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Treatments for Chronic Hepatitis C

Treatment List for Chronic Hepatitis C

The list of treatments mentioned in various sources for Chronic Hepatitis C includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

  • Alpha interferon
  • Combination alpha interferon and ribavirin
  • Hepatitis C is rarely diagnosed in its acute phase and treatment is usually aimed at management of the chronic infection. Treatments include:
    • Avoidance of alcohol and medications that may worsen hepatic function, or rely on the liver for metabolism
    • Antiviral therapy - Ribavirin - usually used in conjunction with interferon
    • Interferon
    • Liver transplantation - used in selected patients for acute fulminant liver failure and end stage disease not responding to other therapy

Chronic Hepatitis C: Is the Diagnosis Correct?

The first step in getting correct treatment is to get a correct diagnosis. Differential diagnosis list for Chronic Hepatitis C may include:

Chronic Hepatitis C: Marketplace Products, Discounts & Offers

Products, offers and promotion categories available for Chronic Hepatitis C:

Chronic Hepatitis C: Research Doctors & Specialists

Research all specialists including ratings, affiliations, and sanctions.

Drugs and Medications used to treat Chronic Hepatitis C:

Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment or change in treatment plans.

Some of the different medications used in the treatment of Chronic Hepatitis C include:

  • Interferon Alfa-2a
  • Roferon-A
  • Interferon alfa-2b and Ribavirin Combination pack
  • Rebetron
  • Interferon Alfacon-1
  • Infergen
  • Peginterferon Alfa-2a
  • Pegasys
  • Peginterferon Alfa-2b
  • PEG-Intron
  • Peginterferon Alfa-2b and Ribavirin - used as part of a combination therapy
  • Pegetron - used as part of a combination therapy
  • Ribavirin - used as part of a combination therapy
  • Copegus - used as part of a combination therapy
  • Rebetol - used as part of a combination therapy
  • Ribasphere - used as part of a combination therapy
  • Virazide - used as part of a combination therapy

Latest treatments for Chronic Hepatitis C:

The following are some of the latest treatments for Chronic Hepatitis C:

Hospital statistics for Chronic Hepatitis C:

These medical statistics relate to hospitals, hospitalization and Chronic Hepatitis C:

  • 0.007% (903) of hospital consultant episodes were for chronic hepatitis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 88% of hospital consultant episodes for chronic hepatitis required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 35% of hospital consultant episodes for chronic hepatitis were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • 65% of hospital consultant episodes for chronic hepatitis were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
  • more hospital information...»

Hospitals & Medical Clinics: Chronic Hepatitis C

Research quality ratings and patient incidents/safety measures for hospitals and medical facilities in specialties related to Chronic Hepatitis C:

Hospital & Clinic quality ratings »

Choosing the Best Treatment Hospital: More general information, not necessarily in relation to Chronic Hepatitis C, on hospital and medical facility performance and surgical care quality:

Discussion of treatments for Chronic Hepatitis C:

In the United States, two different regimens have been approved as therapy for hepatitis C:

  • Monotherapy with alpha interferon

  • Combination therapy with alpha interferon and ribavirin.

Combination therapy consistently yields higher rates of sustained response than monotherapy. Combination treatment is more expensive and is associated with more side effects than monotherapy, but, in most situations, it is preferable. At present, interferon monotherapy should be reserved for patients who have contraindications to the use of ribavirin.

Several forms of alpha interferon are available (alfa-2a, alfa-2b, and consensus interferon). These interferons are given subcutaneously three times weekly in doses of 3 million units (MU) or, in the case of consensus interferon, 9 g per injection. Ribavirin, in contrast, is an oral antiviral agent that is given twice a day in 200-mg capsules for a total daily dose of 1,000 mg for patients who weigh less than 75 kilograms (165 pounds) or 1,200 mg for those who weigh more than 75 kilograms.

