Multiple DAAs provide quality care for HCV patients

Multiple oral direct-acting antiviral (DAA) regimens are safe, tolerable and effective in the treatment of hepatitis C virus (HCV) genotype 1 infection, particularly among patients without cirrhosis, according to a new systematic review.

“The HCV world and knowledge about treatments is evolving rapidly, with multiple trials published in many journals. We wanted to bring together everything in one place to help busy primary care physicians navigate this maze,” lead author Oluwaseun Falade-Nwulia, MBBS, MPH, assistant professor in the division of infectious disease at John Hopkins University, told Medical Economics.

The researchers published their results March 21, 2017 in Annals of Internal Medicine.

They conducted a systematic review of 42 published randomized controlled trials of 10 agents in all six HCV genotypes, as well as in patients with and without cirrhosis, previous treatment, HIV coinfection, and liver transplantation. The trials included patients who had received at least 8 weeks of an FDA-approved interferon-free HCV regimen that comprised at least two DAAs.

Six DAA regimens showed high sustained virologic response (SVR) rates of more than 95% in patients with HCV genotype 1 infection without cirrhosis, including those with HIV co-infection.

Two regimens - sofosbuvir plus velpatasvir or sofosbuvir plus daclatasvir for 12 weeks - were effective in HCV genotype 3 infection.

Serious adverse events and treatment discontinuation rates were less than 10%. The addition of ribavirin was associated with increased SVR rates for patients with HCV genotype 1a or 3 infection, cirrhosis, or previous treatment experience, and led to more mild or moderate adverse events.

Next: Primary care and HCV treatment

“We hope that primary care physicians who have not traditionally dealt with HCV may consider providing care for these patients,” said Falade-Nwulia. “The majority of patients with all types of HCV who don’t have severe liver disease could benefit.”

The goal, she said, is to avoid advanced liver disease, which is harder to treat. Patients with decompensated liver disease who are already symptomatic may need more complex treatment provided by specialists.

Many primary care physicians have become inured with the side effects profile associated with interferon treatment of HCV. “We now have multiple all-oral medications, including those that can be given once daily, with a low risk of side effects,” she said, adding that other regimens in phase 3 clinical trials were not included in the systematic review. “Options continue to increase to treat HCV.”

She noted that all data included in the systematic review come from clinical trials, not real-world patients.

Primary care physicians working in communities have the ability to have an impact on HCV care since up to half of HCV patients in the U.S. are not aware that they are infected. “The first step to treatment is awareness. All those born between 1945 and 1965 should have one HCV test. We have an opportunity to link patients to treatment. Clinicians who know their patients well can provide the services required to possibly eliminate this disease. To do that, we need the majority of infected patients to be treated,” said Falade-Nwulia.