Module 6: Treatment options - section 7

In this document:

Potential new treatments

Activity: Presentation and large group discussion
Section Time: Approximately 10 minutes

This brief section is used to conclude this module on treatment options and used to make participants aware that there is continuing development of new HCV medicines.

Initiate this activity by stating how standard combination drug treatment of pegylated interferon and ribavirin has been a qualified success. However, while it is a definite improvement on previous treatment approximately 50% of those treated (depending on genotype) still do not clear the virus.  Additionally, as will be explored in Module 7, the side effects for some people can be debilitating and sometimes intolerable and are the cause of a number of people stopping treatment. It is also expensive. There is an urgent need for more effective and better tolerated treatments.

Using Slide 6.24 (Potential new treatments) summarise the potential for new treatments:


Supporting content:

The standard combination drug treatment of pegylated interferon and ribavirin has been a qualified success and whilst it is a definite improvement on previous treatment approximately 50% of those treated (depending on genotype) still do not clear the virus. Side effects for some people can be debilitating and cause treatment drop –out. There is an urgent need for more effective and better tolerated treatments. This is particularly the case for the growing number of people for whom treatment has not been successful and for those with a lower chance of achieving SVR.

However, although Interferon is the therapeutic backbone of HCV treatment, it is also a major barrier to HCV treatment access, uptake, and completion because of prohibitive costs, medical contraindications and debilitating side effects. Fortunately, scientific advances are leading to the development of dozens of new HCV treatment drugs. More than 20 experimental HCV agents are currently in the pipeline at pharmaceutical companies worldwide. This means the compounds have at least been created with the goal of eradicating HCV or mitigating its effects and are currently undergoing, or being readied to undergo, clinical tests.

At present research into new HCV treatments is predominantly focused on three approaches:

1. Treatments that target the virus: There are two main areas of research in this field: Drugs or therapies that try and block particular proteins on the virus. The other area of research is drugs that try to interfere with the genetic structure of the virus. The main emphasis has been on targeting particular stages in the life cycle of the virus to stop it being able to replicate and include direct-acting antiviral drugs (DAA). Protease or polymerase inhibitors are designed to stop the virus from being able to replicate by interfering with specific viral proteins and two HCV protease inhibitors, boceprevir and telaprevir, are in the late stages of development and expected to be approved by U.S. Food and Drug Administration (FDA) for use in HCV treatment in 2011.

2. Treatments that boost the human immune response to HCV: These are known as immunomodulatory treatments. Interferon based therapies have shown that that HCV infection can be cleared by stimulating the immune response to the virus. Various drugs are being trialled aimed at boosting the immune response. There is also research into making a therapeutic vaccine, which, in theory, will also bolster the immune response. Therapeutic vaccines are a new approach to vaccines. They are designed to treat people who are already infected with HCV. A preventive or prophylactic vaccine against hepatitis C is also being researched, though a viable preventive vaccine is probably many years away.

3. Modifications to interferon based treatments: There are numerous trials taking place studying different treatment regimes for peg-interferon/ribavirin such as variations in dosage and length of treatment.

Whilst there is a lot of promise that there will be new treatments for HCV and that it may be possible to replace interferon treatment with a combination of specific oral drugs in the near future, these drugs are still currently in development. Peg-interferon/ribavirin is likely to continue to be the mainstay of treatment for some time, particularly as the DAA treatments closest to being licensed will be used in combination with interferon and ribavirin. So, alongside the search for new treatments improving the effectiveness and tolerability of interferon-based treatments will continue to be a vital area of research.

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