Treatment with interferon alone or combination therapy with interferon and ribavirin leads to rapid improvements in serum ALT levels in 50 to 75 percent of patients and the disappearance of detectable HCV RNA from the serum in 30 to 50 percent. However, a long-term improvement in liver disease usually occurs only if HCV RNA disappears during therapy and stays undetectable when therapy is stopped.

A response is considered to be "sustained" if HCV RNA remains undetectable for 6 months or more after therapy stops. With interferon monotherapy, 30 to 35 percent of patients become HCV RNA negative with treatment, but almost half of these relapse when treatment stops: The sustained response rate, therefore, averages only 15 to 20 percent. Combination therapy with interferon and ribavirin, however, leads to loss of HCV RNA on treatment in 50 to 55 percent of patients and a sustained loss in 35 to 45 percent. Thus, combination treatment results in both a higher rate of loss of HCV RNA on treatment and a lower rate of relapse when treatment is stopped.

The optimal duration of treatment varies depending on whether interferon monotherapy or combination therapy is used, as well as by HCV genotype. For patients treated with interferon monotherapy, a 48-week course is recommended, regardless of genotype. For patients treated with combination therapy, the optimal duration of treatment depends on viral genotype. Patients with genotypes 2 and 3 have a high rate of response to combination treatment (60 to 70 percent), and a 24-week course of combination therapy yields results equivalent to those of a 48-week course. In contrast, patients with genotype 1 have a lower rate of response to combination therapy (25 to 35 percent), and a 48-week course yields a significantly better sustained response rate. Again, because of the variable responses to treatment, testing for HCV genotype is clinically useful when using combination therapy.

Who Should Be Treated?

Patients with anti-HCV, HCV RNA, elevated serum aminotransferase levels, and evidence of chronic hepatitis on liver biopsy, and with no contraindications, should be offered therapy with the combination of alpha interferon and ribavirin. The National Institutes of Health Consensus Development Conference Panel recommended that therapy for hepatitis C be limited to those patients who have histological evidence of progressive disease. Thus, the panel recommended that all patients with fibrosis or moderate to severe degrees of inflammation and necrosis on liver biopsy should be treated and that patients with less severe histological disease be managed on an individual basis. Patient selection should not be based on the presence or absence of symptoms, the mode of acquisition, the genotype of HCV RNA, or serum HCV RNA levels.

Patients with cirrhosis found through liver biopsy can be offered therapy if they do not have signs of decompensation, such as ascites, persistent jaundice, wasting, variceal hemorrhage, or hepatic encephalopathy. However, interferon and combination therapy have not been shown to improve survival or the ultimate outcome in patients with preexisting cirrhosis.

Patients older than 60 years also should be managed on an individual basis, since the benefit of treatment in these patients has not been well documented and side effects appear to be worse in older patients.

The role of interferon therapy in children with hepatitis C remains uncertain. Ribavirin has yet to be evaluated adequately in children, and pediatric doses and safety have not been established. Thus, if children with hepatitis C are treated, monotherapy is recommended, and ribavirin should not be used outside of controlled clinical trials.

In people with both HCV and HIV infection, benefits of therapy for hepatitis C have only recently been evaluated. The decision to treat people co-infected with HIV must take into consideration the concurrent medications and medical conditions. If CD4 counts are normal or minimally abnormal (> 400/mL), responses are similar in frequency to those in patients who are not infected with HIV. The efficacy of combination therapy in HIV-infected people has been tested in only a small number of patients. Ribavirin may still have significant interactions with other antiretroviral drugs.

In many of these indefinite situations, the indications for therapy should be reassessed at regular intervals. In view of the rapid developments in hepatitis C today, better therapies may become available within the next few years, at which point expanded indications for therapy would be appropriate.

In patients with clinically significant extrahepatic manifestations, such as cryoglobulinemia and glomerulonephritis, therapy with alpha interferon can result in remission of the clinical symptoms and signs. However, relapse after stopping therapy is common. In some patients, continual, long-term alpha interferon therapy can be used despite persistence of HCV RNA in serum if clinical symptoms and signs resolve on therapy.

