Game changer: Hepatitis C drug may revolutionize treatment

The drug boceprevir helps cure hard-to-treat hepatitis C, says Saint Louis University investigator Bruce R. Bacon, M.D., author of the March 31 New England Journal of Medicine article detailing the study's findings. The results, which were first reported at the 61st annual meeting of the American Association for the Study of Liver Disease's last November, offer a brighter outlook for patients who have not responded to standard treatment.

Bacon, who is professor of internal medicine at Saint Louis University School of Medicine and co-principal investigator of the HCV RESPOND-2 study, studied the protease inhibitor boceprevir and found that it significantly increased the number of patients whose blood had undetectable levels of the virus.

"These findings are especially significant for patients who don't respond to initial treatment," said Bacon. "When the hepatitis C virus is not eliminated, debilitating fatigue and more serious problems can follow."

Hepatitis C is caused by a virus that is transmitted by contact with blood. The infection may initially be asymptomatic, but for patients who develop chronic hepatitis C infection, inflammation of the liver may develop, leading to fibrosis and cirrhosis (scarring of the liver), as well as other complications including liver cancer and death.

The prognosis varies for patients with chronic hepatitis C. With the current standard therapy, about half fully recover after an initial course of peginterferon and ribavirin anti-viral therapy that may last from six months to a year.

The remaining patients, known as non-responders, may improve with initial treatment but the virus is not eliminated, or may not respond to treatment at all. For this group, the only current option is to re-treat patients with the same or similar drugs, which increases the likelihood of severe treatment side-effects. In addition, researchers have found that the success of treatment depends on the major strain, or genotype, of hepatitis C that a patient has.

The HCV RESPOND-2 study looked at 403 patients with chronic hepatitis C infections with genotype one, the most difficult strain of the virus to treat, who still had significant levels of the virus after being treated with peginterferon and ribavirin, the standard hepatitis C treatment.

"These results are very exciting," Bacon said. "In this study, boceprevir helped cure significantly more patients in 36 weeks of therapy than did treatment with peginterferon and ribavirin alone."

A second study, HCV SPRINT-2, examined patients with hepatitis C with genotype one who had not yet been treated with the standard treatment. They, too, responded well to the drug.

Bacon calls the progress made in treating hepatitis C remarkable.

"We've gone from the discovery of the virus in 1989 to where we are now, 22 years later, when we have the ability to cure a large majority of those with hepatitis C," Bacon said. "It's a true success story."