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With the newest forms of antiviral treatment, the most common types of chronic hepatitis C can be cured in most individuals.
The treatment of chronic hepatitis C has gone through several generations of medications. Not long ago, treatment was limited to interferon alpha-2b (Intron A) or pegylated interferon alpha-2b (Pegetron), and ribavirin (RibaPak and others). Interferon and pegylated interferon need to be injected under the skin (subcutaneously), while ribavirin is taken by mouth. This combination therapy is infrequently used today, being recommended for only the least common genotypes of hepatitis C virus (HCV).
Since 2010, direct-acting antiviral (DAA) drugs have been in use. The second generation of antivirals for HCV were the protease inhibitors telaprevir (Incivek) and boceprevir (Victrelis), both taken by mouth. These were used in combination with the earlier drugs to increase effectiveness (efficacy). These drugs are also no longer in common use, and have been replaced by better options.
As more has been learned about how hepatitis C virus multiplies (reproduces) within the liver cells, new drugs continue to be developed to interfere with this multiplication at different stages. As such, we no longer think in terms of generations of drugs, but rather categories of action. Research and development of these direct-acting antivirals continue, with new agents coming to market every few months. Each category is improved and expanded by the addition of new drugs, which are safer and more effective.
As previously mentioned, there are multiple genotypes of HCV. Different antiviral drugs are approved and recommended for different genotypes, based upon the demonstrated effectiveness in clinical trials. This is especially true because the recommended therapy for any given genotype changes frequently as new drugs and new research become available. A detailed description of all the recommendations, options, and how they work is beyond the scope of this article. All of these drugs should be used only under the management of a medical specialist.
Currently available and commonly used direct-acting antiviral drugs include:
- simeprevir (Olysio)
- paritaprevir/ritonavir (always combined)
- daclatasvir (Daklinza)
- sofosbuvir (Sovaldi)
Some of these (those without a brand name in parenthesis) are only used in fixed combination drugs:
- ombitasvir, paritaprevir/ritonavir (Technivie)
- ombitasvir, paritaprevir/ritonavir and dasabuvir (Viekira Pak)
- ledipasvir sofosbuvir (Harvoni)
- elbasvir grazoprevir (Zepatier)
- glecaprevir pibrentasavir (Mavyret)
- sofobuvir velpatasavir (Epclusa)
For more information, read our full medical article on hepatitis C.
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Jensen DM. A new era of hepatitis C therapy begins. N Engl J Med. 2011 Mar 31;364(13):1272-4.
Rosen HR. Clinical practice. Chronic hepatitis C infection. N Engl J Med. 2011 Jun 23;364(25):2429-38