Treatments for Chronic Hepatitis C
Treatments for Chronic Hepatitis C
The list of treatments mentioned in various sources
for Chronic Hepatitis C
includes the following list.
Always seek professional medical advice about any treatment
or change in treatment plans.
Chronic Hepatitis C: Is the Diagnosis Correct?
The first step in getting correct treatment is
to get a correct diagnosis.
Differential diagnosis list for Chronic Hepatitis C may include:
Chronic Hepatitis C: Research Doctors & Specialists
Research all specialists including ratings, affiliations, and sanctions.
Drugs and Medications used to treat Chronic Hepatitis C:
Note:You must always seek professional medical advice about any prescription drug, OTC drug, medication, treatment
or change in treatment plans.
Some of the different medications used in the treatment of Chronic Hepatitis C include:
- Interferon Alfa-2a
- Roferon-A
- Interferon alfa-2b and Ribavirin Combination pack
- Rebetron
- Interferon Alfacon-1
- Infergen
- Peginterferon Alfa-2a
- Pegasys
- Peginterferon Alfa-2b
- PEG-Intron
- Peginterferon Alfa-2b and Ribavirin - used as part of a combination therapy
- Pegetron - used as part of a combination therapy
- Ribavirin - used as part of a combination therapy
- Copegus - used as part of a combination therapy
- Rebetol - used as part of a combination therapy
- Ribasphere - used as part of a combination therapy
- Virazide - used as part of a combination therapy
Latest treatments for Chronic Hepatitis C:
The following are some of the latest treatments for Chronic Hepatitis C:
Hospital statistics for Chronic Hepatitis C:
These medical statistics relate to hospitals, hospitalization and Chronic Hepatitis C:
- 0.007% (903) of hospital consultant episodes were for chronic hepatitis in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 88% of hospital consultant episodes for chronic hepatitis required hospital admission in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 35% of hospital consultant episodes for chronic hepatitis were for men in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- 65% of hospital consultant episodes for chronic hepatitis were for women in England 2002-03 (Hospital Episode Statistics, Department of Health, England, 2002-03)
- more hospital information...»
Discussion of treatments for Chronic Hepatitis C:
In the United States, two different regimens
have been approved as therapy for hepatitis C:
- Monotherapy with alpha interferon
- Combination therapy with alpha interferon and ribavirin.
Combination therapy consistently yields higher rates of
sustained response than monotherapy. Combination treatment is more
expensive and is associated with more side effects than monotherapy, but,
in most situations, it is preferable. At present, interferon monotherapy
should be reserved for patients who have contraindications to the use of
ribavirin.
Several forms of alpha interferon are available (alfa-2a, alfa-2b, and
consensus interferon). These interferons are given subcutaneously three
times weekly in doses of 3 million units (MU) or, in the case of consensus
interferon, 9 µg per injection. Ribavirin, in contrast, is an oral
antiviral agent that is given twice a day in 200-mg capsules for a total
daily dose of 1,000 mg for patients who weigh less than 75 kilograms (165
pounds) or 1,200 mg for those who weigh more than 75 kilograms.
Treatment with interferon alone or combination therapy with interferon
and ribavirin leads to rapid improvements in serum ALT levels in 50 to 75
percent of patients and the disappearance of detectable HCV RNA from the
serum in 30 to 50 percent. However, a long-term improvement in liver
disease usually occurs only if HCV RNA disappears during therapy and stays
undetectable when therapy is stopped.
A response is considered to be "sustained" if HCV RNA remains
undetectable for 6 months or more after therapy stops. With interferon
monotherapy, 30 to 35 percent of patients become HCV RNA negative with
treatment, but almost half of these relapse when treatment stops: The
sustained response rate, therefore, averages only 15 to 20 percent.
Combination therapy with interferon and ribavirin, however, leads to loss
of HCV RNA on treatment in 50 to 55 percent of patients and a sustained
loss in 35 to 45 percent. Thus, combination treatment results in both a
higher rate of loss of HCV RNA on treatment and a lower rate of relapse
when treatment is stopped.
