Effects of delaying Hepatitis C treatment Now that better and more effective treatments exist for Hepatitis C (HCV), should all – not just the sickest – patients be eligible for these therapies? David Rowlands’ latest poll examines the issues around treating earlier or waiting. Deferring antiviral therapy for HCV until a person progresses to advanced liver disease has clear drawbacks, including lower treatment effectiveness and an increased risk of clinical events and death, according to a study of US veterans presented at the European Association for the Study of the Liver (EASL) 50th International Liver Congress in Vienna recently. Over years, or decades, chronic HCV infection can lead to serious liver disease including cirrhosis, hepatocellular carcinoma (liver cancer), and need for a liver transplant. When the standard of care for HCV was interferon-based therapy, with its long course of treatment, poor tolerability, and only modest cure rate, experts generally recommended delaying treatment until a patient developed advanced disease. Now that much more effective and well-tolerated interferon-free direct-acting antiviral therapy is available, a growing number of providers and advocates say that everyone living with HCV should be eligible. But treatment is still often limited to the sickest patients, because of the high cost of the new drugs.
Treatment-experienced people
People living with HCV who have failed to respond to previous regimens containing direct-acting antivirals may be more difficult
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to cure, either through drug resistance or because of host factors, such as liver damage. Several studies of interferon-free combinations presented at the International Liver Congress showed that new regimens can be highly effective in this group of patients. An interferon-free regimen over a 12-week period produced sustained response rates of 83 per cent for people with HCV who had advanced liver cirrhosis and 94 per cent for people who had received liver transplants, with similar cure rates for those with hardto-treat HCV genotype 3, according to findings from the ALLY-1 trial. James, 32, from Leicester: “I have previously successfully completed hepatitis C treatment and was re-infected again within the first year. While I feel I did benefit from doing the treatment, I am going to wait for newer, more tolerable treatments with fewer side effects to become available on the NHS.”
Previously untreated people
A 12-week course of the combination of grazoprevir and elbasvir cured 95 per cent of previously untreated people with genotypes 1, 4 or 6 HCV infection, according to results of the C-EDGE trial. The grazoprevir/elbasvir combination pill is due to be submitted for regulatory approval
Treatment is still often limited to the sickest patients, because of the high cost of the new drugs
David Rowlands
in the US, Europe and other countries shortly, and may be approved by the end of 2015. It will be the third all-oral, interferonfree combination to be marketed exclusively by one company. Maria, 56, from London: “I have been living with hepatitis C for the past 22 years. I was fortunate to be accepted onto a new trial and successfully completed my treatment within 12 weeks. I was able to continue to work and found that I had minimal & manageable side effects. I feel I now have a higher energy level and able to plan a brighter and clearer future.” The latest poll investigated this issue, posing the question: ‘Should people living with hepatitis C access hepatitis treatment now? Or should they wait for emerging therapies?’ Out of 142 respondents, 49.9 per cent