Hepatitis C is now curable?

[CBG23]

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I've been seeing a ton of these commercials on TV/ hearing them on the radio - they urge people to get tested for HCV because they say it can be cured. I briefly did a google search and saw a news report from a couple of months ago about a couple of new drugs that got approved for Hep. C with quotes from patients saying they are cured.

Given the propensity for the news media to confuse all things medical (saw a recent report on local TB cases and the reporters kept interchangeably calling the causative agent a bacterium and virus), I was wondering if this was true or not; It seems like something that should have received more fanfare if it is indeed true since I learned (just a year ago) that there was no cure for HCV infection.

 

[isoquin]

I hadn't heard anything about this. The latest big hype on "vaccination" is actually diabetes, surprisingly. HepC would be quite a great step though.

 

[dr zaius]

With protease inhibitor + Peg-IFN/RBV they've gotten a much better sustained virologic response.

Edit: Looking back at my hepC lectures it looks like the protease inhibitors became available this year.

 

[FIREitUP]

yep, my sister actually is involved in marketing the drug; it's called telaprevir

 

[redpanda]

Also, there is boceprevir from Merck.

yep, my sister actually is involved in marketing the drug; it's called telaprevir

 

[FIREitUP]

Also, there is boceprevir from Merck.

yes, but it has much less market share

 

[Isoprop]

Who the hell makes up these drug names?

 

[Morsetlis]

Who the hell makes up these drug names?

There is actually an art behind it.

 

[sleepy425]

Who the hell makes up these drug names?

That would be the US Adopted Names Council.

Also, the "cure rate" or sustained viral response depends on the genotype. Ribavrin and interferon produce a sustained viral response in something like 70-80% of patients with genotypes 2 and 3, a little less for those with genotype 4, and only about 50% for those with genotype 1 (which is the most common in the US). So HCV has effectively been curable in many patients for a while now, but, from what I understand, the newer protease inhibitors may increase the chance of having a sustained viral response.

 

[Lbgem]

I worked for one of those two companies on one of those protease inhibitors.

Hep C has had Peg/Riba for a while, but only produces about 50% cure rate. Keep in mind some people clear the virus on their own. I've seen figures any where from 20-50% spontaneous clearance.

This leaves about 50-80% of the people uncured, and from those, only 50% of them were cured with Peg/Riba.

Telaprevir, which was renamed Incivek btw, was approved for release this year by the FDA. Boceprevir, renamed Victrelis, released by Merck was also approved for release. Telaprevir was actually ahead of boceprevir, and produced by a small pharma company (Vertex), but Merck being the big pharma was able to push boceprevir way ahead of schedule and released theirs before Vertex did by a few days. They were months behind originally.

I obviously have a personal bias, but looking at the stats, I would tell someone with Hep C to take Incivek over Victrelis, because the SVR (sustained viral response = cure rate) is better. And the fact that if you take Victrelis they tend to put you on Epo due to higher anemia rates. Fun drug company fact - Merck's drug actually caused higher rates of anemia than Telaprevir, so they put their patients on epo, which then reduced the anemia problems. Then they claimed they had less anemia side effects than Telaprevir, which they did but they didn't mention the fact they were putting the patients on epo as well.

The names - the marketing team comes up with them actually. They come up with a list of names that doesn't sound like any other drug out there, then they send the list to the FDA iirc, who then tells them which ones would be approved. Then the marketing team decides which one sounds better, i.e. what is more memorable/people more likely to ask their doctors for. Incivek (pronounced In - SEE - vek btw) was chosen because they wanted the C sound in the name for Hep C. I assume Victrelis same thing Viral/Hep C.

So yes, there's been a cure for Hep C for a while, but there were a lot of people that it didn't work for, so now you have the protease inhibitor (triple drug therapy) which significantly increases the SVR. That is the 50% went up to 75% (83% on the high end of the trials iirc IF you were compliant, the rates were lower due to non compliance; some people didn't like the rash side effects). Boceprvir's/Victrelis's cure rate was a little lower.

That being said, if you got Hep C today, and it's not causing problems, I would tell you to wait a couple years. There's some really promising treatments coming out of Europe, one in particular that has an even better cure rate than the two protease inhibitors out on the market.