The optimal duration of treatment varies depending on whether
interferon monotherapy or combination therapy is used, as well as by HCV
genotype. For patients treated with interferon monotherapy, a 48-week
course is recommended, regardless of genotype. For patients treated with
combination therapy, the optimal duration of treatment depends on viral
genotype. Patients with genotypes 2 and 3 have a high rate of response to
combination treatment (60 to 70 percent), and a 24-week course of
combination therapy yields results equivalent to those of a 48-week
course. In contrast, patients with genotype 1 have a lower rate of
response to combination therapy (25 to 35 percent), and a 48-week course
yields a significantly better sustained response rate. Again, because of
the variable responses to treatment, testing for HCV genotype is
clinically useful when using combination therapy.
Who Should Be Treated?
Patients with anti-HCV, HCV RNA, elevated
serum aminotransferase levels, and evidence of chronic hepatitis on liver
biopsy, and with no contraindications, should be offered therapy with the
combination of alpha interferon and ribavirin. The National Institutes of
Health Consensus Development Conference Panel recommended that therapy for
hepatitis C be limited to those patients who have histological evidence of
progressive disease. Thus, the panel recommended that all patients with
fibrosis or moderate to severe degrees of inflammation and necrosis on
liver biopsy should be treated and that patients with less severe
histological disease be managed on an individual basis. Patient selection
should not be based on the presence or absence of symptoms, the mode of
acquisition, the genotype of HCV RNA, or serum HCV RNA levels.
Patients with cirrhosis found through liver biopsy can be offered
therapy if they do not have signs of decompensation, such as ascites,
persistent jaundice, wasting, variceal hemorrhage, or hepatic
encephalopathy. However, interferon and combination therapy have not been
shown to improve survival or the ultimate outcome in patients with
preexisting cirrhosis.
Patients older than 60 years also should be managed on an individual
basis, since the benefit of treatment in these patients has not been well
documented and side effects appear to be worse in older patients.
The role of interferon therapy in children with hepatitis C remains
uncertain. Ribavirin has yet to be evaluated adequately in children, and
pediatric doses and safety have not been established. Thus, if children
with hepatitis C are treated, monotherapy is recommended, and ribavirin
should not be used outside of controlled clinical trials.
In people with both HCV and HIV infection, benefits of therapy for
hepatitis C have only recently been evaluated. The decision to treat
people co-infected with HIV must take into consideration the concurrent
medications and medical conditions. If CD4 counts are normal or minimally
abnormal (> 400/mL), responses are similar in frequency to those in
patients who are not infected with HIV. The efficacy of combination
therapy in HIV-infected people has been tested in only a small number of
patients. Ribavirin may still have significant interactions with other
antiretroviral drugs.
In many of these indefinite situations, the indications for therapy
should be reassessed at regular intervals. In view of the rapid
developments in hepatitis C today, better therapies may become available
within the next few years, at which point expanded indications for therapy
would be appropriate.
In patients with clinically significant extrahepatic manifestations,
such as cryoglobulinemia and glomerulonephritis, therapy with alpha
interferon can result in remission of the clinical symptoms and signs.
However, relapse after stopping therapy is common. In some patients,
continual, long-term alpha interferon therapy can be used despite
persistence of HCV RNA in serum if clinical symptoms and signs resolve on
therapy.
Who Should Not Be Treated?
Therapy is inadvisable outside of
controlled trials for patients who have
- Clinically decompensated cirrhosis because of hepatitis C.
- Normal aminotransferase levels.
- A kidney, liver, heart, or other solid-organ transplant.
- Specific contraindications to either monotherapy or combination
therapy.
Contraindications to alpha interferon therapy include severe depression
or other neuropsychiatric syndromes, active substance or alcohol abuse,
autoimmune disease (such as rheumatoid arthritis, lupus erythematosus, or
psoriasis) that is not well controlled, bone marrow compromise, and
inability to practice birth control. Contraindications to ribavirin and
thus combination therapy include marked anemia, renal dysfunction, and
coronary artery or cerebrovascular disease, and, again, inability to
practice birth control.
Alpha interferon has multiple neuropsychiatric effects. Prolonged
therapy can cause marked irritability, anxiety, personality changes,
depression, and even suicide or acute psychosis. Patients particularly
susceptible to these side effects are those with preexisting serious
psychiatric conditions and patients with neurological disease.