Who Should Not Be Treated?

Therapy is inadvisable outside of controlled trials for patients who have

  • Clinically decompensated cirrhosis because of hepatitis C.

  • Normal aminotransferase levels.

  • A kidney, liver, heart, or other solid-organ transplant.

  • Specific contraindications to either monotherapy or combination therapy.

Contraindications to alpha interferon therapy include severe depression or other neuropsychiatric syndromes, active substance or alcohol abuse, autoimmune disease (such as rheumatoid arthritis, lupus erythematosus, or psoriasis) that is not well controlled, bone marrow compromise, and inability to practice birth control. Contraindications to ribavirin and thus combination therapy include marked anemia, renal dysfunction, and coronary artery or cerebrovascular disease, and, again, inability to practice birth control.

Alpha interferon has multiple neuropsychiatric effects. Prolonged therapy can cause marked irritability, anxiety, personality changes, depression, and even suicide or acute psychosis. Patients particularly susceptible to these side effects are those with preexisting serious psychiatric conditions and patients with neurological disease.

Strict abstinence from alcohol is recommended during therapy with interferon. Interferon therapy can be associated with relapse in people with a previous history of drug or alcohol abuse. Therefore, alpha interferon should be given with caution to a patient who has only recently stopped alcohol or substance abuse. Typically a 6-month abstinence is recommended before starting therapy. Patients with continuing problems of alcohol or substance abuse should only be treated in collaboration with alcohol or substance abuse specialists or councilors. Patients can be successfully treated while on methadone.

Alpha interferon therapy can induce autoantibodies, and a 6- to 12-month course triggers an autoimmune condition in about 2 percent of patients, particularly if they have an underlying susceptibility to autoimmunity (high titers of antinuclear or antithyroid antibodies, for instance). Exacerbation of a known autoimmune disease (such as rheumatoid arthritis or psoriasis) occurs commonly during interferon therapy.

Alpha interferon has bone marrow suppressive effects. Therefore, patients with bone marrow compromise or cytopenias, such as low platelet count (< 75,000 cells/mm3) or neutropenia (< 1,000 cells/mm3) should be treated cautiously and with frequent monitoring of cell counts.

Ribavirin causes red cell hemolysis to a variable degree in almost all patients. Therefore, patients with a preexisting hemolysis or anemia (hemoglobin < 11 g or hematocrit < 33 percent) should not receive ribavirin. Similarly, patients who have significant coronary or cerebral vascular disease should not receive ribavirin, as the anemia caused by treatment can trigger significant ischemia. Fatal myocardial infarctions and strokes have been reported during combination therapy with alpha interferon and ribavirin.

Ribavirin is excreted largely by the kidneys. Patients with renal disease can develop hemolysis that is severe and even life-threatening. Patients who have elevations in serum creatinine above 2.0 mg/dL should not be treated with ribavirin.

Finally, ribavirin causes birth defects in animal studies and should not be used in women who are not practicing adequate means of birth control. Alpha interferon also should not be used in pregnant women as it has direct antigrowth and antiproliferative effects.

Combination therapy should therefore be used with caution. Patients should be fully informed of the potential side effects before starting therapy.

Side Effects of Treatment

Common side effects of alpha interferon (occurring in more than 10 percent of patients) include

  • Fatigue

  • Muscle aches

  • Headaches

  • Nausea and vomiting

  • Skin irritation at the injection site

  • Low-grade fever

  • Weight loss

  • Irritability

  • Depression

  • Mild bone marrow suppression

  • Hair loss (reversible).

