Chronic Hepatitis C
Optimizing Care In A Rapidly Changing Landscape
Sandy Hickey, RPh
Ryan Nolan, PharmD, MBA, CSP
Diplomat Specialty Pharmacy
The authors report no financial conflicts with any products discussed in this paper.
In only a few decades drug therapy for chronic
hepatitis C has evolved tremendously from interferononly monotherapy to the anticipated interferon-free
oral regimens that are expected to come to market
in 2014. Over time we have also seen incredible
improvements in drug effectiveness, ease of
administration, and side effect profiles. Today, with
over 20 oral therapies in phase II and III trials, we are
anticipating significant changes in the approach to
hepatitis C drug therapy.1 The treatment of hepatitis
C has never been simple. Specialty pharmacies
and their high-touch models of care help alleviate
the complexities of treatment through patient
education, side effect management, laboratory
reminders, and response-guided therapy. In order
to continue providing innovative, high-quality care,
specialty pharmacies must prepare and educate their
organizations on what’s coming. In this article we
will discuss the history of hepatitis C drug therapy,
current treatment strategies, the drug development
pipeline, and the care needed to support patients on
their treatment journey.
Introduction
The hepatitis C virus (HCV) is the most common
blood borne pathogen in the United States (U.S.)
affecting approximately 3-4 million people.2 There
are six genotypes associated with HCV; genotype 1
is the most prevalent in the U.S. and has historically
been the most difficult to treat.3 Of those infected,
45% to 85% of patients are not aware that they
have the virus because of its insidiously slow and
silent spread.4 Those that are exposed to the virus
are commonly asymptomatic or the symptoms they
develop are mild and can be confused with other
ailments that include abdominal pain, fatigue, fever,
loss of appetite, and nausea.3 HCV infection is most
prevalent among those born between the years of
1945-1965.4 Injection drug use is considered the
single largest risk factor for infection.5 Other risk
factors associated with transmission include the
receipt of blood, blood products, or organs donated
prior to 1992, use of clotting factors prior to 1987,
needlestick injuries in a professional setting, tattoos,
or vertical transmission from an infected mother to
her child during birth.5
Approximately 85% of patients infected with HCV will
go on to develop chronic HCV.3 If left untreated the
chronic inflammation of the liver can lead to fibrosis,
cirrhosis, and hepatocellular carcinoma.3 The goal of
treating HCV is to eradicate the infection.3 Therapy
is considered successful when patients achieve
sustained virologic response (SVR).3 Sustained
virologic response is defined as undetectable viral
levels measured 12-24 weeks after the completion
of therapy.3 While many factors can influence the
ability to achieve SVR, adherence to therapy is one
of the most significant. In one study it was found that
patients were much more likely to achieve SVR when
they were at least 80% adherent to their therapy
regimen.6
3