Strict abstinence from alcohol is recommended during therapy with
interferon. Interferon therapy can be associated with relapse in people
with a previous history of drug or alcohol abuse. Therefore, alpha
interferon should be given with caution to a patient who has only recently
stopped alcohol or substance abuse. Typically a 6-month abstinence is
recommended before starting therapy. Patients with continuing problems of
alcohol or substance abuse should only be treated in collaboration with
alcohol or substance abuse specialists or councilors. Patients can be
successfully treated while on methadone.
Alpha interferon therapy can induce autoantibodies, and a 6- to
12-month course triggers an autoimmune condition in about 2 percent of
patients, particularly if they have an underlying susceptibility to
autoimmunity (high titers of antinuclear or antithyroid antibodies, for
instance). Exacerbation of a known autoimmune disease (such as rheumatoid
arthritis or psoriasis) occurs commonly during interferon therapy.
Alpha interferon has bone marrow suppressive effects. Therefore,
patients with bone marrow compromise or cytopenias, such as low platelet
count (< 75,000 cells/mm3) or neutropenia (< 1,000
cells/mm3) should be treated cautiously and with frequent
monitoring of cell counts.
Ribavirin causes red cell hemolysis to a variable degree in almost all
patients. Therefore, patients with a preexisting hemolysis or anemia
(hemoglobin < 11 g or hematocrit < 33 percent) should not receive
ribavirin. Similarly, patients who have significant coronary or cerebral
vascular disease should not receive ribavirin, as the anemia caused by
treatment can trigger significant ischemia. Fatal myocardial infarctions
and strokes have been reported during combination therapy with alpha
interferon and ribavirin.
Ribavirin is excreted largely by the kidneys. Patients with renal
disease can develop hemolysis that is severe and even life-threatening.
Patients who have elevations in serum creatinine above 2.0 mg/dL should
not be treated with ribavirin.
Finally, ribavirin causes birth defects in animal studies and should
not be used in women who are not practicing adequate means of birth
control. Alpha interferon also should not be used in pregnant women as it
has direct antigrowth and antiproliferative effects.
Combination therapy should therefore be used with caution. Patients
should be fully informed of the potential side effects before starting
therapy.
Side Effects of Treatment
Common side effects of alpha interferon
(occurring in more than 10 percent of patients) include
- Fatigue
- Muscle aches
- Headaches
- Nausea and vomiting
- Skin irritation at the injection site
- Low-grade fever
- Weight loss
- Irritability
- Depression
- Mild bone marrow suppression
- Hair loss (reversible).
Most of these side effects are mild to moderate in
severity and can be managed. They are worse during the first few weeks of
treatment, especially with the first injection. Thereafter, side effects
diminish. Acetaminophen may be helpful for the muscle aches and low-grade
fever, and side effects may be less troublesome if interferon is taken in
the evening. Fatigue and depression are occasionally so troublesome that
the dose of interferon should be decreased or therapy stopped early.
Depression and personality changes can occur on interferon therapy and be
quite subtle and not readily admitted by the patient. These side effects
need careful monitoring.
Ribavirin also causes side effects, and the combination is generally
less well tolerated than interferon monotherapy. The most common side
effects of ribavirin are
- Anemia
- Fatigue and irritability
- Itching
- Skin rash
- Nasal stuffiness, sinusitis, and cough.
Ribavirin causes a dose-related hemolysis of red cells; with
combination therapy, hemoglobin usually decreases by 2 to 3 g/dL and the
hematocrit by 5 to 10 percent. The amount of decrease in hemoglobin is
highly variable. The decrease starts between weeks 1 and 4 of therapy and
can be precipitous. Some patients develop symptoms of anemia, including
fatigue, shortness of breath, palpitations, and headache.
The sudden drop in hemoglobin can precipitate angina pectoris in
susceptible people, and fatalities from acute myocardial infarction and
stroke have been reported in patients receiving combination therapy for
hepatitis C. For these important reasons, ribavirin should not be used in
patients with preexisting anemia or with significant coronary or cerebral
vascular disease. If such patients require therapy for hepatitis C, they
should receive alpha interferon monotherapy.
Ribavirin has also been found to cause itching and nasal stuffiness.
These are histamine-like side effects; they occur in 10 to 20 percent of
patients and are usually mild to moderate in severity. In some patients,
however, sinusitis, recurrent bronchitis, or asthma-like symptoms become
prominent. It is important that these symptoms be recognized as
attributable to ribavirin, because dose modification (by 200 mg per day)
or early discontinuation of treatment may be necessary.
