Hepatitis C Treatments on the Horizon

In October, the FDA approved a drug that can cure hepatitis C quicker than ever before — and with fewer side effects. Plus, more effective drugs are on the horizon.

“A number of companies are trying to develop other drugs with greater ease of administration and cost,” says Thomas D. Boyer, MD. He’s the director of the Liver Research Institute at the University of Arizona Medical Center in Tucson.

The latest drug to be approved, Harvoni (ledipasvir and sofosbuvir), is a once-a-day pill that can cure hepatitis C in eight, 12, or 24 weeks (depending on the individual) with mild side effects. Before Harvoni was approved, most people with hepatitis C needed interferon, a drug that you inject once a week, combined with pills. This wasn’t an ideal treatment: People don’t like to inject themselves, and interferon has serious side effects, like fever, nausea, and depression. Today, most hepatitis C patients can take Harvoni instead of interferon.

“It’s a very exciting time for hepatitis C treatment,” says Jonathan M. Fenkel, MD, director of the Hepatitis C Center at Thomas Jefferson University Hospital in Philadelphia. “Harvoni is an excellent drug with a high cure rate and very few side effects. It’s one pill a day, which for most patients is very easy to take.”

Within the next year, the FDA should approve three or four drugs that can cure hepatitis C by mouth, not needle. And even more are expected in the next 2 years. Like Harvoni, all will combine two or more types of medicine in each pill.

“It’s a cocktail therapy – a number of drugs that target different viral proteins,” says virologist Stephen J. Polyak, PhD. He’s a research professor in the department of laboratory medicine at the University of Washington in Seattle. “The harder that you can hit a virus and knock it down, hit it in multiple places, the more you can keep it suppressed.”

Because the hepatitis C virus can mutate, one type of medicine can’t cure the disease on its own — two or more are needed.

“They all attack the virus in different sites,” Boyer says. “You can’t give a single drug for hepatitis C; it will just mutate and become resistant.”

The old, standard hepatitis C treatment (interferon plus pills) wasn’t cheap, but Harvoni costs even more, about $100,000 per person. Right now, insurance companies only approve Harvoni for the sickest patients. Doctors think the price will come down as newer drugs are approved.

“The hope is that as more drugs come out, the competition will drive the price down,” Fenkel says. “The big challenge is getting this treatment for everyone. Most patients can’t afford it out of pocket.”

Researchers won’t stop the search for new ways to treat hepatitis C. Their goal: Drugs that cure the disease in shorter time-frames with fewer side effects.

“If we can cure this disease in 4 weeks instead of 8 or 12 with one pill a day, that would be great,” Fenkel says.

So far, hepatitis C drugs target the virus itself, but research is under way to create new drugs that target the cells that host the virus.

“There are two ways to prevent a virus from growing: You target the virus or target the cell,” Polyak says. “Hepatitis C is capable of mutating, which can lead to resistance to drugs that target the virus. In theory, development of drug-resistant viruses is less of an issue with drugs that target the cell.”

There are different types of hepatitis C. In the U.S., most people have a type called genotype 1, but some people have genotype 2 or 3. The drugs on the market today can only target one genotype at a time. Future drugs will likely be able to cure all hepatitis C genotypes.

“We’ll try to find one pill for every hepatitis C patient,” says Norah A. Terrault, MD, director of the Viral Hepatitis Center at the University of California, San Francisco. “One drug cocktail for a broader array of patients.”

Within the next 5 to 10 years, researchers could create a vaccine for hepatitis C. A vaccine could help wipe out the disease, when combined with drugs. The drugs would cure people with the disease, and a vaccine would prevent more people from getting sick.

“This is an active area of research,” Polyak says. “No infectious disease has been globally eradicated by drug treatments alone – you need a vaccine for that.”