Adding Third Drug May Improve Hepatitis C Treatment

The current two-drug standard treatment for the potentially lethal hepatitis C could be rendered nearly twice as effective if doctors added in a third antiviral medication called boceprevir, new research suggests. The finding might help the estimated 170 million people worldwide who are infected with this particular type of hepatitis C (genotype 1), the study authors say, given that the liver infection is difficult to treat. The study, funded by Merck, the maker of boceprevir, was reported online Aug. 8 in The Lancet. According to the researchers, led by Dr. Paul Y. Kwo of Indiana University School of Medicine in Indianapolis, the standard two-drug treatment of pegylated interferon plus ribavirin prompts the desired virological response in less than half of patients.

Searching for a way to improve these outcomes, the Indiana team launched a two-phase trial involving 520 hepatitis C patients in 67 sites across the United States, Canada and Europe. Patients received one of several drug cocktails of various strengths for upwards of 48 weeks. Some of the drug combinations included boceprevir, while some did not. Irrespective of other factors including attempts to reduce the length of treatment or the amount of standard medications given to patients adding boceprevir to the mix appeared to consistently boost viral response, Kwo and his colleagues reported.

However, the effectiveness of the three-drug regimen was undercut somewhat when the team lowered the amount of ribavirin the patients received. In a news release from the journal, the team concluded that, "boceprevir, in combination with pegylated interferon and ribavirin, achieves high (virological response) rates with 28 weeks of therapy in most patients, and is safe and effective for use up to 48 weeks in the few patients who benefit from longer duration of therapy." They also noted "increased response rates in difficult-to-treat groups, including black participants and those with cirrhosis."

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