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Are Sofusbuvir,Ribavirin And Interferon Effective In Treatment Of Hepatitis C?

Posted on Wed, 17 Sep 2014

Question: I am a 59 year old white male who was diagnosed 32 years ago with Hepatitis C (type 1A) and have never received any sort of treatment for Hep C. After seeing the results of my recent blood work and liver biopsy the internal disease specialist I am working with told me that 80% of my liver has cirrhosis. The other 20% he said is fibrotic and still curable with the new drugs approved by the FDA late last year. He told me that I have 3rd stage hepatitis C with a viral load of 6.7 logs?, and is putting me on a 12 week med regime of Sofusbuvir , Ribavirin, and interferon. He said that a person can live a normal life with only 10% of the liver in tact.

I am aware that Sofusbuvir in combination with at least one other of the new medications including; ledipasvir, simeprevir, daclatasvir, asunaprevir and faldaprevir has a 92% cure rate and very mild, if any, side effects. I am wondering why my doctor is putting me on three medications only one of which is in the group of new medications, i.e., sofusbuvir. Interferon and Ribavarin are old school, potentially dangerous with brutal side effects, some of which can be permanent. We are awaiting authorization from BCBS for the Sovaldi and then I’ll get started. A little confused though!

Here are my questions:

1.     Why might he be prescribing ribavirin and interferon with the Sofusbuvir rather than in combination with one of the other new milder medications? (I intend to ask him but didn’t get a chance in yesterday’s appointment)
2.     Is 6.7 logs a really high viral load ?
3.     Do you agree that a person can live a normal life with 10% of their liver intact?
4.     Is my risk of cancer high going forward, (assuming the 20% of my liver that is intact is cured)?
5.     What is your overall impression of my situation in terms of seriousness, prognosis, etc.
6.     Should I get a 2nd opinion or is time of the essence and I should just suck it up and get started with treatment?

Answered by Dr. Bhagyalaxmi Nalaparaju (4 hours later)

Brief Answer:
Answers below.

Detailed Answer:
Hello XXXXXXX

I understand your concerns and my comments are as follows:

1. Yes, those listed in your query (ledipasvir, simeprevir, daclatasvir, asunaprevir and faldaprevir) are new medicines. However the effects of these with combination (with sofusbuvir) are still not fully known. This combination of sofusbuvir with newer drugs is still under clinical trails. For example sofusbuvir with ledipasvir still yet to be approved. Perhaps the reason why your treating doctor prescribed Sofusbuvir with interferon+ribavirin combination medication.

2. Viral load more than 8 log is considered as very high. Less than 8 log means your prognosis is good with treatment.

3. The prognosis of liver condition depends on other factors including bilirubin levels, ascitis and so on. If you are clinically alright, you will be able to live with 10% liver. However be in touch with your treating doctor. Avoid over the counter medications or new therapies.

4. Yes, with cirrhosis of liver there is chance of liver cancer. But if you take complete course of treatment then the chance is decreased to less than 3%.

5. As I mentioned in the past we cannot comment about the prognosis with complete details and clinical examination. It depends upon your body immunity and your body response to your treatment.

6. If you have still doubt with the current treatment, you can consult a new gastro enterologist.

Hope I have answered your query.
Thank you.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Bhagyalaxmi Nalaparaju (2 days later)

Follow-up question. I would like to take a month or so to get a 2nd opinion, probably at the Mayo Clinic in XXXXXXX Minnesota and/or look at options for treatment in XXXXXXX I have dual citizenship Irish/American and am eligible for government healthcare. They have just approved the combination of Sofusbuvir with Daclatasvir which has little or no side effects and a 98% cure rate. It has been approved for all EU countries. Plus for Irish Citizens with chronic Hepatitis C medications are paid for by the government. I have chronic Hepatitis C type 1A and I have no fatigue, nausea, jaundice, swelling, water retention, diarrhea, pain, etc. I have had the illness for 30 years and My doctor tells me 80% of my liver has cirrhosis. My viral load is 6.7 logs. I have lost about 15 to 20 pounds of weight without trying. My appetite is normal. My liver is not enlarged at all and my spleen shows "a slight protrusion" according to my doctor.

My question is this: Am I taking a big risk if I postpone treatment two months? Or do I have a little bit of time to explore treatment in XXXXXXX or a second opinion at the Mayo Clinic? Thanks much.

XXXX

Answered by Dr. Bhagyalaxmi Nalaparaju (15 hours later)

Brief Answer:
Get a second opinion.

Detailed Answer:
Hello XXXXXXX
I am very sorry for delay in response.
Yes,the combination of Sofusbuvir with Daclatasvir has been approved only for Europian contries.
I would suggest you get a second opinion at Mayo clinic or XXXXXXX
Since you have 80% of liver cirrhosis and weight loss I suggest you better go for treatment in XXXXXXX or at mayo clinic as early as possible to decrease risk.You can wait for few more days but not for 2 months.
Until you get a second opinion I suggest be in touch with your treating doctor at least for supportive treatment and to know about progression of disease or symptoms and also get liver function test done.
Kindly discuss about post pone of treatment with your current treating doctor since he knows very well about your health condition.

Once again I am sorry for delayed response.
If you have any queries I will be happy to help you.
Thank you.

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Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju