Hepatitis C: Updated Guidelines and New Drugs
The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) updated their Recommendations for Testing, Managing, and Treating Hepatitis C in March 2014 and then again in December 2014. These updates correlated with the approvals of four new medications by the US Food and Drug Administration (FDA) since October 2013. The updated guidelines have changed how patients with HCV infection are treated.
Table 1 compares the changes in the recommendations for drug treatment of HCV genotype 1 over the last three updates since 2011.
The most drastic change has come with the introduction of tablet-only (oral) treatments, which were nonexistent before the March 2014 update.
This aids in the treatment of patients with contraindications to or who require cautious use of pegylated interferon (PEG-IFN)-alpha, which includes patients with autoimmune disorders, psychiatric disorders, cardiovascular diseases, thyroid disease, pancreatitis, or pulmonary disease. Not only must PEG-IFN be used with caution in patients with psychiatric disorders, but some such patients are also at high risk of contracting HCV infection owing to potential use of injectable drugs and dual diagnoses of a substance abuse disorder. Also, PEG-IFN is associated with an extensive number of severe side effects, such as myocardial infarction, arrhythmias, pulmonary toxicity, pancreatitis, vision loss, and thrombocytopenia, among others. The availability of oral HCV treatments without PEG-IFN is advantageous in avoiding the severe side effects and contraindications associated with PEG-IFN.
A complete list of contraindications and precautions to treatments is provided in Table 2 .
New Standards of Treatment
The American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) updated their Recommendations for Testing, Managing, and Treating Hepatitis C in March 2014 and then again in December 2014. These updates correlated with the approvals of four new medications by the US Food and Drug Administration (FDA) since October 2013. The updated guidelines have changed how patients with HCV infection are treated.
Table 1 compares the changes in the recommendations for drug treatment of HCV genotype 1 over the last three updates since 2011.
The Advent of Oral Therapy
The most drastic change has come with the introduction of tablet-only (oral) treatments, which were nonexistent before the March 2014 update.
This aids in the treatment of patients with contraindications to or who require cautious use of pegylated interferon (PEG-IFN)-alpha, which includes patients with autoimmune disorders, psychiatric disorders, cardiovascular diseases, thyroid disease, pancreatitis, or pulmonary disease. Not only must PEG-IFN be used with caution in patients with psychiatric disorders, but some such patients are also at high risk of contracting HCV infection owing to potential use of injectable drugs and dual diagnoses of a substance abuse disorder. Also, PEG-IFN is associated with an extensive number of severe side effects, such as myocardial infarction, arrhythmias, pulmonary toxicity, pancreatitis, vision loss, and thrombocytopenia, among others. The availability of oral HCV treatments without PEG-IFN is advantageous in avoiding the severe side effects and contraindications associated with PEG-IFN.
A complete list of contraindications and precautions to treatments is provided in Table 2 .