High cure rates for hepatitis C much likelier with new drugs

Cure rates for hepatitis C appear to be climbing significantly among JGH patients, following the introduction of a new and greatly improved generation of medications, says Dr. Nir Hilzenrat, a JGH gastroenterologist. However, Dr. Hilzenrat notes that despite a success rate of 95 per cent, it’s still too early to make conclusive statements about the results, because patients began receiving the latest drugs only in the early months of 2014.

“Nevertheless, the prospects for the future look very good,” says Dr. Hilzenrat, an expert in treating hepatitis C. “Not only is it easier to administer the medications, but treating sicker patients is now possible. Since the new drugs enable the liver to regenerate, they can be used in advanced cases, and in many instances, this allows patients to avoid a liver transplant.”

According to Dr. Hilzenrat, approximately 1 per cent of the Canadian population has hepatitis C, a virus that is passed through the blood in poorly performed transfusions or sharing of needles among intravenous drug users. Once infected, a patient can develop various diseases, notably cirrhosis of the liver. Approximately 85 per cent of hepatitis C patients will develop a life-long chronic disease, if the virus is not eradicated in its early stages.

Cure rates in treating hepatitis C leaped ahead from about 6 to 60 per cent between the early 1990s and the early 2000s. However, the medications often had severe side effects, such as anemia and depression, which had to be managed by healthcare teams.

This prompted the development of a drug, known as an NS3 inhibiter, which attacks the protein responsible for activating other proteins that enable the hepatitis C virus to replicate (make copies of itself). Introduction of the NS3 inhibiter in 2010 raised the success rate to 80 per cent, but many side-effects remained, forcing patients to take additional medications.

More recently, Dr. Hilzenrat says, the JGH has had great success with Simeprevir, which is taken once a day and has fewer side-effects, but still requires the patient to take other drugs. Even better is Sofosbuvir, which has a success rate of at least 95 per cent, but costs $1,000 per daily pill, because of its expensive research and development.

The JGH is currently awaiting approval of a combination of medications that affects different sites of the virus’ replication process, but produces minimal side effects and promises a high success rate in eradicating virus. At the moment, this drug is still part of a clinical trial that began last winter, with Health Canada agreeing to let it be given to a single JGH patient. “The results look very promising,” says Dr. Hilzenrat, “and we definitely seem to be heading in the right direction.”

With its recently acquired Fibroscan Unit, the JGH Liver Disease Clinic—the most active in Quebec, with over 4,500 patient visits per year—is now better equipped to address the rising incidence of fatty-liver disease and the dramatic growth in treating hepatitis B and C.

This ultrasound-based, diagnostic tool provides a quicker, safer, painless and non-invasive alternative to liver biopsy for evaluating the stage of liver fibrosis (scarring), an essential part of treating liver disease. It enables the clinic’s physicians to identify patients who have or are at risk of advanced fibrosis, thus allowing timely intervention before the development of cirrhosis.

In addition, the Fibroscan dramatically improves the availability of crucial data during decision-making, while allowing the clinic to treat more patients. Acquisition of this tool was made possible, thanks to generous contributions by individual donors, as well as the proceeds from the JGH Auxiliary’s 2013 Fall Fair and Raffle.