What drugs are used for hepatitis C?

Until 2014, primarily interferon and drugs that inhibit the replication of the virus were used to treat hepatitis C. Most of the time, interferon-α was given in combination with ribavirin.

New drugs that attack the virus directly have been approved since 2015. NS5-A inhibitors (Ledipasvir, daclatasvir, ombitasvir), NS5-B inhibitors (Sofosbuvir, Dasabuvir), NS3A / NS4A inhibitors (Simeprevir, paritravir) and combinations of NS5A / 5B inhibitors or so-called multi-inhibitors against NS3, NS5A / NS4A, NS3A are drugs that directly attack the hepatitis C virus. These agents ensure that the hepatitis virus can no longer produce the proteins it needs. This means that the virus can no longer multiply. In some cases, ribavirin tablets must also be given. Ribavirin is a drug that also prevents the hepatitis C viruses from multiplying. The new drugs for hepatitis C have a good chance of success and fewer side effects than interferon therapy. The choice of drug depends, among other things, on the type of infection, acute or chronic, on the previous treatment and on the liver and kidney function.

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Read more on the topic: Liver disease

You can choose from standard therapeutic agents such as interferon-α and ribavirin or newer, direct antiviral drugs such as hepatitis C virus protease inhibitors with the ending -previr, hepatitis C virus polymerase inhibitors ending in -buvir and hepatitis C virus NS5A inhibitors with the suffix -asvir .

interferon

Interferon is a cytokine, that is, a naturally occurring protein in the human body that controls the immune response. Our body cells produce interferon in viral and neoplastic infections. Diseases. Different cell types produce three different types of interferons. Interferons can also be genetically engineered and used to treat various diseases.

Before 2011, interferon in combination with the agent ribavirin was the standard therapy for hepatitis C. Interferon-α was used for the therapy. The duration of treatment with interferon and ribavirin ranged from 24 to 48 weeks, depending on the genotype of the hepatitis C virus. This therapy led to a healing of the disease in 80% of those affected, so that no components of the hepatitis C virus could be detected any more. A major disadvantage of therapy with interferon was the frequency of side effects. More than half of those treated described flu-like symptoms.

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Side effect of interferon

Therapy with interferon often causes side effects. The most common side effects include flu-like symptoms such as fever, chills, tiredness, fatigue, muscle pain, joint pain, headache, nausea, diarrhea and increased sweating. A deficiency in white blood cells and blood calcium can result. Often there is also anemia, a lack of blood platelets, cardiac arrhythmias, blue discoloration of the skin, dry mouth and taste disturbance, weight loss and water retention in the tissue (Edema formation). Occasionally there is a mineral deficiency and depression, anxiety, confusion, nervousness, memory and sleep disorders can occur. Visual disturbances, dizziness, high blood pressure, psoriasis, itching and an increased excretion of protein and cells in the urine as well as an increase in liver values ​​in the blood can occur. Side effects such as pneumonia, herpes infection, autoimmune diseases, thyroid dysfunction, temporary erectile dysfunction, liver inflammation, heart attack and other serious illnesses rarely occur.

Chances of success

Genetically engineered interferon has an antiviral effect in the case of hepatitis C virus infection, as the active ingredient makes the body's own cells more resistant to virus infection and activates special scavenger cells of the immune system in such a way that the viruses can be switched off and virus-infected cells destroyed.

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In combination with ribavirin, the therapy led to a cure in around 80% of those infected by 2011.

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Ribavirin

Rivavirin is a drug that is used to treat certain viral infections, a so-called Antiviral. In chronic hepatitis C, ribavirin is given in combination with interferon-α in order to prevent the hepatitis C-related form of liver inflammation from worsening and from progressive impairment of the liver's function. The active ingredient ribavirin inhibits the replication of viruses and can treat complications such as respiratory synccytial virus infection and hemorrhagic fever. Ribavirin is used specifically for chronic hepatitis C virus infections.

Side effect of ribavirin

Like any drug, ribavirin can cause side effects. Side effects do not have to occur, however, as everyone reacts differently to medication. If ribavirin is given as part of what is known as an inhalation treatment, rashes, redness and swelling of the skin are common. There may be slight cramping of the respiratory muscles. Headache, shortness of breath, slight anemia, cough and changes in breathing occur rarely during inhalation treatment. In individual cases it can lead to severe anemia.