 

[MossPoh]

Yea, the name thing they have all sorts of strategies. I've had docs tell me they will get questions with "which name is more memorable" or they may give the name and then come back later and ask in some random questionaire.

Sometimes focus groups are used, which are the most worthless things every created.

 

[TexasPhysician]

Sustained viral response(SVR) does NOT equal cure.

SVR is just good marketing.

 

[dr zaius]

Sustained viral response(SVR) does NOT equal cure.

SVR is just good marketing.

Follow up studies post treatment showed no evidence of virus in the blood or liver for 10 years in something like 70 or 80% of patients using the combined therapy.

But yes, I see what you're saying about SVR. It's like when HAART came out and HIV patients believed they were cured when their viral loads were undetectable. They stopped taking their meds and developed HIV.

 

[Lbgem]

Sustained viral response(SVR) does NOT equal cure.

SVR is just good marketing.

Fair enough 😛 but I would argue in this case for all intents and purposes SVR = cure. If you don't have any detectable viral levels after ten years, you can be pretty sure that you don't have Hep C any more. Or at the very least no further damage as far as we could tell as compared to a detectable HCV level.

I wouldn't use the term SVR = cure for HIV/etc however.

 

[TexasPhysician]

Fair enough 😛 but I would argue in this case for all intents and purposes SVR = cure. If you don't have any detectable viral levels after ten years, you can be pretty sure that you don't have Hep C any more. Or at the very least no further damage as far as we could tell as compared to a detectable HCV level.

I wouldn't use the term SVR = cure for HIV/etc however.

Not all patients in the studies avoided relapse. To use the word "cure" is a lie. It isn't a cure at all. Even patients with initially excellent responses can relapse on these new drugs.

 

[tiedyeddog]

Not all patients in the studies avoided relapse. To use the word "cure" is a lie. It isn't a cure at all. Even patients with initially excellent responses can relapse on these new drugs.

I could read the studies myself but you seem educated on the issue.... Is any percentage of the population cured? If so, is this the first instance of human intervention actually curing a virus? That's a super big deal, right?

 

[Lbgem]

Not all patients in the studies avoided relapse. To use the word "cure" is a lie. It isn't a cure at all. Even patients with initially excellent responses can relapse on these new drugs.

Yes but for most people it is a cure (only 1-2% will have a relapse after reaching SVR).

I feel like we're being nitpicky on definitions here. They were/are considering revising the definition of SVR to make it clearer/more indicative of a cure, i.e. undetectable viral load after a longer period of time. HCV is relatively new, so the definitions/research around it aren't perfect; i.e. didn't expect people to have relapses after achieving SVR (but again this is a very small percentage, 1-2%). But I would say not having detectable levels of virus in your blood 6 months AFTER you complete treatment is a cure for most people.

As it stands now, achieving SVR is a pretty good sign that the treatment has worked and that yes you are cured of HCV as far as modern science can tell (i.e. undetectable viral load). Perhaps in the future we'll have more sensitive tests that will say oh you have 1 virus left in your system so it's not technically a full cure, but you'll never have any effects of HCV.

Would you argue that penicillin isn't a cure for some bacterial infections just because some strains are resistant to it? What about the person that has an infection that is initially susceptible to it, but then stops taking treatment halfway through and develops penicillin resistance? Which btw, is what happened in some cases of relapse for HCV treatment. The triple combo therapy was working but the patient stopped taking the meds before all the virus could be eliminated, and relapsed.

So out of curiosity, what would you call people that have taken the treatment and have no detectable levels of HCV after 5 years? Not cured?

Edit: I searched around for some actual numbers.

 

[TexasPhysician]

Yes but for most people it is a cure (only 1-2% will have a relapse after reaching SVR).

I feel like we're being nitpicky on definitions here. They were/are considering revising the definition of SVR to make it clearer/more indicative of a cure, i.e. undetectable viral load after a longer period of time. HCV is relatively new, so the definitions/research around it aren't perfect; i.e. didn't expect people to have relapses after achieving SVR (but again this is a very small percentage, 1-2%). But I would say not having detectable levels of virus in your blood 6 months AFTER you complete treatment is a cure for most people.

