New drug could transform the treatment of hepatitis C

Radically improved treatments for one of the world's worst health scourges are looking more likely after scientists reported patients were cured more quickly and more often if an experimental new drug was added to the normal therapy.

More than 180 million people worldwide, including 250,000 in Australia, are infected with the hepatitis C virus, which, if untreated, can lead to liver cirrhosis and cancer. Currently the only treatment is a 48-week course of two drugs, pegylated (or slow-release) interferon and ribavirin, which are notorious for causing a "brain fog" that makes it hard for people to stay at work.

Results from two studies presented to a European conference of liver specialists show that when a new drug called telaprevir was taken alongside the usual drugs for the first 12 weeks of treatment, the success rate increased from 41per cent of treated patients to 61per cent. More significantly, the treatment time for those given telaprevir was halved from 48weeks to 24 weeks.

In a separate but related study due to be presented last night, the success rate for patients given telaprevir rose to 68per cent.

Telaprevir is the most advanced of a new class of drugs for hepatitisC infection called protease inhibitors, which work by blocking a key stage of the virus's replication cycle.

Presenting the findings at the conference of the European Association for the Study of the Liver in Milan, John McHutchison, the Melbourne-trained lead investigator and professor of medicine at Duke University in the US, said that if these results were borne out in a larger trial about to start, the drug had the "potential to halve treatment duration in most subjects".

"This is a very big step forward," Professor McHutchison told The Weekend Australian. "If this goes well in phase III trials (about to start), we will be able to decrease the duration of therapy from a year to six months. This is a huge advance - but we have still got our hurdles."
Professor McHutchison said side effects from telaprevir were an issue and included an itchy rash and anaemia. As a result, more patients dropped out of telaprevir-based treatment (18 per cent) compared with normal therapy (4 per cent).

Australian experts at the conference welcomed the results as "absolutely exciting". Greg Dore, head of the viral hepatitis clinical research program at the Sydney-based National Centre in HIV Epidemiology and Clinical Research, said that although there was some additional toxicity from telaprevir, its ability to halve treatment time would be a huge benefit.

Neil Graham, the Adelaide-trained doctor who is leading the hepatitis C program for telaprevir's maker, Boston-based drug company Vertex, said that if subsequent trials went well, an application to register the drug could be lodged with US regulators in 2010.

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