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Thursday, August 19, 2010

The Tale of the HCV Drug Cocktail

"Flaming" cocktails contain a small ...Image via Wikipedia
In addition to reading a lot of new scientific finding about Hepatitis C, I am also reading about the new hope and promise of the first two antiviral drugs for the treatment of Hepatitis C: telaprevir and boceprevir.

New Ingredients


Here are some of the rave reviews:


Boceprevir, combined with interferon-α and ribavirin, cured the infections of about two-thirds of the patients who followed a 48-week course... Some patients were able to finish the course even sooner, at 28 or 36 weeks. (as reported by Nature News)

and


Telaprevir, also combined with the standard drugs, cured 72% of patients after just 24 weeks of treatment... Patients who responded quickly to the drug, within 4 to 12 weeks, were the most likely to be cured by it. (as reported by Nature News)

These first HCV-specific protease inhibitors represent a HUGE step forward in Hepatitis C treatment. It is anticipated that these two drugs will be approved by the FDA very soon. So what is a few more months when I have been waiting for these drugs for 12 years. Would it be so wrong of me to say that I want these drugs, that I need these drugs, to help me conquer my chronic HCV infection?

While I certainly don't want to rain on anyone's parade or take the wind out of anyone's sails, I admit that now that they are almost here, I have some concerns.

Concern One: The Old Recipe

First, I am very disappointed that, for now, these drugs need to be taken with the standard Hepatitis C treatment of interferon and ribavirin. I tried the standard treatment back in 2007 for two weeks. Why only two weeks? Because the standard treatment totally kicked my butt, landed me in the hospital, worsened my then undiagnosed dysautonomia symptoms and took my overall level for functioning from a 30/100 to a bed-bound 10/100.

So you can see, I am not very gung ho about trying interferon and ribavirin again.

Concern Two: Mixers

Secondly, I don't see any information about these two drugs being used together. I what I am asking, that 1) different drugs companies have to work together and 2) this approach could potentially expose one treatment as superior to another (among other things.) But if the future of HCV treatment is an antiviral cocktail of multiple drugs, shouldn't the emphasis be on testing the cocktail in controlled clinical trial settings versus experimenting with drug combinations willy-nilly in the doctor's office?

I don't want the competitive corporate interests of huge pharmaceutical companies to turn me a guinea pig when it comes time for my doctor to start prescribing antiviral medications for me.

Concern Three: Perfection

Third, I am worried about drug resistance. From what I have read, it became clear in clinical trials that taking just one protease inhibitor alone allowed the Hepatitis C virus the opportunity to become immune to the drug over time. It is for this reason the telaprivir and boceprivir are paired with interferon and ribavirin. I think this means you have to be near perfect in taking all three of these medications to avoid this happening to you.

Quite honestly, I don't know that I could be perfect for 24 to 48 weeks.

My Conclusion

For these reasons, I reluctantly admit that this may not be the right time for me to try and treat my chronic HCV infection again, even though my last viral load was 11 million. Much like the preview of coming attractions before the movie, the new HCV drugs appear to be just a glimmer of hope for more options to come. I pray that these two drugs open the flood gates, that more antiviral drugs become available soon so I can have my cocktail, sans interferon and ribavirin.

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2 comments

mangiabella said...

found you via woo your blog at red riter's! Just became your newest follower :) - my mom struggles with lupus and a few other ailments that has made this season of her life very challenging - but I am so amazed at how she continues to press on and live the best life she can - i can't wait to show her your blog!

come by and visit me at mangia-bella.blogspot.com

mangiabella said...

found you via woo your blog at red riter's! Just became your newest follower :) - my mom struggles with lupus and a few other ailments that has made this season of her life very challenging - but I am so amazed at how she continues to press on and live the best life she can - i can't wait to show her your blog!

come by and visit me at mangia-bella.blogspot.com