As it stands now, achieving SVR is a pretty good sign that the treatment has worked and that yes you are cured of HCV as far as modern science can tell (i.e. undetectable viral load). Perhaps in the future we'll have more sensitive tests that will say oh you have 1 virus left in your system so it's not technically a full cure, but you'll never have any effects of HCV.

Would you argue that penicillin isn't a cure for some bacterial infections just because some strains are resistant to it? What about the person that has an infection that is initially susceptible to it, but then stops taking treatment halfway through and develops penicillin resistance?

So out of curiosity, what would you call people that have taken the treatment and have no detectable levels of HCV after 5 years? Not cured?
.

It isn't nitpicky about definitions. Saying this treatment is a cure is like saying my cat is a horse. It's just incorrect.

If penicillin fails to kill bacteria, it isn't a cure. An effective bacterial treatment with penicillin however is a cure. No bacteria remains and relapse 5 years from now does not occur. You would need to be re-infected.

This is not the case with Hep C. I can treat Hep C to the point where we can no longer find the virus. However it is still there. The drug companies admit this. There is a possibility that the same Hep C infection can come roaring back because it never left. Just because a good percentage of people will not relapse does not mean they can't.

So patients with Hep C will forever have Hep C until we eventually do find a cure. Maybe in my lifetime, we will find this cure you speak of.

 

[Lbgem]

This is not the case with Hep C. I can treat Hep C to the point where we can no longer find the virus. However it is still there. The drug companies admit this.

It is being nitpicky about definitions because you're saying it shouldn't be called a cure because for 1-2% of people that seemed to be cured, they relapse. But you discount the 98-99% that do achieve a cure.

And it's not "still there" in the majority of people that attain SVR. Sure if it were a latent infection, but it's not. I would bet anything the people that relapse are the ones that had a tiny population of resistant HCV quasispecies to the treatment left that can't be detected by current methods, and then those viruses replicate to the point they can be detected, hence relapse. This happens within a short period of time. But for the majority that attain SVR/cure all the virus has been eliminated and can no longer be detected. HCV doesn't just sit there looking pretty if there is virus left. It replicates. That's what it does. And it'll keep replicating to the point you'll be able to detect it again. So if you don't see any detectable viral levels in 3? 5? 10? years after the person has achieved SVR that's a pretty good indicator all the virus was eliminated.

I'd be interested to see your sources for your claim: "I can treat Hep C to the point where we can no longer find the virus. However it is still there. The drug companies admit this."

The company I worked at, we never said this ever. I'm pretty sure I would have remembered 'hey guys we're curing Hep C but it's not really a cure cause there's still virus left.'

SVR is a cure to the majority of people working with HCV.

Here's my proof:

"A sustained virologic response (SVR) is also considered a virologic "cure." "
Diagnosing and Treating Hepatitis C Infection

"hepatitis C is the only human chronic viral disease that can be cured, as all other pathogenic viruses infecting humans either display self-limited courses or establish non-eradicable persistent infections."
Directly acting antivirals against hepatitis C virus

 

[TexasPhysician]

Your own first article says "cure" in parenthesis. Your own sources won't admit it to be a full cure.

The Phase 2 study named study 107 showed a 16% relapse rate in less than 1 year.

Different populations seem to have different relapse rates and different success rates. Some only show a mild improvement over past treatments.

I'll admit though that these drugs are an improvement. A big breakthrough definitely. Cure? No.

 

[DoctwoB]

Great news, but how about the side effects? Interferon + ribavirin is already a pretty brutal regimen to be taken long term.

 

[Lbgem]

Your own first article says "cure" in parenthesis. Your own sources won't admit it to be a full cure.

The Phase 2 study named study 107 showed a 16% relapse rate in less than 1 year.

Different populations seem to have different relapse rates and different success rates. Some only show a mild improvement over past treatments.

I'll admit though that these drugs are an improvement. A big breakthrough definitely. Cure? No.

Because Cure and SVR are not exactly the same all the time due to that 1-2% of relapse but for most people SVR=cure, hence me (and most HCV experts equating SVR/cure for Hep C). And you must have missed the second article I linked where it clearly says cure. And yes different relapse rates, but most people are cured.

