The most effective pharmaceutical treatment for hepatitis C consists of taking two drugs, pegylated interferon and ribavirin, and is known as dual or combination therapy. In trials, it has been shown to be effective in 55% of cases. Effective here means that the hepatitis C virus was no longer detectable in blood 6 months after treatment ended (known as a sustained virological response or SVR). 55% is an overall figure: the SVR was something over 40% for people with genotype 1 (the latest trials are now producing figures of 50% for genotype 1) and around 80% for those with genotype 2 or 3.
In addition, treatment has been shown in trials to reduce both inflammation and fibrosis. This even happens in patients who do not have an SVR, although only in about half the number of cases. Even in cases of cirrhosis, which until recently was believed to be irreversible, there is evidence that it can be reversed through treatment.
The first treatment for hepatitis C was standard (alpha) interferon. It was used by itself initially and had a very limited effect. Then, in combination with ribavirin, the response rate improved significantly. However, the problem with standard interferon is that the body breaks it down too quickly, making it difficult to keep a consistent amount of the drug in the system. This led to the development of new pegylated interferons, which break down much more slowly and are consequently more effective.
In England and Wales the National Institute for Clinical Excellence (NICE) decides which drugs the NHS should use. In January 2004 NICE ruled that treatment should be pegylated interferon and ribavirin for all genotypes and that it should be available for everyone with moderate to severe liver disease or significant symptoms. New guidelines published in August 2006 for patients with mild to moderate disease state that:-
People with mild chronic hepatitis should also be offered combination therapy with peginterferon alpha and ribavirin within the licensed indications of these drugs.
People with mild chronic hepatitis who are unable to tolerate ribavirin, or for whom ribavirin is contraindicated, should be offered peginterferon alpha monotherapy.
The decision as to whether a person with mild chronic hepatitis C should be treated immediately or should wait until the disease has reached a moderate stage (watchful waiting) should be made by the patient after fully informed consultation with the responsible clinician.
You may be refused pegylated interferon and ribavirin for medical reasons. These are powerful drugs that can have important side effects. This means one or both drugs may be unsuitable for some people. If you cannot tolerate ribavirin, you may be offered interferon by itself, known as monotherapy (ribavirin by itself is not effective against hepatitis C).