Uncommon side effects of alpha interferon and combination therapy
(occurring in less than 2 percent of patients) include
- Autoimmune disease (especially thyroid disease)
- Severe bacterial infections
- Marked thrombocytopenia
- Marked neutropenia
- Seizures
- Depression and suicidal ideation or attempts
- Retinopathy (microhemorrhages)
- Hearing loss and tinnitus.
Rare side effects include acute congestive heart failure,
renal failure, vision loss, pulmonary fibrosis or pneumonitis, and sepsis.
Deaths have been reported from acute myocardial infarction, stroke,
suicide, and sepsis.
A unique but rare side effect is paradoxical worsening of the disease.
This is assumed to be caused by induction of autoimmune hepatitis, but its
cause is really unknown. Because of this possibility, aminotransferases
should be monitored. If ALT levels rise to greater than twice the baseline
values, therapy should be stopped and the patient monitored. Some patients
with this complication have required corticosteroid therapy to control the
hepatitis.
Options for Patients Who Do Not Respond to Treatment
Few options
exist for patients who either do not respond to therapy or who respond and
later relapse. Patients who relapse after a course of interferon
monotherapy may respond to a 24-week course of combination therapy,
particularly if they became and remained HCV RNA negative during the
period of monotherapy. Another approach is the use of long-term or
continual interferon, which is feasible only if the interferon is well
tolerated and has a clear-cut effect on serum aminotransferases and liver
histology, despite lack of clearance of HCV RNA. New medications and
approaches to treatment are needed. Most promising for the immediate
future are newer forms of "long-acting" interferons, which are alpha
interferons that are modified by polyethylene glycol (PEG) so that they
can be given once a week and yet provide a sustained level of interferon.
These "pegylated" formulations may avoid the peaks and troughs of
interferon levels and interferon side effects that occur when it is given
three times a week. Pegylated interferons and other experimental drugs
such as recombinant interleukin 10 (IL-10), are now being evaluated in
prospective controlled trials. Other promising approaches are the use of
other cytokines and the development of newer antivirals, such as RNA
polymerase, helicase, or protease inhibitors.
(Source: excerpt from
Chronic Hepatitis C Current Disease Management: NIDDK)
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Book Excerpts: Treatment of Chronic Hepatitis C
Treatments of Chronic Hepatitis C: Online Medical Books
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Hepatomegaly:
Treatment
(In a Page: Signs and Symptoms)
-
Heart failure: Diuretics, inotropes, and afterload reduction
-
Viral hepatitis: Supportive care and antivirals in some chronic cases
-
Alcoholic liver disease: Abstinence from alcohol, steroids in severe cases, and possible transplant
-
Fatty liver: Treat underlying obesity, diabetes, hyperlipidemia
-
Sarcoidosis: Steroids
-
Hemochromatosis: Iron removal by weekly phlebotomy for 2–3 years and/or deferoxamine chelation
-
Wilson's disease: Copper chelation with D-penicillamine or trientine; may require liver transplantation
-
Neoplasms: Resection and chemotherapy
-
Abscess or cyst: Antimicrobials, percutaneous drainage, and/or surgical resection
-
Amyloidosis: Prednisone and alkylating agents
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Jaundice:
Treatment
(In a Page: Signs and Symptoms)
-
Discontinue and avoid potentially hepatotoxic medications
-
Supportive care for viral hepatitis
-
Rehydrate/refeed for Gilbert's syndrome
-
Consider steroids in fulminant alcoholic hepatitis
-
Cholecystectomy or ERCP with stone removal for obstructing gallstones
-
Treat underlying causes of hemolysis or other disorders
-
Antibiotics for cholangitis, sepsis
-
Hydroxyurea and folate for sickle cell disease, prevent crises by adequate hydration, vaccinating against diseases, and try to prevent other infections
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Hepatomegaly:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Geared towards specific disease
-
Cholestasis
–Ursodeoxycholic acid
–Supplemental fat soluble vitamins A, D, E, K
-
Infections
–Consider interferon for hepatitis B
–Consider interferon and ribaviron for hepatitis C
-
Toxins
–Use of NTBC for tyrosinemia
-
Metabolic disease
–Metabolism consultation
–Often requires specific restricted formulas
-
Surgical repair for biliary atresia
–Kasai portoenterostomy has better outcome if done before 60 days of age
-
Mucomyst for acute acetaminophen toxicity
-
Immune suppression for autoimmune hepatitis
