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Overview of treatment

Up until 2012, the most effective pharmaceutical treatment for hepatitis C consisted of taking two drugs, pegylated Interferon and Ribavirin. This is known as dual or combination therapy. In trials, it has been shown to be effective in 55% of cases .

Effective means that the hepatitis C virus was no longer detectable in blood 6 months after treatment ended (known as a sustained virological response or SVR).

Interferon and ribavirin

55% is an overall figure. The SVR was over 45% for people with genotype 1 and around 80% for those with genotype 2 or 3.

Treatment regimes for patients with genotype 1 and 4 are generally 48 weeks; Treatment regimes for patients with genotype 2 and 3 are generally 24 weeks

At the beginning of 2012 NICE approved two new drugs for the treatment of hepatitis C – Telaprivir and Boceprivir also known as Incivo and Victrelis. It is important to remember that these new drugs are taken WITH the old drugs - Interferon and Ribavirin. They are also only for those with Genotype 1.

They are now available on the NHS if your clinician decides they are appropriate and you want this treatment .

These drugs are known as ‘protease inhibitors’ and are prescribed for patients with genotype 1 only. In trials they have proved effective in around 70% of cases. They are taken in conjunction with pegylated interferon and ribavirin. This is known as triple or combination therapy. These treatment regimes are usually 48 weeks but may be shortened in a significant number of patients who have a very rapid response.

The majority – but not all - patients undergoing hepatitis C treatments experience side effects. These may include weight loss, headaches, joint pains, sleeplessness and fatigue. Before you begin treatment a specialist nurse will explain all the possible side effects in detail and provide advice as to how to minimise their effect.

Treatment has also been shown to reduce both inflammation and fibrosis. This even happens in patients who do not have an SVR, although only in about half the number of cases. Even in cases of cirrhosis, which until recently was believed to be irreversible, there is evidence that it can sometimes be reversed through treatment .

The decision as to whether a person with mild chronic hepatitis C should be treated immediately or should wait until the disease has reached a moderate stage (watchful waiting) should be made by the patient after fully informed consultation with the responsible clinician. This consultation is all the more important given that around 30 new and improved hepatitis C drugs are in trial phase at present and will be available to patients over the next five years.

We also recommend you contact The Hepatitis C Trust’s helpline (0845 223 4424 or 020 7089 6221) so that you can listen to a patient perspective, which may not always be the same as that of a clinician.

You may be refused treatment for medical reasons. Telaprevir, Boceprevir, Interferon and Ribavirin are all powerful drugs that can have important side effects. This means one or more drugs may be unsuitable for some people.