Hepatitis C is on the rise among adolescents. Where do new antivirals fit in the treatment picture?

liver hepatitis C antivirals adolescents

Direct-acting antiviral drugs like sofosbuvir have provided amazing (albeit very expensive) outcomes in patients with hepatitis C (HCV), with cure rates approaching 90 percent. Can these medications—which promise a rapid cure of HCV, as opposed to long-term management of the virus and its complications—do the same for children?

The answer is, we don’t yet know. We need to figure it out quickly, though, because as Gastroenterology & Endoscopy News (G&EN) reports, doctors are seeing a surge of HCV cases associated with injection drug use among adolescents and young adults.

But we may have more information soon. Maureen Jonas, MD, clinical director of the Center for Childhood Liver Disease at Boston Children’s Hospital, tells G&EN that pediatric studies of these drugs are ongoing. Though none of the data have been published yet, she expects good things from them and advises delaying treatment of pediatric hepatitis C patients if possible until new drugs are approved:

So far, Dr. Jonas said there is no reason to believe that children will not experience cure rates above 90 percent with 12 weeks of direct-acting antivirals, as do adults. That prospect makes the currently available drugs, which may require a year-long regimen and only cure about half of patients, an unappealing option for pediatric patients, she said.

“It’s hard to justify treating children with the currently approved medications,” she said.

That recommendation could be a bitter pill for some families:

Dr. Jonas acknowledged that with ads promoting the effectiveness of direct-acting antivirals for adults, it might be a challenge to explain to parents why the treatments are not yet available for children and adolescents.

“It’s just as hard to tell families with children we want to wait,” she said.

So what should providers, patients and families do while awaiting the trials’ results?

[Jonas] and her colleagues teach patients and their families how to prevent further transmission, provide vaccinations against hepatitis A and B, and recommend that patients maintain a healthy weight. For patients with a history of using injected drugs, she also recommends drug treatment and advises about the hazards of alcohol use for those with HCV.

Read more about treatment options for hepatitis C infections in adolescents on G&EN.