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Hep C Long-Term Management Strategies

July 7, 2008

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Since only about half of those on combination therapy beat Hepatitis C, the remaining people must strive to prevent their liver disease from progressing. Thus far, a liver wellness approach is a safer, more effective way to remain healthy compared to long-term interferon therapy.

by Nicole Cutler, L.Ac.

Over the past decade, clinical trials worldwide have been evaluating the effectiveness of Hepatitis C’s current standard of treatment, pegylated interferon and ribavirin. Most study results concur that approximately 50 percent of infected individuals are able to successfully clear the virus with the combination of these medicines. While this is good news for those who have been able to beat Hepatitis C, it leaves about half of those infected with a need for long-term management.

Sustained Viral Response
Successful Hepatitis C treatment is determined by the achievement of a sustained viral response (SVR). Considered to be the absence of detectable virus six months after the completion of treatment, SVR may even be a cure for those lucky enough to reach it. Although pegylated interferon and ribavirin have the potential to permanently get rid of Hepatitis C, it is a common occurrence for viral loads to rebound shortly after completing the medicine.

In the past, people with Hepatitis C who fail to achieve SVR have had few drug options for the continued battle against their liver disease. In general, Western medicine offers two choices for individuals in this position. They can:

1. repeat the pegylated interferon and ribavirin treatment with all of their side effects.

2. wait by the sidelines to see if new drugs are approved for Hepatitis C.

In lieu of curing the disease, those aiming to manage Hepatitis C share the goal of minimizing liver inflammation, thus reducing liver damage. Managing Hepatitis C has two distinct approaches – supporting liver wellness and using medications to slow down liver damage.

Liver Wellness for Hepatitis C Management
An increasing number of physicians and patients are recognizing the value of practicing liver wellness to delay disease advancement and enhance quality of life. Liver wellness is an approach that incorporates many daily aspects of living such as:

· Good nutrition
· Restful sleep
· Toxin avoidance
· Supplementing with milk thistle
· Alcohol abstinence
· Regular exercise
· Other liver supportive action

Despite being infected with Hepatitis C, combining the different facets of liver wellness has helped thousands of people live long, healthy lives.

Medications for Hepatitis C Management
In addition to practicing liver wellness, pharmaceutical companies also appreciate the value of keeping Hepatitis C viral loads to a minimum. Two U.S. studies have been conducted to determine if liver fibrosis progression caused by Hepatitis C can be stopped or significantly slowed with long-term, low-dose interferon treatment. The two studies, known as Hepatitis C Antiviral Long-term Treatment against Cirrhosis (HALT-C) and Colchecine versus Peg-Intron Long-term (COPILOT), evaluated approximately 1,600 people with Hepatitis C.

· HALT-C – The 517 patients randomized to the treatment arm in the HALT-C study received 90 micrograms of pegylated interferon in weekly injections for 3.5 years. Preliminary results from HALT-C looked promising, since pegylated interferon maintenance therapy led to improvements in liver enzymes, viral load and liver inflammation – markers typically assumed to predict liver disease progression. However, while these markers remained true, they ultimately did not translate into a lower likelihood of fibrosis progression, liver cancer, liver failure or death. Based on the HALT-C trial, maintenance doses of pegylated interferon are not an effective means of managing Hepatitis C.

· COPILOT – In this trial, patients are given a weekly injection of Peg-Intron or a twice-daily dosage of colchecine, an anti-inflammatory drug that has been found to help stave off the instance of liver cancer in cirrhotic patients. Differing from HALT-C, the COPILOT trial administers low dose Peg-Intron based on the patient’s weight. Given the side effects associated with standard doses of pegylated interferon, it was unclear whether lower-dose maintenance therapy would improve or impair quality of life. Thus far, the researchers have determined that treatment with weight-based, low-dose pegylated interferon does not adversely affect quality of life over a two-year period. Although it is too soon to determine the outcome of COPILOT, these preliminary results suggest that the weight-based low dosages of pegylated interferon may be tolerable by previous non-responders as maintenance therapy.

Major progress has been made in treating chronic Hepatitis C infection since the virus was isolated nearly 20 years ago. Since the current standard of therapy successfully eliminates the virus in approximately 50 percent of those affected, strategies to help people manage their illness is crucial for the remaining half of Hepatitis C infections.

At this time, no therapy is approved by the U.S. Food and Drug Administration for treatment failures of pegylated interferon and ribavirin. So far, the studies investigating low-dosage interferon as a maintenance therapy are inconclusive. However, preliminary results give us hope that a pharmaceutical concoction could delay liver disease advancement. Until an official approval for Hepatitis C maintenance therapy surfaces, liver wellness programs are an infected person’s best option for preserving their liver’s health. Often referred to as healthful lifestyle choices, investigating the many components of supporting the liver may help maintain hepatic health until a sustained viral response can be attained.

References:

Kelleher, T. Barry, et al., Maintenance Therapy for chronic hepatitis C, Current Gastroenterology Reports, June 2007.

www.hivandhepatitis.com, HALT-C Trial Shows Minimal Long-term Benefit of Pegylated Interferon Alfa-2a (Pegasys) Maintenance Therapy in Patients with Chronic Hepatitis C, Liz Highleyman, hivandhepatitis.com, November 2007.

www.hivandhepatitis.com, Treatment with Low-dose Pegylated Interferon Alfa-2b (PegIntron) Did Not Adversely Affect Quality of Life over a 2-year Period in Patients Staying on Therapy: The COPILOT Trial, hivandhepatitis.com, November 2007.

www.liverhealthtoday.com, Stalling Hepatitis C, Marc S. Botts, Liver Health Today, 2007.

www.nih.gov, Hepatitis C Treatment Reduces the Virus but Serious Liver Problems May Progress, US Department of Health and Human Services, November 2007.

Posted by Editors at July 7, 2008 12:00 PM