Also you do realize that Study 107 run by Vertex was done not on naive patients, but patients that had failed previous treatments? Most companies doing HCV research won't touch null-responders because they make the data look bad, but Vertex did. So that is a pretty biased source you're using for relapse results.

I would still like to see your source where you claim that drug companies say that they don't cure Hep C with protease inhibitors because virus remains in the system.

 

[Lbgem]

Great news, but how about the side effects? Interferon + ribavirin is already a pretty brutal regimen to be taken long term.

Rash mostly. If you're talking about Incivek/Telaprevir. That's usually the reason people stop taking it due to side effects.

Anemia is the main one iirc for Boceprevir/Victrelis. But you will get prescribed Epo to counter it.

And yes, there are current research being done trying to get away from that peg/riba combo. I can't remember which one has the really bad side effects (worst flu of your life for 6 months was how someone described it to me), but they are testing to see if they can get rid of that one. So far no dice, but that is the goal.

 

[TexasPhysician]

Because Cure and SVR are not exactly the same all the time due to that 1-2% of relapse but for most people SVR=cure, hence me (and most HCV experts equating SVR/cure for Hep C). And you must have missed the second article I linked where it clearly says cure. And yes different relapse rates, but most people are cured.

Also you do realize that Study 107 run by Vertex was done not on naive patients, but patients that had failed previous treatments? Most companies doing HCV research won't touch null-responders because they make the data look bad, but Vertex did. So that is a pretty biased source you're using for relapse results.

I would still like to see your source where you claim that drug companies say that they don't cure Hep C with protease inhibitors because virus remains in the system.

I've spoken to their drug reps.

Study 107 is biased by using non-responders? Hahahaha. It's called a real life situation. If anything, the other studies are more biased by selecting ideal candidates. Of course drug companies want ideal candidates. It makes their data appear better than it is.

So with the patients that achieve SVR and then relapse (we both agree this happens at variable rates), how is such a relapse possible? The answer is that the virus is never truly gone. It's like when someone gets HIV, but tests aren't sensitive enough to find it for months sometimes. Hep C is still there in SVR, but our tests aren't 100% accurate. No test is.

How else do you have a relapse ( not reinfection)? Magic? Hep C fairy?

 

[tco]

Texas is basically saying that there's no way to tell if those 98% are "cured" because we have limits to our ability to detect the virus. It's quite possible that there is residual disease that is below our detection level. You're saying that it's safe to assume that those 98% are cured because they will never relapse. Your assumption is that the drugs were effective enough to cause complete elimination of the virus in those patients that will never relapse into disease. Until our virus detection becomes more sensitive, we will not know who wins this debate.

 

[Lbgem]

Texas is basically saying that there's no way to tell if those 98% are "cured" because we have limits to our ability to detect the virus. It's quite possible that there is residual disease that is below our detection level. You're saying that it's safe to assume that those 98% are cured because they will never relapse. Your assumption is that the drugs were effective enough to cause complete elimination of the virus in those patients that will never relapse into disease. Until our virus detection becomes more sensitive, we will not know who wins this debate.

I'm saying after a certain period of time that you allow for relapse potential it's safe to assume there is no more virus left.

If there is virus left there will be relapse because HCV will replicate.

I think SVR should be amended to longer than 6 months, say 2 years. If there were any virus left at that point it would have replicated until it was detectable.

Even with bacteria are you seriously going to say a patient isn't cured until you run a test, which I doubt even exists yet, to detect 1 bacterium left in their system? No, you see that the symptoms are gone, and you can't find any evidence of the bacteria left. By your logic, how can you prove that a bacterial infection is really gone? Perhaps it's just hiding. People that have successfully been treated for HCV that haven't relapsed in say 2 years, same thing. You're saying it's not a cure because they relapse at all. Just because the virus broke through, the patient didn't complete treatment, etc. We could apply this to a bacterial infection that can be cured with penicillin but patient stopped midway, and 'relapsed.' Does that mean for all other people infected with this the treatment can never be proven to be a cure? No. If you assume that it's a cure because you don't see relapse after 6 months of bacterial infection then you should be able to apply that to viruses. The only thing that should be amended is SVR to 2 years and then you'd eliminate all cases of relapse, as far as current science can tell.

