It is as if some noble hepatologist found a bottle, rubbed it, got some wishes and "poof": Amazingly better cures for HCV appeared. Well, almost. It does not take much to improve upon the archaic, toxic and only modestly effective combination of interferon and ribavirin. The recent approvals of boceprevir and telaprevir are upgrades as far as response rates go, but they also pile on more side effects and complexity.
The genie, though, is on it: This year, we saw a maddening array of HCV drugs in development. It portends a future for HCV therapy that looks a lot like what we have for HIV now -- except we are talking cure here, people.
Pharmaceutical companies you have and have not heard of are conducting studies of potent molecules. Some of these agents play well with others, don't rely on interferon, and have been presented or described in press releases with rates of sustained virologic suppression that can make one giddy. Jeez Louise, some of these may even be able to lose the ribavirin and be coformulated! If even two or three of the drugs in later-stage development come to market, we are in for a revolution in HCV care.
There are less data regarding most of these promising agents in those who are coinfected with HIV, but what we have seen so far looks good. Drug interactions will need to continue to be investigated, certainly, but could the situation be much worse than what we have now?
That we are so tantalizingly close to a major medical breakthrough is exciting for our patients and us. Almost certain to make it to the FDA approval finish line will be sofosbuvir, the tongue-punishing name of an NRTI in the final phases of clinical study, including in HIV coinfection. Daclastasvir, an NS5A inhibitor, also looks potent and promising.
Learning how to best use these new drugs will be our task over the next couple of years, but it was in 2012 that the notion of short-course, well-tolerated, highly active, interferon-free HCV therapy became more than wishful thinking.