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Combination Antiviral Therapy for Hepatitis C

Examples

Peginterferon and ribavirin combinations

Generic Name Brand Name
peginterferon alfa-2a and ribavirin Peginterferon
peginterferon alfa-2b and ribavirin Pegintron/Rebetol Combo Pack

Protease inhibitors

Generic Name Brand Name
boceprevir Victrelis
simeprevir Olysio
telaprevir Incivek

Nucleotide analog inhibitors

Generic Name Brand Name
sofosbuvir Sovaldi

How It Works

Combination antiviral therapy helps prevent the virus that causes hepatitis C from reproducing in the body. Peginterferon and ribavirin often are combined for treatment. A protease inhibitor or a nucleotide analog inhibitor may be given along with peginterferon and ribavirin or with ribavirin alone.

The length of your treatment depends on what hepatitis C genotype you have. Genotypes 1 and 2 generally are treated for 12 weeks, and genotype 3 generally is treated for 12 or 24 weeks. If your viral load does not improve after initial treatment, a different set of medicines may be used.

Why It Is Used

Combination antiviral therapy is prescribed for people who have ongoing (chronic) hepatitis C infection. It may be given to people who have never had treatment or when the first set of medicines has failed to cure the infection.

How Well It Works

How well treatment works is measured by whether you still have the virus in your blood after treatment.

  • Studies have shown that treatment with peginterferon and ribavirin works for up to 50 out of 100 people who have genotype 1 or 4 and up to 80 out of 100 people who have genotype 2 or 3.1
  • Adding boceprevir to peginterferon and ribavirin treatment of people who have hepatitis C (genotype 1 only) worked significantly better than using peginterferon and ribavirin alone.2, 3
  • Adding telaprevir to peginterferon and ribavirin significantly improved hepatitis C treatment in people who had genotype 1.4, 5
  • Adding simeprevir or sofosbuvir to peginterferon and ribavirin significantly improved hepatitis C treatment in people who had genotype 1.6, 7 Using sofosbuvir with only ribavirin was effective for people with genotype 2.7

Combination antiviral therapy is more likely to be effective if you:

  • Have a low level of the hepatitis C virus in your blood when treatment starts.
  • Have a low amount of liver damage when treatment starts.
Click here to view a Decision Point.Hepatitis C: Should I Take Antiviral Medicine?

Side Effects

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

  • Usually the benefits of the medicine are more important than any minor side effects.
  • Side effects may go away after you take the medicine for a while.
  • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call 911 or other emergency services right away if you have:

  • Trouble breathing.
  • Swelling of your face, lips, tongue, or throat.

Call your doctor if you have:

  • Hives.

Common side effects of this medicine include:

  • Fatigue, headache, muscle and joint aches, fever, or chills.
  • Nausea, loss of appetite, or weight loss.
  • Irritability, insomnia, or confusion.
  • Depression.
  • Thyroid problems.
  • Hair loss or skin rash.
  • Low levels of red cells, white cells, and platelets in your blood.

If you develop anemia as a result of taking ribavirin, your doctor may prescribe a medicine called erythropoietin to help your body create more red blood cells.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

You will need regular follow-up visits with a liver specialist during treatment. The specialist will order blood tests to check your liver enzyme levels and to see whether the virus is still present.

Peginterferon and other interferons may be given without ribavirin if you have anemia or heart or kidney problems.

Even if the initial treatment does not eliminate the virus, your doctor may advise you to continue antiviral treatment, because it may reduce liver inflammation. For some people with significant liver damage, antiviral therapy may slow the progression of liver damage or make liver cancer less likely.8, 9 If you already have cirrhosis, some studies show that antiviral therapy can help you live longer.10

Only a few clinical trials have tested antiviral medicines in children. The results suggest that they work about as well in children as in adults. Combination therapy using interferon and ribavirin is now approved by the U.S. Food and Drug Administration for use in children ages 3 to 17 years.

If you are obese or have poorly controlled diabetes, you may need to delay treatment until you get your weight or blood sugar under control.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Pregnancy advice for women and men

If you need to take this medicine, talk to your doctor about how you can prevent pregnancy.

For women: Do not use this medicine if you are pregnant or planning to get pregnant.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Complete the new medication information form (PDF)new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

References

Citations

  1. Pawlotsky JM, McHutchinson J (2012). Chronic viral and autoimmune hepatitis. In L Goldman, A Shafer, eds., Goldman's Cecil Medicine, 24th ed., pp. 973–979. Philadelphia: Saunders.
  2. Poordad F, et al. (2011). Boceprevir for untreated chronic HCV genotype 1 infection. New England Journal of Medicine, 364(13): 1195–1206.
  3. Bacon BR, et al. (2011). Boceprevir for previously treated chronic HCV genotype 1 infection. New England Journal of Medicine, 364(13): 1207–1217.
  4. McHutchison JG, et al. (2009). Telaprevir with peginterferon and ribavirin for chronic HCV genotype 1 infection. New England Journal of Medicine, 360(18): 1827–1838.
  5. McHutchison JG, et al. (2009). Telaprevir and peginterferon with or without ribavirin for chronic HCV infection. New England Journal of Medicine, 360(18): 1839–1850.
  6. Simeprevir (Olysio) for Chronic Hepatitis C (2014). The Medical Letter On Drugs and Therapeutics, 56(1433): 1–2.
  7. Koff RS (2014). Review article: The efficacy and safety of sofosbuvir, a novel, oral nucleotide NS5B polymerase inhibitor, in the treatment of chronic hepatitis C virus infection. Alimentary Pharmacology and Therapeutics, published online January 6, 2014. DOI: 10.1111/apt.12601. Accessed February 12, 2014.
  8. Singal AK, et al. (2010). Antiviral therapy reduces risk of hepatocellular carcinoma in patients with hepatitis C virus-related cirrhosis, Clinical Gastroenterology and Hepatology, 8(2): 192–199.
  9. Morgan RL, et al. (2013). Eradication of hepatitis C virus infection and the development of hepatocellular carcinoma: A meta-analysis of observational studies. Annals of Internal Medicine, 158(5, Part 1): 329–337.
  10. Dienstag JL (2010). Chronic viral hepatitis. In GL Mandell et al., eds., Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 7th ed., vol. 1, pp. 1593–1670. Philadelphia: Churchill Livingstone Elsevier.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer W. Thomas London, MD - Hepatology
Current as of June 4, 2014

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