NICE has recommended the use of boceprevir (Victrelis) and telaprevir (Incivo), both in combination with peginterferon alfa and ribavirin, as options for the treatment of the most common strain of hepatitis C in adults, in latest guidance.
Hepatitis C is a blood-borne virus that is transmitted by contact with contaminated blood. The most common way in England and Wales that people are infected with hepatitis C is by sharing equipment to inject drugs.
According to the Health Protection Agency, there were 8,147 reported new cases of hepatitis C in England and Wales during 2010 but the true figure is probably much higher. It is estimated that around 255,000 people in England and Wales have hepatitis C, with around 146,000 infected chronically.
Approximately 15 per cent of those infected with hepatitis C virus will naturally clear the virus from their body and experience no long-term effects from the infection.
However, for the remaining 85 per cent, chronic infection will develop which can cause significant damage to the liver and may eventually lead to liver cirrhosis or liver cancer.
Genotype 1 is the most common subtype of hepatitis C in England and Wales affecting around half of people with hepatitis - and is the most resistant to treatment.
Poor diagnosis rates, low treatment compliance rates and a high annual incidence of new infection mean that chronic hepatitis C presents a major public health challenge, despite the availability of treatments that provide the opportunity to address this challenge.
This latest guidance recommends boceprevir and telaprevir as options for the treatment of people with genotype 1 chronic hepatitis C, in combination with peginterferon alfa and ribavirin, in adult patients with compensated liver disease who are previously untreated or in whom previous treatment has failed.
Both boceprevir and telaprevir work by inhibiting the activity of the NS3/4A serine protease. This protease is essential for viral replication and may be partially responsible for the ability of the hepatitis C virus to evade clearance by the host immune system.
The drugs are administered orally three times a day. Clinical trials have demonstrated that treatment with boceprevir or telaprevir plus pegylated interferon and ribavirin, produces higher sustained virological response rates (considered to be equivalent to a cure) than pegylated interferon and ribavirin combination therapy.
Professor Carole Longson, Health Technology Evaluation Centre Director at NICE, said: “The significant improvement in sustained virological response rates seen with boceprevir or telaprevir plus peginterferon alfa and ribavirin compared with peginterferon alfa and ribavirin alone represents a major benefit for people with genotype 1 chronic hepatitis C.
“In the past, patients have declined treatment because the perceived chance of a sustained virological response with peginterferon alfa plus ribavirin was too low for them to accept the associated side effects. We are therefore very pleased to be able to recommend boceprevir and telaprevir as a cost-effective use of NHS resources.”