Response to Hepatitis C treatment: no benefits and possible harm, By Ronald Koretz, M.D., by Lucinda K. Porter, RN
Thank you for your thought-provoking opinion. Although I don’t agree with much of it, I certainly appreciate the opportunity to explore this issue. I’d like to make a couple of points:
1) Hepatitis C mortality and morbidity stats are deceiving since they don’t take in to consideration non-liver-related causes of death. http://cid.oxfordjournals.org/content/53/2/150
2) Successful clearance of HCV lowers all-cause mortality rates www.jwatch.org/jg201301110000001/2013/01/11/successful-clearance-hepatitis-c-virus
3) Projected # of cases of HCV-related cirrhosis are increasing with estimates around 1 million by 2020 www.milliman.com/insight/research/health/Consequences-of-Hepatitis-C-Virus-HCV-Costs-of-a-Baby-Boomer-Epidemic-of-Liver-Disease/
4) Many cost-analyses have been published showing that HCV treatment is cost-effective compared to the cost of no treatment
The part of your article I appreciate most is your obvious concern about putting patients through interferon treatment. I know these side effects well as I have been though HCV treatment 3 times, and have walked with many patients through their treatments in my work as a hepatology nurse and HCV advocate. Living with a potentially infectious virus is a private hell. The damage from the stigma and fear of infecting others far outweighs the damage to the liver.
Fortunately, more effective treatments with easier to tolerate side effects are around the corner, with the first interferon-free regimen positioned to be approved in December for genotype 2/3. Many other drugs are right behind.
As for current generations of HCV medications—I don’t think of them as toxic—I think of them as medicine.
Lucinda K. Porter, RN Author of Free from Hepatitis C and Hepatitis C Treatment One Step at a Time – Inspiration and Practical Tips for Successful Treatment (October 2013 release) LucindaPorterRN.com
Article: Hepatitis C treatment: no benefits and possible harm, By Ronald Koretz, M.D.
Patients with hepatitis C have two concerns. The first concern relates to how likely it is that he or she will develop end-stage liver disease, namely either symptoms of cirrhosis that will incapacitate them, lead to the need for a liver transplantation, or even death, or primary liver cancer (hepatocellular carcinoma). The second concern is what can be done to prevent, or at least reduce the likelihood of, the development of those conditions. The first relates to the natural history of the process and the second relates to the benefit of treatment.
Concluding comment by Dr. Koretz:
Given the natural history of chronic hepatitis C, as well as what we know therapy accomplishes, it is very difficult to justify a policy for routinely treating such patients to prevent decompensated liver disease. The surrogate outcomes were not valid in the one occasion when validation information was available. The treatment has not been proven to be efficacious with regard to preventing clinically important disease, it is expensive, and it causes substantial morbidity (including death). It is an inappropriate clinical decision to prescribe a toxic therapy (especially an expensive one) that has never been shown to provide clinical benefit in properly-done randomized trials.