It's like growing bacteria on an agar plate; you won't see anything by eye within an hour of plating regular e. coli, but wait say 6 hours you may see some tiny colonies, wait 24 and you'll see lots. Now let's say it very slowly replicates, and the most time it could ever take was 3 days. After 3 days you see nothing then you can assume no bacteria were present on the plate.

This is the same idea with HCV and relapse. If they don't relapse after a certain point then they don't have any virus that can replicate to the point of detection.

And Texas, drugs reps =/= scientists doing the research. The marketing division often didn't know most of the science behind what the researchers were doing.

I don't agree that Study 107 is like a real life situation. You're taking people that have been proven not to respond to treatment and saying here, this is just like real life. It's not. Real life is a mixed population - naive and non-responders, breakthroughs etc.

 

[Lbgem]

Texas is basically saying that there's no way to tell if those 98% are "cured" because we have limits to our ability to detect the virus. It's quite possible that there is residual disease that is below our detection level. You're saying that it's safe to assume that those 98% are cured because they will never relapse. Your assumption is that the drugs were effective enough to cause complete elimination of the virus in those patients that will never relapse into disease. Until our virus detection becomes more sensitive, we will not know who wins this debate.

And I'm saying you can by theory even if not by current detection standards because you know currently the period of maximum relapse. How long it takes a very small viral population to replicate. You may not be able to detect it but you know how long it takes for them to grow until it reaches detectable levels. So once you pass that amount of time and there is still no detectable virus then you know there wasn't any left/to begin with.

 

[TexasPhysician]

This argument is a joke. You want to change the definition of SVR (cure in your terms) from 6 months of being disease free to 2 years?

Hahahahaha.

A cure is FOREVER! Not 6 months. Not 2 years. Not 10 years. Common bacterial knowledge is that it IS eradicated. Relapse doesn't occur with bacteria. No relapse in 20 years. No relapse in 50 years.

Good attempt at deceiving people though.

 

[YSPharm12]

That being said, if you got Hep C today, and it's not causing problems, I would tell you to wait a couple years. There's some really promising treatments coming out of Europe, one in particular that has an even better cure rate than the two protease inhibitors out on the market.

Pharmasset has two HCV drugs in phase III studies right now that look promising. Both are polymerase inhibitors. There are a ton of HCV studies going on.

 

[Lbgem]

This argument is a joke. You want to change the definition of SVR (cure in your terms) from 6 months of being disease free to 2 years?

Hahahahaha.

A cure is FOREVER! Not 6 months. Not 2 years. Not 10 years. Common bacterial knowledge is that it IS eradicated. Relapse doesn't occur with bacteria. No relapse in 20 years. No relapse in 50 years.

Good attempt at deceiving people though.

Um, you completely misunderstood what I said. That would be the time period to determine if the person is disease free or not. I.e. is it really a cure or is there virus left that will replicate to detectable levels. Two years would be a sufficient time period for any HCV (if there is any) to replicate to detectable levels. Meaning if it's still undetectable after two years then it really is a cure. And relapse doesn't occur in patients cured of HCV either.

And what common knowledge? You're trusting years of scientific evidence, which is the same as what I'm doing. You can't prove to me without a doubt there is 0 bacteria left in an individual by any current tests. They're not sensitive enough, same with the HCV one. You 'know' the person is cured because the bacteria WILL show up/replicate within a certain time frame if it's not cured. Same thing with HCV. I was saying amend the definition so it excludes any possible replication time, so that SVR will be 100% equivalent (instead of 98%) to a cure.

As you haven't provided any sources or evidence for your argument other than 'some drug rep told me this' I won't continue to debate with you as enlightening as "Hahahahaha" is 😉.

OP, I hope I've answered your question sufficiently.

 

[Lbgem]

Pharmasset has two HCV drugs in phase III studies right now that look promising. Both are polymerase inhibitors. There are a ton of HCV studies going on.

There are, how's your polymerase inhibitors looking? The first generation ones I saw weren't as good as the protease inhibitors, but I didn't get a chance to see all of them.

