Hepatitis C no longer a ‘death sentence’

LIM (third from left) and Yu (far right) served as resource speakers during the recent MSD Asia Pacific Media held in Taiwan. The two were joined by (from left) Dr. Fernando Bognar, MSD Asia-Pacific regional director for medical affairs, and Pedicone. Photo by Charles E. Buban

Because Hepatitis C symptoms often do not manifest themselves until the later stages of the illness, afflicted individuals are not likely to know that they have one, much more see a doctor to check for its presence.

However, by the time these symptoms have manifested, the disease is usually hard to cure if not irreversible.

Hepatitis C is a blood borne virus, mainly transmitted by sharing drug-injecting equipment, using a razor previously used by an infected person, through blood transfusions, or having sex with an infected individual.

Transmission can also occur via nonsterile tattooing and body piercing, unsterile medical or dental procedures, from mother to infant during delivery or exposure to blood or blood product.

Because hepatitis C virus slowly damages the liver—often over the course of several decades—the result may eventually cause permanent scarring of the liver (cirrhosis). People with cirrhosis can go on to develop liver failure or liver cancer.

In fact, hepatitis C is four times more common than the human immunodeficiency virus in the United States and accounts for more than half of all patients with cirrhosis. It is also the most common indication currently for liver transplants, and it is the cause of about a third of primary cancers that arise within the liver in that country.

Only treatment

The only treatment for people with end-stage liver disease is a liver transplant.

“Which is why by the time the person notices that he or she is always fatigued, has recurring fever, feeling nauseated, has yellowing of the skin, whites of the eyes, and body fluids, has poor appetite, suffers from muscle and joint pains, has tenderness in the area of the liver, his or her hepatitis C case might already be too tough to cure if not too late for any cure,” explained Ming-Lung Yu, professor at the Kaohsiung Medical University and deputy secretary general of the Asian Pacific Association for the Study of the Liver.

This is why Yu has advocated for early screening, the best way to fight hepatitis C considering that no vaccine exists to prevent its infection, unlike those for hepatitis A and B.

Education

“Until 1989, the medical profession didn’t have a name for what we now call hepatitis C. But now that the disease is recognized as a leading cause of cirrhosis and liver cancer, we also find that education and awareness are most essential to its effective treatment,” he said.

According to professor Seng Gee Lim of the Singapore National University Hospital, aside from advising the patient not to take any form of alcoholic drink or use illicit drug, reduce weight if he or she is obese, strict control of diabetes and compliance with any other therapies his or her doctor puts in place, there is now the availability of treatment option for those suffering from chronic hepatitis C.

Last year, Merck Sharp & Dohme introduced to the market boceprevir (Victrelis), the first new drug for hepatitis C in 20 years.

New class

“Boceprevir is a new class of hepatitis drug belonging to protease inhibitors, which block a key enzyme required by the hepatitis virus to replicate. With this new drug, we could now regard hepatitis C from a debilitating disease into a manageable condition for the majority of people infected with the virus,” said Dr. Lisa Pedicone, MSD global director of scientific affairs.

The drug, which is approved only for use in conjunction with the current hepatitis C drugs, peginterferon-alpha and ribavirin, was found to nearly double the number of patients who achieved what is known as a sustained virologic response—otherwise known as cure—in patients with new hepatitis C infections.

It tripled the response rate in those for whom prior therapy had failed.

In two clinical trials reported in the New England Journal of Medicine, the combination of boceprevir, peginterferon-alpha and ribavirin produced a sustained virologic suppression in as many as 66 percent of patients, compared with a response of only 38 percent in patients who received only peginterferon-alpha and ribavirin.

Among patients in which previous therapies had failed, the combination produced a 59-percent response in one group and a 66-percent response in a second group, compared with a 21-percent response rate in those who received the current therapy.