NEW YORK (Reuters Health) – For people with mild cases of hepatitis C, combination drug therapy appears not only to be more likely to prolong life and to prevent complications such as cirrhosis, but also to be more cost-effective than a strategy of “watchful waiting,” according to new research.
An estimated 170 million people worldwide and 2.7 million in the US have chronic hepatitis C infection. Because of the lag time between infection and illness, the disease often goes undetected for years until a person develops serious complications.
Even when hepatitis C is detected early, deciding what, if any, treatment is needed is difficult, according to Dr. John B. Wong, of New England Medical Center in Boston, Massachusetts.
“Not everyone (with hepatitis C) will develop advanced liver disease though, but at this time, physicians cannot accurately distinguish those who will progress from those who will not” he told Reuters Health.
The best way to decide on a treatment is to analyze a small sample of liver tissue through a procedure called a biopsy, according to Wong. If the biopsy indicates cirrhosis, which is severe scarring of the liver, pre-cirrhosis or substantial inflammation of the liver, then most doctors would recommend treatment, Wong explained. For people with normal biopsy results, treatment is not usually recommended, he said.
The tricky decision is what to do with people with mild inflammation of the liver, the Boston researcher added. Combination drug therapy with interferon and ribavirin may treat the hepatitis infection, but the drugs can cause unpleasant side effects and do not clear the virus in all people, Wong said.
But the “watchful waiting” approach requires a person to have repeated liver biopsies, which carry a “small but real” risk of complications, Wong said. He also pointed out that drug therapy may not be as effective when started after scarring has occurred or in older people.
Using a computer model, Wong’s team analyzed the long-term effects of the different approaches. Writing in the November 7th issue of the Annals of Internal Medicine, the authors report that immediate treatment should lead to increased survival and lower costs than the watchful waiting approach.
The investigators estimate that over the course of 20 years, the risk of cirrhosis would be 18% in patients who underwent a biopsy every 3 years, 16% in those treated immediately and 27% in those who received no treatment. They suggest that beginning treatment immediately would extend the life expectancy of a person with mild hepatitis C by an average of one year compared to someone who underwent regular biopsies instead.
However, Wong and colleagues note that there is a need to find an inexpensive, noninvasive way to evaluate liver tissue and to predict which people with hepatitis C are most likely to become ill.
The research team received funding from Schering-Plough, the company that makes the antiviral drugs used to treat hepatitis C. Two of the researchers have received additional funding from the company and one serves as a consultant to Schering-Plough.
SOURCE: Annals of Internal Medicine 2000;133:665-675.