 

[YSPharm12]

There are, how's your polymerase inhibitors looking? The first generation ones I saw weren't as good as the protease inhibitors, but I didn't get a chance to see all of them.

I'd have to look into it some more since I actually found out about it through a project on HCV, but phase II trials were definitely promising. The phase III trials I heard of are looking into using one of the drugs, the nucleotide analog, with ribavirin for 12 weeks. If the results are good, it would mean shorter duration of therapy that is IFN-free. Also, generally, nucleotide analogs are less likely to cause resistance than most other antiviral targets. Exciting. 🙂

 

[Bernoull]

I haven't read up on this topic, so forgive my ignorance... That said, do you guys know how much of these therapeutic advances in HCV is transferrable to other viral Hep infections (HBV for instance)?

 

[Lbgem]

I haven't read up on this topic, so forgive my ignorance... That said, do you guys know how much of these therapeutic advances in HCV is transferrable to other viral Hep infections (HBV for instance)?

They're completely different viruses. One's a DNA virus the other is RNA. I know it seems like one treatment should apply to the other cause there's 'only' a letter difference, but even within Hep C, the genotype of the virus makes a big difference on how it'll respond to treatment.

And remember, sometimes when we initially classify viruses we don't know everything about them and they just get tossed into a category that seems like it should fit based on clinical symptoms instead of viral genome. And even then we sometimes don't know which family/genus to stick a virus into (i.e. Hep E).

So basically none of the treatments in HCV would be transferable to HBV. Unfortunately.

 

[Gastrapathy]

This argument is a joke. You want to change the definition of SVR (cure in your terms) from 6 months of being disease free to 2 years?

Hahahahaha.

A cure is FOREVER! Not 6 months. Not 2 years. Not 10 years. Common bacterial knowledge is that it IS eradicated. Relapse doesn't occur with bacteria. No relapse in 20 years. No relapse in 50 years.

Good attempt at deceiving people though.

You are a resident?

Go read.

In contrast to HIV and HBV, HAV and HCV are frequently cured (by the body's immune system with or without the help of medications). There are lots of viruses that are cured. You are not a carrier of the common cold, are you?

For HCV specifically, there are very few cases of relapse after SVR and none after another 6 months.

The discussion of SVR rates above is a little limited. The data so far is for treatment-naive genotype I patients. The new guideline is on the AASLD website. Read it.

If you are going to berate medical students...be right.

 

[Gastrapathy]

I'd have to look into it some more since I actually found out about it through a project on HCV, but phase II trials were definitely promising. The phase III trials I heard of are looking into using one of the drugs, the nucleotide analog, with ribavirin for 12 weeks. If the results are good, it would mean shorter duration of therapy that is IFN-free. Also, generally, nucleotide analogs are less likely to cause resistance than most other antiviral targets. Exciting. 🙂

INF-free trials are starting but this is a long way from clinical practice. Keep in mind that at every national meeting for the last 6 years, we were told that telaprivir was 2 years away.

My Vertex stock did me right. Buy at 22, sell at 54. Now I'm staying away because Merck is playing dirty. Merck has a deal to market boceprivir with both Pegasys and PEG-Intron. We'll see but I think they are going to start tilting market-share back their way soon. Also, the rash with telaprivir is a little tougher to manage than the anemia with boceprivir. I still prefer telaprivir because of the way they designed their trials (the run-in phase with boceprivir is really annoying).

 

[Gastrapathy]

I could read the studies myself but you seem educated on the issue.... Is any percentage of the population cured? If so, is this the first instance of human intervention actually curing a virus? That's a super big deal, right?

See TexasResident, if you post in the med stud forums, you need to be right.

Unlike you, who "could treat patients", I actually do treat HCV patients and some of them are CURED.

 

[Gastrapathy]

Texas is basically saying that there's no way to tell if those 98% are "cured" because we have limits to our ability to detect the virus. It's quite possible that there is residual disease that is below our detection level. You're saying that it's safe to assume that those 98% are cured because they will never relapse. Your assumption is that the drugs were effective enough to cause complete elimination of the virus in those patients that will never relapse into disease. Until our virus detection becomes more sensitive, we will not know who wins this debate.

