A combination drug therapy for hepatitis C has cured almost half of patients tested. Experts say the results, described in tomorrow's New England Journal of Medicine, make a good case for giving both ribavirin and interferon alfa-2b as a standard treatment. But they note that even more effective drugs will be needed to eliminate the virus from all patients.
One of the most common infections in the world, hepatitis C is carried by an estimated 170 million people. While most people show no symptoms, some 20% develop chronic inflammation that scars and destroys the liver. The virus kills about 10,000 people every year. Until recently, the only accepted treatment was 6 months of repeated interferon injections to stimulate an immune response against the virus. This approach, experts say, manages to cure less than 20% of patients who undergo it. Recent clinical trials showed that the antiviral drug ribavirin could boost the effectiveness of interferon, but few patients have been tested.
Two teams have now studied the drug combo in randomized, controlled trials. John McHutchinson of the Scripps Clinic in La Jolla, California, gave daily doses of either the combination or interferon alone to 912 previously untreated patients. After 6 months, the combo had rid the virus from the blood of 31% of subjects in that group. "For a chronic disease, we've got something that's very impressive," says McHutchinson. Another trial, led by Gary Davis of the University of Florida, Gainesville, tried the drug combo on 345 patients who had been successfully treated with interferon alone but later relapsed. This cured 49% of patients. (The success rate was higher than in the Scripps trial because the Florida trial's relapsed patients were known to respond to interferon.) The studies were funded in part by Schering-Plough, which makes both drugs.
The findings represent "a breakthrough in treatment of hepatitis C," says Jake Liang, a researcher at the National Institute of Diabetes and Digestive and Kidney Diseases. But he says that it will take the discovery of new drugs to see more dramatic improvements in therapy.