PEGYLATED INTERFERON Pegylated interferon is a time-released interferon and is believed that by maintaining constant levels of interferon in the blood that the hepatitis C virus can not replicate as successfully. Recent studies have reported a higher response rate. August 8, 2001 the FDA Approved PEG-Intron (Peginterferon alfa-2b) for use in combination with Rebetol (ribavirin) capsules. PEG-Intron with Rebetol appears to be somewhat more effective than Intron A with Rebetol. The Intron A with Rebetol was 46% compared to the Peg-intron with Rebetol of 52%.
AMANTADINE (Symmetrel) is an antiviral medication used to treat influenza A. It is also used as a triple combination with interferon and ribavirin. A small study showed that Amantadine, Interferon and Ribavirin combination was effective in treating people with HCV who did not respond to interferon monotherapy. Further studies are needed and approval is pending as a treatment for HCV.
MAXIMINE is most effective in combination with interferon. It is medication that is believed to work by reversing immune suppression that is caused by viruses and is taken in combination with interferon. More studies are needed and FDA approval is pending.
HELICASE INHIBITORS Prevents unwinding of double-stranded viral RNA during HCV replication. 2001 - 2001
PROTEASE INHIBITORS Prevents cleavage of large viral protein into smaller segments. 2001 2003
RNA-DEPENDANT RNA HCV GENOME POLYMERASE INHIBITORS Prevents replication of copying of the HCV genome. 2001-2003
IRES (INTERNAL RIBOSOMAL ENTRY SITE) INHIBITORS Prevents the expression of viral proteins. 2001-2003
DNA VACCINES Stimulate cytotoxic T cell activity. 2008
DOMINANT NEGATIVE MUTANTS Block viral protein production 2008
RIBAVIRIN The most common side effect is anemia. This is seen more often in older persons taking ribavirin. The anemia can be serious in patients who have kidney problems. With the anemia there is usually a darkening in the color of urine. In patients who have coronary artery disease (narrowing of blood vessels in the heart), this anemia may make the problem worse, leading to chest pain or, rarely, heart attack. Other side effects are itching, cough and muscle pain. Inflammation and pain in your joints (gout) has been reported in people taking ribavirin. Effects on the nervous system such as depression, which may be severe; nervousness; difficulty sleeping; and dizziness may also occur
Note - Each person reacts differently to interferon. Some people don't have many symptoms during interferon treatment. With most people side effects decrease after being on therapy for awhile.
TREATMENT RESPONSE A person is more likely to have a sustained response (clearing the virus from your blood and keeping it gone even after therapy has discontinued) if: · Has a genotype other than 1. Unfortunately the most common genotype in the US is genotype 1 and is the hardest to treat. This doesn't mean that people with genotype 1 cannot clear the virus. Genotype 2 and 3 just have higher response rate and seem to respond better to interferon. · Female · Low viral load (less than 2 million) · Has been infected for a shorter time and has moderate disease
MANAGING TREATMENT SIDE EFFECTS
· Muscle and joint pain. The most common side effect is muscle and joint pain, which can be treated with acetaminophen (Tylenol) in low doses (2 grams per day). High doses of Tylenol can be toxic to the liver. Keep as active as possible. Exercise helps with joint and muscle aches but don't overdo and rest when tired. · Fatigue: It may help to have a daily nap or rest period. Daily activity and exercise can also help with fatigue. · DRINK WATER!!!!!! Drinking 2 glasses of water with 2 regular strength Tylenol taken just before you have your injection will help with side effects. Drink at least 2 ½ quarts of fluid a day to avoid dehydration. This is one of the most important things that you can do to help reduce the side effects of therapy. · Nausea and loss of appetite. A little ginger can help with nausea. Eating small meals frequently throughout the day may be helpful. · Depression/ anxiety - Be sure to tell your Doctor when and if you start feeling depressed. There are antidepressants that can help with this. Medications can now be given to help with anemia and thrombocytopenia. Anemia - Erythropoietin (Procrit). Thrombocytopenia - Interleukin 11 (Neumega). · Skin - Rotate infection site and keep skin moisturized. · Joining a support group can be very helpful and is highly recommended. (especially when on therapy).
During interferon therapy you will need frequent blood tests. The main reason for doing these blood tests is to be certain your blood counts are adequate. Interferon reduces the white blood cell count (anemia) and the platelet count (thrombocytopenia). This effect of interferon is directly related to the dose used. Sometimes the dose of interferon may need to be reduced or even discontinued. Your physician will also need to watch out for other rare side effects, including thyroid disease or the development of other autoimmune disorders.
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