Hepatitis C, drug resistance, and personalized medicine

A huge boost to treatment for the Hepatitis C virus (HCV) is on the horizon, as two pharmaceutical companies are set to release new drugs to market.  And with development complete, the marketing war begins.

Forbes reports that Merck has won FDA approval for Victrelis, and the drug, which costs $35,000 for the course of treatment, will hit pharmacies’ shelves by next week, along with the company’s targeted marketing campaign.

But Merck is on the clock, since a favorable approval from the FDA expected on rival drug, Incivek, manufactured by Vertex Pharmaceuticals by the end of the month.

A quick look into the Phase III studies conducted by Merck and Vertex reveals that both HCV drugs are protease inhibitors intended to be given in combination with other currently available treatments. And a paper published this past February in Science Translational Medicine provides a plausible explanation why, going forward, choosing the proper drug cocktail for each patient will be crucial.

It seems that HCV can rapidly mutate, perhaps even faster than HIV or Hepatitis B, and successfully combating this disease will require substantial efforts in personalized medicine:

Overall, this study predicts that rapid emergence of HCV protease inhibitor resistance in patients, particularly those with genotype 1a infection and with high viral loads, is expected. Combination therapies of direct antivirals with/without IFN+/-RBV would be promising to combat drug resistance. However, as with HIV, they need to be chosen carefully and with regard to both preexisting and on-treatment generated drug-resistant variants.

  By Brian Mossop