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Jaundice in Infants – Direct:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Varies by specific disorder
-
General medication principles of cholestasis include
–Promoting bile flow with ursodeoxycholic acid
–Consider phenobarbital (increases bile excretion)
–Fat-soluble vitamins including K, D, E
–Vitamin A is a relative contraindication given hepatotoxicity at high levels
Consider formula with medium chain triglycerides as fat source (does not require bile acids to be absorbed)
Treat underlying disorder
–Kasai portoenterostomy for biliary atresia
–Surgical repair of choledochal cyst
–Special formulas for tyrosinemia
–Lactose free formula for galactosemia (e.g., soy based)
–Remove toxic exposures
–Treat infections
–Treat hypothyroidism
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Jaundice in Infants – Indirect:
Treatment
(In A Page: Pediatric Signs and Symptoms)
-
Treatment options vary based on level of bilirubin, age of presentation, and cause
–Goal is prevent levels high enough to cause kernicterus
-
Phototherapy involves the use of photon energy to change the structure of bilirubin and permit excretion without glucuronidation
–Decisions for use are age-based
–Considered when serum level above 14 mg/dL
-
Exchange transfusion should be considered with serum levels above 25 mg/dL
-
IVF or breast-feed more frequently to increase volume
-
-
-
Correct endocrine abnormality
-
Improve perfusion if cardiac problem
-
Correct anatomic abnormality
-
Consider enteral binding agents
–Cholestyramine, charcoal, calcium phosphate
-
Crigler-Najjar: Phenobarbital, may need liver transplantation
» READ BOOK EXCERPT ONLINE »
Source: In A Page: Pediatric Signs and Symptoms, 2007
Jaundice [Icterus]:
Patient counseling
(Professional Guide to Signs & Symptoms (Fifth Edition))
Encourage the patient with a hepatic disorder to decrease his protein intake sharply and increase his intake of carbohydrates. If he has obstructive jaundice, encourage a nutritious, balanced diet (avoiding high-fat foods) and frequent small meals.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Hepatomegaly:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Instruct the patient to avoid alcohol. Explain the importance of following the treatment plan to correct or control the underlying disorder as needed. Tell the patient to avoid exposure to people with infections and to maintain good personal hygiene. Explain the importance of pacing activities and having frequent rest periods.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Jaundice:
Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Encourage the patient with a hepatic disorder to decrease his protein intake sharply and increase his intake of carbohydrates. If he has obstructive jaundice, encourage a nutritious, balanced diet (avoiding high-fat foods) and frequent small meals. Teach the patient ways to reduce pruritus.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Hepatomegaly:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ Prepare the patient for liver enzyme, alkaline phosphatase, bilirubin, albumin, and globulin studies to evaluate liver function and for X-rays, a liver scan, celiac arteriography, a computed tomography scan, and ultrasonography to confirm hepatomegaly.
▪ Provide bed rest, relief from stress, and adequate nutrition to help protect liver cells from further damage and to allow the liver to regenerate functioning cells.
▪ Monitor and restrict dietary protein as needed.
▪ Give hepatotoxic drugs or drugs metabolized by the liver in very small doses, if at all.
Patient teaching
▪ Explain the underlying disorder and its treatments.
▪ Stress the importance of avoiding alcohol and people with infections.
▪ Discuss the importance of pacing activities and rest periods.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Jaundice [Icterus]:
Nursing considerations
(Nursing: Interpreting Signs and Symptoms)
▪ To decrease pruritus, frequently bathe the patient; apply an antipruritic lotion, such as calamine; and administer diphenhydramine or hydroxyzine.
▪ Prepare the patient for diagnostic tests to evaluate biliary and hepatic function, including laboratory studies (such as urine and fecal urobilinogen, serum bilirubin, liver enzyme, and cholesterol levels; prothrombin time; and a complete blood count), computed tomography, ultrasonography, cholangiography, liver biopsy, and exploratory laparotomy.
Patient teaching
▪ Teach the patient appropriate dietary changes.
▪ Discuss ways to reduce pruritis.
▪ Review with the patient prescribed medications and their possible adverse effects.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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