Hepatitis News

New hep C drugs strut their stuff

The nature and success rate of hepatitis C (HCV) treatment should be transformed in 2-3 years’ time, if early results from trials of a number of new drugs are anything to go by.

At the recent European AIDS Conference, Spain’s Dr Vincent Sorriano said that there were some 16 compounds currently under investigation as possible HCV treatments. They work in a similar way to HIV drugs, interfering with the way viral enzymes called protease and polymerase make new viruses. However in HCV viral elimination is possible, although interferon would probably always have to be included in anti-HCV combination therapy for a complete cure.
The following week at the American Association for the Study of Liver Disease (AASLD) Conference, results from trials of three new drugs were presented.

The furthest along in development is nitazoxanide (Alinia®). This drug was originally developed as a treatment for the AIDS-related bug cryptosporidium, but it was then found to have anti-HCV properties.
The study presented at AASLD was conducted in Egypt, which has high levels of infection with genotype 4 of HCV, a subtype of the virus that is particularly hard to treat and is increasingly spreading to southern Europe.

The addition of nitazoxanide to standard pegylated interferon/ribavirin (pegIFN/RBV) therapy increased the proportion of patients cured of genotype 4 from 48% to 79%. When used with pegIFN alone and no RBV the cure rate was 68%.

Nitazoxanide manufacturers Romark are currently conducting a large trial of the drug in the USA for patients who’ve failed previously on standard pegIFN/RBV therapy and who have HCV genotype 1, the other hard-to-treat kind. They will start a trial in patients new to therapy in 2008.

The two other drugs presented have so far only been used in short 14- or 28-day trials by themselves to check for their safety and see how they work against HCV.

They so far are only designated by the numbers R1626 and R7128 and are being developed by Roche, who make the Pegasys brand of pegIFN. Both are nucleoside polymerase inhibitors.

The first drug given twice-daily for 28 days produced an undetectable HCV viral load in 81% of patients given it, with an average 160,000-fold viral load reduction. The second, given in four different doses for 14 days, produced a 500-fold viral load drop at the largest dose, with one person already reaching undetectability by this time.

The two drugs are being advanced into larger treatment studies in combination with pegIFN/RBV.

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