Tuesday, July 12, 2016

Dr. Bill Elliott: Epclusa among hepatitis drugs that are medical miracles of the 21st century

Last week the Food and Drug Administration approved a new drug to treat hepatitis C. The approval did not receive much fanfare in the lay press maybe because the new drug is similar to several other medications that are already on the market.

The drug, called Epclusa, is made by Gilead Sciences, a Bay Area company, and it will likely be extremely successful, especially since it costs more than $75,000 for a complete course of therapy.

But that isn’t the real story. The amazing thing about Epclusa is that it treats all five types of the hepatitis C virus — the first drug to do that — and cures more than 95 percent of patients with hepatitis C.

Curing a viral disease is a big deal because up until the new hepatitis C treatments became available, we were unable to cure any virus. We can prevent viruses with vaccines, but we have had no success curing them — until now.

Most of the time our immune system will get rid of viruses, given enough time. This is true of viruses ranging from the common cold to Zika. Viruses make us sick, sometimes really sick, but then we get better and the virus is gone and we are immune to that particular virus forever.

But there are some viruses that we can’t get rid of. All herpes viruses have the ability to stay in our body for our entire life. Chicken pox is a herpes virus that causes infections in young children, then the same virus can come back decades later as shingles.

Hepatitis C is a virus leads to a chronic infection in the majority of those who get infected. It was commonly spread back in the ’60s as a direct result of the ’60s lifestyle along with tainted blood transfusions. Many baby boomers (those born between 1945 and 1965) became infected when they were in the teens, 20s or 30s, and some have carried the virus ever since. Chronic hepatitis C infection can cause low-grade liver inflammation that can lead to cirrhosis or even liver cancer.

The first treatment breakthough came in the early ’90s when the FDA approved interferon to treat hepatitis C. But interferon had many drawbacks including severe side effects and limited effectiveness. Still, interferon offered a potential cure — the first time we were able to cure a chronic viral illness.

Since the ’90s, the drug technologies have improved year by year. Many of the same drugs have been tried on the AIDs virus (HIV) and other hepatitis viruses, including hepatitis B. Unfortunately, the new drugs have not been as effective for other viruses as they were for hepatitis C. Diseases like AIDs have been controlled, but not yet cured.

The progress on hepatitis C, however, has been nothing short of miraculous. With the approval of Epclusa along with its cousin medications Harvoni, Viekira Pak and Technivie, we are now able to cure most patients infected with hepatitis C — one of the true medical miracles of the 21st century. These drugs are expensive and need to be given by experts, but virtually anyone infected with hepatitis C is now a candidate for treatment.

Interestingly, because hepatitis C can stay dormant for decades, it is estimated that more than 3 million Americans are infected, with the majority not knowing they carry the virus. Because of the high prevalence and good treatment options now available, the CDC is recommending all baby boomers get tested for hepatitis C. Others at risk who should be tested include injection drug users and anyone who got a blood transfusion before 1987 when they started testing transfused blood for hepatitis C.

Widespread screening for hepatitis C is still in the planning stages, so you may want to ask your doctor about getting a test if you are in a high-risk group.

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