better Against Hepatitis C


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"We managed to cure significantly more patients by adding telaprevir to standard care," McHutchison said. "We cured 50 percent more patients, and we also reduced the duration of treatment from 48 weeks to 24 weeks."

Among patients taking all three drugs, 67 percent were cured compared with 41 percent of patients receiving standard treatment, the Duke researchers found.

McHutchison noted that side effects of pegylated interferon and ribavirin can include flu-like symptoms, depression, fatigue, insomnia and anemia, but adding telaprevir significantly reduces exposure to these drugs, which in turn makes the treatment easier to complete. Twenty-one percent of patients receiving telaprevir did drop out, with rash being the most common reason why.

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In addition, 7 percent of the patients developed resistance to telaprevir. "There is an upside and a downside," McHutchison said. "The treatment's shorter, we cure more people, but unfortunately, there are more people who are discontinuing."

There is a phase 3 trial under way, McHutchison said. "If all goes well, this combination could be available in 2011," he said.

"The future looks very bright for people with HCV. Instead of being able to cure less than half of them, we can now, hopefully when these drugs are approved, say to any patient with genotype 1 hepatitis C, we've got a two-out-of-three chance of curing them," McHutchison said.

Dr. Eugene Schiff, chief of the division of hepatology at the University of Miami School of Medicine, thinks these studies are the first step in a major change in HCV treatment.

"Telaprevir represents the type of antiviral therapy for hepatitis C we will see in the future," Schiff said. "In the future, what you are going to see is a mixture of antivirals and my own prediction is you won't see it with interferon and ribavirin," he said.

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Last updated 4/29/2009

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SOURCES: John G. McHutchison, M.D., Duke University Medical Center, Durham, N.C.; Jean-Michel Pawlotsky, M.D., Ph.D., Henri Mondor Hospital, University of Paris, France; Eugene Schiff, M.D., chief, division of hepatology, University of Miami School of Medicine; April 30, 2009, New England Journal of Medicine


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