A rich pipeline of anticipated new drugs to treat hepatitis C is motivating one clinician to delay treatment in select patients who have chronic disease and can safely defer treatment.
According to Dr. Norah Terrault, director of the Viral Hepatitis Center at the University of California, San Francisco, two new protease inhibitors — boceprevir and telaprevir — are expected to be approved as add-on therapy for hepatitis C sometime in the first quarter of 2011, to be used in combination with pegylated interferon and ribavirin.
At a recent conference, Dr. Terrault discussed the pros and cons of treating vs. delaying treatment of hepatitis C in patients co-infected with HIV. The co-infected patients whose hepatitis C she generally treats without delay include any with genotypes 2 or 3 (because all the new drugs are being developed primarily for genotype 1), patients with low levels of hepatitis C RNA regardless of genotype (because they’re the most likely to achieve a sustained viral response to therapy), patients with advanced fibrosis (because “they can’t wait for new treatments”), and patients with acute (not chronic) hepatitis C who are on stable antiretroviral therapy with no opportunistic infections and CD4 counts above 200 cells per cubic millimeter.
For all other co-infected patients, “it’s a matter of weighing the risks and benefits of treating now versus later,” she said. For example, hepatitis C tends to progress faster in the presence of HIV, which could argue for earlier treatment, but the new regimens should offer a better chance of response, if the patient can wait. Toxicity with today’s hepatitis C drugs is a bigger burden for patients with HIV than those without HIV, but the new drug combinations will be even harder to tolerate.
It’s only in the past year that she’s begun deferring treatment for hepatitis C, she said, and the main reason is that better treatments are “just around the corner.”
Dr. Terrault has received research support from Schering-Plough Corporation (boceprevir) and Vertex Pharmaceuticals Incorporated (telaprevir) as well as numerous other pharmaceutical manufacturers.