We have 30+ years of data on this question. Remember that some people clear acute HCV spontaneously (~20%) and we've been treating people with less successful regimens for years. A cure is a true result in HCV.

This is a huge difference between HBV and HCV. HBV patients with no viremia , SAg neg but with a positive Core Ab have relapsed on R-CHOP presumably from CCC DNA.

 

[YSPharm12]

INF-free trials are starting but this is a long way from clinical practice. Keep in mind that at every national meeting for the last 6 years, we were told that telaprivir was 2 years away.

My Vertex stock did me right. Buy at 22, sell at 54. Now I'm staying away because Merck is playing dirty. Merck has a deal to market boceprivir with both Pegasys and PEG-Intron. We'll see but I think they are going to start tilting market-share back their way soon. Also, the rash with telaprivir is a little tougher to manage than the anemia with boceprivir. I still prefer telaprivir because of the way they designed their trials (the run-in phase with boceprivir is really annoying).

That's true, but it's something to look out for in the next few years.

Hard to say whether marketing with both Pegasys and PEG-Intron will really affect the market share. Merck does own PEG-Intron but nothing on the PI bars MDs from giving telaprevir with either peg-interferon. The biggest factor will be when they eventually do a comparison trial. As far as side effects, I see anemia potentially being a bigger issue when both boceprevir and ribavirin cause anemia.

At any rate, Vertex should be doing fine. Their cystic fibrosis trials are getting a lot of attention. 🙂

 

[Gastrapathy]

That's true, but it's something to look out for in the next few years.

Hard to say whether marketing with both Pegasys and PEG-Intron will really affect the market share. Merck does own PEG-Intron but nothing on the PI bars MDs from giving telaprevir with either peg-interferon. The biggest factor will be when they eventually do a comparison trial. As far as side effects, I see anemia potentially being a bigger issue when both boceprevir and ribavirin cause anemia.

At any rate, Vertex should be doing fine. Their cystic fibrosis trials are getting a lot of attention. 🙂

Most of us prefer Pegasys to PEG-Intron, so the fact that boceprivir will be priced as a package deal with Pegasys is a very big deal.

For my system, that package pricing saves us about $10k for boceprivir +PEG/RIBA versus telaprivir + PEG/RIBA regardless of which interferon you choose.

No one is telling me which to use yet but...

There will never be a comparison trial. No one will fund it. Same reason there has never been head to head studies of infliximab and its various rivals.

 

[YSPharm12]

Most of us prefer Pegasys to PEG-Intron, so the fact that boceprivir will be priced as a package deal with Pegasys is a very big deal.

For my system, that package pricing saves us about $10k for boceprivir +PEG/RIBA versus telaprivir + PEG/RIBA regardless of which interferon you choose.

No one is telling me which to use yet but...

There will never be a comparison trial. No one will fund it. Same reason there has never been head to head studies of infliximab and its various rivals.

Oh I didn't know it was being marketed as a package. Well...that sucks for Vertex with all of their HCV commercials.

There might be a comparison trial eventually, though not for a while, and only if evidence emerges that one is likely superior to the other. In which case that company would fund it to get more market share.

 

[TexasPhysician]

There might be a comparison trial eventually, though not for a while, and only if evidence emerges that one is likely superior to the other. In which case that company would fund it to get more market share.

Even then, I doubt it. Physicians are smart people and catch on if one option is truly better through clinical results. Once physicians realize this, there is no need for a study because they already prescribe it more. There would be more to lose than to gain.

 

[Elbowstoopointy]

I've been seeing a ton of these commercials on TV/ hearing them on the radio - they urge people to get tested for HCV because they say it can be cured. I briefly did a google search and saw a news report from a couple of months ago about a couple of new drugs that got approved for Hep. C with quotes from patients saying they are cured.

Given the propensity for the news media to confuse all things medical (saw a recent report on local TB cases and the reporters kept interchangeably calling the causative agent a bacterium and virus), I was wondering if this was true or not; It seems like something that should have received more fanfare if it is indeed true since I learned (just a year ago) that there was no cure for HCV infection.

Yet they can't cure herp...