Hepatitis C Treatment Options

Interferon is a genetically engineered product originally licensed in 1986 to treat hairy cell leukemia. It is a copy of a protein found naturally in low levels in the human body. It was OK'd by (US) FDA Feb. 25, 1991, to treat hepatitis C. The product, alpha interferon, is the first effective treatment against this form of hepatitis, which affects an estimated 150,000 Americans each year.

Besides hairy cell leukemia and hepatitis C, alpha interferon is licensed for treatment of AIDS-related Kaposi's sarcoma and genital warts. Schering-Plough Corporation of Kenilworth, N.J., which markets a version of the product under the trade name Intron-A, received approval for the product's use for hepatitis.

Interferon has been approved for chronic HCV. Patients are selected for therapy on the basis of persistently abnormal liver function (blood) tests, rather than on the presence or absence of symptoms. It's not known what should be done for patients with mild chronic HCV infection; since some patients with mild disease can go on to develop cirrhosis, a trial of therapy with interferon is usually recommended. It's recommended that such patients be referred to specialists with knowledge in liver disease (gastroenterologist/hepatologists). -- "Prevention, Diagnosis, and Management of Viral Hepatitis", AMA

About half of patients treated with interferon respond, with better blood tests and better liver biopsies. Half the patients who respond relapse once the interferon is stopped. -- "Prevention, Diagnosis, and Management of Viral Hepatitis", AMA

Alpha interferon seems to work better the sooner it is used after infection. However, in many cases of hepatitis C the symptoms get worse again when the treatment is stopped. In one study, half of the chronic hepatitis C sufferers who had responded to alpha interferon had a relapse within six months after treatment stopped. Thus only 25 percent of HCV patients respond favorably without relapsing.

The average six months of injections three times a week are expensive ($75 a week). Many patients also suffer side effects, such as flulike symptoms, a reduction in the number of disease fighting white blood cells, and a decreased number of platelets in the blood. (Platelets are needed for blood clotting.)

Factors most closely associated with response to IFN are:

  1. absence of fibrosis or cirrhosis in the pretreatment liver biopsy

  2. HCV genotype other than 1

  3. lower RNA levels in the blood (e.g., less than 2 million/ml)

  4. shorter duration of infection (which often isn't known)

So what about those patients who either don't respond to Interferon, or relapse? Doctors and scientists are now beginning to experiment with combination therapies. Combining INF with other drugs, such as anti-virals, are showing promising results in trial studies.

For more information about the combinations, such as Ribaviron,click here

Patients with chronic hepatitis B or C, with fluid in the abdomen (ascites), bleeding from dilated veins in the esophagus (variceal bleeding), or mental confusion (encephalopathy) should be treated only in a clinical trial. Others not suitable for treatment are those with symptomatic heart, lung or kidney disease, with human immunodeficiency virus (HIV) infection or organ transplant recipients on prednisone, cyclosporine and FK-506 and patients on antidepressants or with a history of suicide attempts. Interferon should not be given to women considering pregnancy, nor to the intended father. Patients with active substance abuse (alcohol or illegal drugs) should not be offered this therapy. - "Interferon Treatment for Hepatitis B and C Fact Sheet", American Liver Foundation

For more information concerning Interferon, Click here

For information concerning Alternative and Herbal therapies, Click here

To read my personal experiences while taking Interferon Click here

This is an excerpt from a 1994 "Drug Information for the health care professional"

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