Side effects are very common when ribavirin is combined with interferon-α. These include: dry mouth, anemia, fever, tiredness, muscle and joint pain, flu-like symptoms, weight loss, diarrhea, vomiting, nausea, sleep disorders, depression, anxiety disorders and poor concentration as well as rhinitis, inflammation of the airways, otitis media and urinary tract infections. In addition, the combination therapy often causes increased sweating, reddening of the skin, accelerated heartbeat (tachycardia), high blood pressure, thyroid dysfunction, hearing disorders, psoriasis, menstrual cycle disorders in women and many other complaints.

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Chances of success

Despite frequent side effects, the combination therapy of ribavirin and interferon-α leads to a cure for most of those affected. This therapy was the standard treatment until 2011 and healed around 80% of those affected, so that no RNA from the hepatitis C virus could be detected.

New drugs for hepatitis C.

The newer drugs for treating hepatitis C infection can be divided into different classes. There are remedies that end with –buvir. These are polymerase inhibitors. Polymerases are enzymes that help cells multiply. These drugs, for example Sofosbuvir and Dasabuvirattack an enzyme of the hepatitis C virus, the HCV polymerase (RNA-dependent RNA polymerase NS5B). This is why drugs that end in –buvir are also called NS5B inhibitors.

Means like Simeprevir, hepatitis C drugs with the ending –previr, inhibit another enzyme of the hepatitis C virus, namely the NS3 / 4A protease. This enzyme is important for virus replication, so that replication is inhibited during therapy with simeprevir.

Drugs that end in -asvir bind the viral protein NSS5A. Unlike other hepatitis C drugs, this protein is not an enzyme, but a phosphoprotein that plays an important role in the reproduction of the virus. examples are Daclatasvir and Elbasvir.

Side effects

Side effects of the new hepatitis C virus drugs that end in –buvir can include tiredness, headaches, nausea, sleep disorders and anemia.

Daclatasvir and other asvir drugs often cause tiredness, headaches, and nausea.

Common side effects to simeprevir include rash, itching, and nausea. The product can also make the skin sensitive to UV and solar radiation (Photosensitization).

Chances of success

The new drugs for hepatitis C virus infections attack the virus directly. The remedies are suitable for patients who are untreated or previously unsuccessfully treated, with or without liver cirrhosis. The funds are also suitable for patients who are infected with HIV. In addition to treatment with interferon and ribavirin, the new options are a good option for those who are ill for whom interferon is not an option. The side effects are far less serious than those of interferon therapy. The prospects of success for the new drugs are promising. The therapies last about 12 weeks and have response rates of 95%.

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Read more on the topic: Therapy of AIDS

costs

Means ending in –buvir have been around in Germany since 2014, with a tablet costing around € 488. This corresponds to therapy costs of € 43,500 for one person over 12 weeks. A pack for four-week therapy with the drug simeprevir costs around € 9,360. Therapy with new agents ending in –asvir, such as daclatasvir, also cost almost € 40,000 for a twelve-week therapy. Combination therapies with several drugs are correspondingly more expensive; in 2014 the costs for therapy with daclatasvir and sofosbuvir over 12 weeks were more than € 80,000.

Who should be treated and how?

The new drugs against hepatitis C infection are very suitable for patients who have previously received unsuccessful treatment or are chronically infected with genotype 1 or 4. You can grip well when interferon hasn't helped. The new products are also suitable for patients who, in addition to hepatitis C, also suffer from HIV infection. The drugs can also be used for previously untreated hepatitis C virus infections, and with or without liver cirrhosis. This means that this therapy is suitable for a large number of hepatitis C patients. A combination therapy of interferon and ribavirin is still used. Which active ingredient or which active ingredient combination is suitable for the patient must be discussed with a specialist and individually adapted to the patient.

More about hepatitis C

  • Liver disease
  • Therapy of AIDS
  • Anemia
  • Dry mouth
  • Joint pain
  • Cirrhosis of the liver

Exclusion of liability / disclaimer

We would like to point out that medication must never be discontinued, applied or changed independently without consulting your doctor.
Please note that we cannot claim that our texts are complete or correct. The information may be out of date due to current developments.


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