New, highly effective direct acting antivirals for treating hepatitis C are now available under the Pharmaceutical Benefits Scheme (PBS).
Until 1 March 2016, standard therapy for hepatitis C has been a combination of pegylated interferon and ribavirin with or without simeprevir.
This therapy has significant side effects and varying success rates. For most people new treatments using direct acting antivirals (DAA) offer success rates of 90 per cent or more, fewer side effects and shorter treatment periods. The new drugs available in Australia on the Pharmaceutical Benefits Scheme (PBS) are sofosbuvir, daclatasvir, sofosbuvir/ ledipasvir and a combination of ombitasvir, paritaprevir, ritonavir and dasabuvir.
Hepatitis C treatment in Australia
Hepatitis C treatment options depend on genotype and other individual factors such as disease severity, co-morbidities and previous treatment experience.
These new DAA medicines for hepatitis C are taken orally as tablets, mostly once a day. They are used in various combinations with each other and/or with ribavirin and/or pegylated interferon. Most combinations are interferon-free.
Following is a brief outline of the new treatments. It is not meant to replace your doctor's advice. Speak to your specialist about the treatment option that's best for you and for more details about the specific regimen prescribed for you.
Preparing for treatment
If you are considering treatment your viral hepatitis nurse will ensure that all the necessary tests are done before you begin. The tests may include:
- Fibroscan - a non-invasive scan to assess the extent of fibrosis, if any, in your liver.
- Genotype test to determine which strain of the hepatitis C virus you have so that the most suitable therapy can be prescribed.
- Viral load test to determine the amount of virus in your blood. This is used as a baseline for monitoring your progress through treatment.
Your treatment nurse will also help you to be prepared physically so you are most able to cope with side effects, and talk with you about mental preparation and social supports during treatment.
Who can prescribe the new treatments?
Your specialist can prescribe the new treatments. Your GP may also prescribe the new treatments, provided they are experienced in the treatment of chronic hepatitis C or do it in consultation with a specialist experienced in the treatment of chronic hepatitis C. More information.
Who can dispense the new drugs?
The new medicines can be dispensed by hospital or community pharmacies depending on who wrote the script. Hepatitis SA has compiled a guide to South Australian pharmacies which dispense the new drugs.
The most common hepatitis C strains in Australia are genotype 1 (54%) and genotype 3 (37%). New therapies for these two genotypes are:
Genotype 1 treatment
Genotype 1 hepatitis C can be treated with:
- Sofosbuvir + daclatasvir with or without ribavirin for 12 to 24 weeks.
- Sofosbuvir/ledipasvir (Harvoni ®) for 12 to 24 weeks. This combination comes pre-combined in one tablet.
- Ombitasvir + paritaprevir + ritonavir tablets and dasabuvir tablet (also known as Viekira Pak) for 12 to 24 weeks, with or without ribavirin.
Genotype 3 treatment
First line treatment for hepatitis C genotype 3 consists of:
- Sofosbuvir + daclatasvir for 12 to 24 weeks.
- Sofosbuvir + ribavirin for 24 weeks.
Alternative treatments include:
- Sofosbuvir + pegylated interferon + ribavirin for 12 weeks
Call the Hepatitis SA Helpline on 1800 437 222 for information on treatment for other genotypes.
Possible side effects for the new DAAs, interferon and ribavirin are as follows:
- Sofosbuvir - generally well tolerated with few recognised side effects.
- Daclatasvir - fatigue, nausea, headaches and diarrhoea.
- Sofosbuvir/ledipasvir (Harvoni ®) - fatigue and headaches.
- Viekira Pak – Feeling sick, itching, insomnia, lack of energy, tiredness, headaches, anaemia.
- Interferon - flu-like symptoms, nausea, weight loss, depression, mood disturbances, anaemia, impaired blood clotting, dry skin and hair-thinning.
- Ribavirin - anaemia, rashes and nausea. Associated with birth defects. Contraception is essential for BOTH men and women during and for six months after treatment.
For the best chance of a cure, it is vital that you take all medicines as directed by your doctor.
If you are taking other medicines including over the counter drugs or herbal remedies, please check with your specialist as there may be harmful interactions which may affect your chance of a cure.
There are recognised drug interactions between these DAAs and some HIV medicines, anti-mycobacterials, St John’s Wort and some other common medicines.
You will receive regular monitoring during treatment. This is done with blood tests that measure the level of virus in your blood.
If the amount of virus in your blood drops to an undetectable level and remains undetectable for 12 weeks after you complete treatment, it is known as a Sustained Virological Response (SVR). This effectively means you are cured.
What if treatment doesn't work?
There is much on-going research into new drugs and combinations so if available treatments didn't work for you, stay in touch with your liver nurses or doctors.
It is important to maintain regular liver health checks and keep up to date on when new and more suitable treatments may be available. For information about clinical trials, talk to your doctor or viral hepatitis nurse.
Information on clinical trials in Australia can also be found on the Australian Clinical Trials. Read more about it at http://bit.ly/ozclintrials.
Support and information
There are many factors to weigh up when deciding whether treatment is right for you at this time. Speak to your GP, liver nurse or specialist or call the Hepatitis Helpline.
Hepatitis SA can answer many of your questions and talk to you about any concerns you have. We can also put you in touch with other people who have been on treatment who can share their experiences with you. Having a supportive network of friends, family and services will be invaluable if you decide to start treatment.
Helpline: 1800 437 222
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