In the fight against Hepatitis C, there has been some very exciting new developments. I receive daily news updates about all of the activities going on in pharma/biotech in the field, including several [expensive] acquisitions by big pharma just to have access to the new Hepatitis C drugs in development. There are several new classes of therapies that either just were approved or should in the next few years that are considered direct acting antivirals. As usual, it is incredible frustrating that these new drugs *in theory* would benefit my father, however the timing could not be worse as he needed those therapies a few years ago and now it's too late--well, sort of.
Interferon and ribavirin first came-out in the 1990s as a Hepatitis C combination treatment. These drugs have seen various updates over the past 20 years, however they really all mean the same thing to Dad: they have ~25% shot of reducing his viral load while giving tremendous side effects. These side effects include feeling like you have the flu every single day and be so depressed that they even named the type of depression after one of the drugs: "Riba Rage". (Note: I am not sure if the Riba Rage is really from the ribavirin or the interferon, but in any case, it's a side effect of the drug combo) Don't YOU want to sign-up to take that every day for 6-12 months?
Dad actually tried the interferon-ribavirin combination a long time ago (in the 1990s), however it didn't seem to be doing much other than make him miserable. His viral count didn't seem to go down even though he certainly had flu-like symptoms every single day. The problem comes down to his type of Hepatitis C virus, or genotype. Hep C virus (HCV) is actually a range of viruses that are similar enough to be classified as HCV. The breakdown of HCV goes to genotypes, then subtypes, and finally quasi species, however I'll keep this at the level of genotype. There are 11 HCV genotypes, not-so-creatively named genotypes 1-11. For those curious about HCV types (particularly the scientists out there), here is some information from the World Health Organization (WHO). One quote from that WHO link:
Last year, 2 new drugs came to the market: both targeting genotype 1 (Dad's HCV genotype) using a new approach: protease inhibitors. Correction: this type of target is new for treating HCV, it actually has been used for over 16 years targeting HIV, yet the first HCV protease inhibitors were just approved less than 12 months ago. These 2 new drugs are boceprevir or Victrelis by Merck and telaprevir or Incivek by Vertex:
What this means today for Dad?
Well, in theory, nothing, since his cirrhosis is so advanced that he is not a candidate for the new combination therapy (protease inhibitor + ribavirin + interferon). Advanced liver diseased patients are at high risk for taking these medications--any of them. In fact, Dad's physician at UCLA not only refused to treat him when I asked a few times over the past 2 years (even off-label), he also told Dad in October that he has had 3 patients in Dad's condition die while taking the new anti-HCV drug combo. Yikes.
BUT--what happened on Day 2 in Indianapolis? Dad started taking a revised version of the anti viral therapy including one of the new protease inhibitors. It has been an incredibly challenging situation made worse by not only the fear of dying from taking these drugs while having such advanced liver disease, but also suffering severe, daily side effects. The side effects alone are worthy of a separate post.
There is actually some good news, though. So far, Dad's viral load has been below detection since the first week after he began treatment. That means that for the 7 weeks that his blood has been tested, the amount of virus in his system was too low to measure. Does it mean the virus is completely gone? No--not necessarily. Does it mean the virus won't come back? Not for sure. However, to go through the utter hell he's gone through the past 7+ weeks of anti-viral treatment with advanced cirrhosis to have the chance at potentially being Hepatitis C free is pretty amazing. In the meantime, I am trying to ignore the fact that all of the medications that just came to market or will be approved in the next few years could have prevented Dad's liver from becoming cirrhotic in the first place several years ago.
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| Viral life cycle and direct acting antiviral targets. http://hepatitiscnewdrugs.blogspot.com/2012/01/direct-acting-antivirals-for-treatment.html |
Hepatitis C has been identified for a couple of decades now with plenty of research done towards a cure, however the drugs that came-out in the 1990s were not very effective and came with a lot of side effects as I briefly mention in one of my first posts.
Interferon and ribavirin first came-out in the 1990s as a Hepatitis C combination treatment. These drugs have seen various updates over the past 20 years, however they really all mean the same thing to Dad: they have ~25% shot of reducing his viral load while giving tremendous side effects. These side effects include feeling like you have the flu every single day and be so depressed that they even named the type of depression after one of the drugs: "Riba Rage". (Note: I am not sure if the Riba Rage is really from the ribavirin or the interferon, but in any case, it's a side effect of the drug combo) Don't YOU want to sign-up to take that every day for 6-12 months?
Dad actually tried the interferon-ribavirin combination a long time ago (in the 1990s), however it didn't seem to be doing much other than make him miserable. His viral count didn't seem to go down even though he certainly had flu-like symptoms every single day. The problem comes down to his type of Hepatitis C virus, or genotype. Hep C virus (HCV) is actually a range of viruses that are similar enough to be classified as HCV. The breakdown of HCV goes to genotypes, then subtypes, and finally quasi species, however I'll keep this at the level of genotype. There are 11 HCV genotypes, not-so-creatively named genotypes 1-11. For those curious about HCV types (particularly the scientists out there), here is some information from the World Health Organization (WHO). One quote from that WHO link:
HCV is highly heterogeneous. Eleven HCV genotypes with several distinct subtypes have been identified throughout the world. These diversities have distinct consequences: although different strains have not been shown to differ dramatically in their virulence or pathogenicity, different genotypes vary in their responsiveness to interferon/ribavirin combination therapy. Moreover, such heterogeneity hinders the development of vaccines, since vaccine antigens from multiple serotypes will probably be necessary for global protectionThe only treatment option available for HCV-infected patients until last year has been interferon-ribavirin and it only helps ~25% with Dad's genotype: genotype 1. That is why he didn't seem to respond to the combination interferon-ribavirin therapy in the 1990s--he has the wrong genotype.
Last year, 2 new drugs came to the market: both targeting genotype 1 (Dad's HCV genotype) using a new approach: protease inhibitors. Correction: this type of target is new for treating HCV, it actually has been used for over 16 years targeting HIV, yet the first HCV protease inhibitors were just approved less than 12 months ago. These 2 new drugs are boceprevir or Victrelis by Merck and telaprevir or Incivek by Vertex:
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| http://www.scielo.br/scielo.php?pid=S1413-86702011000600002&script=sci_arttext |
Well, in theory, nothing, since his cirrhosis is so advanced that he is not a candidate for the new combination therapy (protease inhibitor + ribavirin + interferon). Advanced liver diseased patients are at high risk for taking these medications--any of them. In fact, Dad's physician at UCLA not only refused to treat him when I asked a few times over the past 2 years (even off-label), he also told Dad in October that he has had 3 patients in Dad's condition die while taking the new anti-HCV drug combo. Yikes.
BUT--what happened on Day 2 in Indianapolis? Dad started taking a revised version of the anti viral therapy including one of the new protease inhibitors. It has been an incredibly challenging situation made worse by not only the fear of dying from taking these drugs while having such advanced liver disease, but also suffering severe, daily side effects. The side effects alone are worthy of a separate post.
There is actually some good news, though. So far, Dad's viral load has been below detection since the first week after he began treatment. That means that for the 7 weeks that his blood has been tested, the amount of virus in his system was too low to measure. Does it mean the virus is completely gone? No--not necessarily. Does it mean the virus won't come back? Not for sure. However, to go through the utter hell he's gone through the past 7+ weeks of anti-viral treatment with advanced cirrhosis to have the chance at potentially being Hepatitis C free is pretty amazing. In the meantime, I am trying to ignore the fact that all of the medications that just came to market or will be approved in the next few years could have prevented Dad's liver from becoming cirrhotic in the first place several years ago.
My Mazel.
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