At a glance: Roche hepatitis drug thrust onto front line

Is this NICE’s new guidelines on hepatitis B?

Indeed. The NHS in England and Wales is now recommended to use Roche's Pegasys (peginterferon alfa-2a) for the initial treatment of adults with chronic hepatitis B (CHB). The disease can cause severe liver damage. Pegasys is already licensed to treat hepatitis C.

What's the difference between hepatitis B and C? And what about A?
Well, they are each inflammations of the liver and tend to be spread virally by contact with infected blood or other bodily fluids. Hepatitis
A commonly affects children and is generally mild. Both B and C can lead to serious liver damage – the latter often affects HIV sufferers.

Who is Roche competing with in the CHB market?
GlaxoSmithKline's Epivir (lamivudine) is the best-known product in this disease area, although Schering-Plough's Intron A (interferon alfa-2b) is also used to treat CHB. As well as making Pegasys a frontline drug, NICE has recommended Gilead Sciences' Hepsera (adefovir dipivoxil), which slows the progression of CHB, as a treatment if other drugs are not successful or are rejected.

So GSK has a fight on its hands?
In trials, Pegasys has given a greater number of CHB sufferers lasting remission when compared with treatment with lamivudine. This may be partly because sufferers have been known to develop resistance to lamivudine over a course of treatment. Greg Page, Roche PR manager for oncology and virology, says the PR focus for Pegasys is on hepatitis specialists. A secondary audience will be GPs, whose role in recommending people for hepatitis B testing is crucial.

So what's the scale of the CHB problem?
Ninety per cent of people recover from hepatitis B infection and develop immunity to it in six months. If they don't, it becomes CHB and may well last for life. The number of UK carriers of hepatitis B is not known, but medical experts estimate 180,000 people have CHB – most of whom contracted it abroad. There are believed to be 350 million carriers worldwide, up to a quarter of whom will suffer liver diseases including cirrhosis and cancer.

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