Most of these side effects are mild to moderate in severity and can be managed. They are worse during the first few weeks of treatment, especially with the first injection. Thereafter, side effects diminish. Acetaminophen may be helpful for the muscle aches and low-grade fever, and side effects may be less troublesome if interferon is taken in the evening. Fatigue and depression are occasionally so troublesome that the dose of interferon should be decreased or therapy stopped early. Depression and personality changes can occur on interferon therapy and be quite subtle and not readily admitted by the patient. These side effects need careful monitoring.

Ribavirin also causes side effects, and the combination is generally less well tolerated than interferon monotherapy. The most common side effects of ribavirin are

  • Anemia

  • Fatigue and irritability

  • Itching

  • Skin rash

  • Nasal stuffiness, sinusitis, and cough.

Ribavirin causes a dose-related hemolysis of red cells; with combination therapy, hemoglobin usually decreases by 2 to 3 g/dL and the hematocrit by 5 to 10 percent. The amount of decrease in hemoglobin is highly variable. The decrease starts between weeks 1 and 4 of therapy and can be precipitous. Some patients develop symptoms of anemia, including fatigue, shortness of breath, palpitations, and headache.

The sudden drop in hemoglobin can precipitate angina pectoris in susceptible people, and fatalities from acute myocardial infarction and stroke have been reported in patients receiving combination therapy for hepatitis C. For these important reasons, ribavirin should not be used in patients with preexisting anemia or with significant coronary or cerebral vascular disease. If such patients require therapy for hepatitis C, they should receive alpha interferon monotherapy.

Ribavirin has also been found to cause itching and nasal stuffiness. These are histamine-like side effects; they occur in 10 to 20 percent of patients and are usually mild to moderate in severity. In some patients, however, sinusitis, recurrent bronchitis, or asthma-like symptoms become prominent. It is important that these symptoms be recognized as attributable to ribavirin, because dose modification (by 200 mg per day) or early discontinuation of treatment may be necessary.

Uncommon side effects of alpha interferon and combination therapy (occurring in less than 2 percent of patients) include

  • Autoimmune disease (especially thyroid disease)

  • Severe bacterial infections

  • Marked thrombocytopenia

  • Marked neutropenia

  • Seizures

  • Depression and suicidal ideation or attempts

  • Retinopathy (microhemorrhages)

  • Hearing loss and tinnitus.

Rare side effects include acute congestive heart failure, renal failure, vision loss, pulmonary fibrosis or pneumonitis, and sepsis. Deaths have been reported from acute myocardial infarction, stroke, suicide, and sepsis.

A unique but rare side effect is paradoxical worsening of the disease. This is assumed to be caused by induction of autoimmune hepatitis, but its cause is really unknown. Because of this possibility, aminotransferases should be monitored. If ALT levels rise to greater than twice the baseline values, therapy should be stopped and the patient monitored. Some patients with this complication have required corticosteroid therapy to control the hepatitis.

Options for Patients Who Do Not Respond to Treatment

Few options exist for patients who either do not respond to therapy or who respond and later relapse. Patients who relapse after a course of interferon monotherapy may respond to a 24-week course of combination therapy, particularly if they became and remained HCV RNA negative during the period of monotherapy. Another approach is the use of long-term or continual interferon, which is feasible only if the interferon is well tolerated and has a clear-cut effect on serum aminotransferases and liver histology, despite lack of clearance of HCV RNA. New medications and approaches to treatment are needed. Most promising for the immediate future are newer forms of "long-acting" interferons, which are alpha interferons that are modified by polyethylene glycol (PEG) so that they can be given once a week and yet provide a sustained level of interferon. These "pegylated" formulations may avoid the peaks and troughs of interferon levels and interferon side effects that occur when it is given three times a week. Pegylated interferons and other experimental drugs such as recombinant interleukin 10 (IL-10), are now being evaluated in prospective controlled trials. Other promising approaches are the use of other cytokines and the development of newer antivirals, such as RNA polymerase, helicase, or protease inhibitors. (Source: excerpt from Chronic Hepatitis C Current Disease Management: NIDDK)

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