Is hepatitis C fully treatable with oral direct-acting agents?

A new systematic evidence review has demonstrated that USA Food and Drug Administration (FDA)-approved oral direct-acting antiviral (DAA) regimens appear to produce high sustained virologic response rates against hepatitis C. The authors suggest these findings provide evidence that hepatitis C is fully treatable; however, barriers to treatment need to be addressed.

Rapid improvements in therapies for hepatitis C have led tot he approval of multiple DAA regimens by the FDA in recent years. The authors aimed to summarize the published literature on these therapies, examining the safety and efficacy of oral DAAs.

The study, published recently in the Annals of Internal Medicine, reviewed data from 42 published clinical trials of adults with chronic hepatitis C infection. In order to qualify the trials were required to have evaluated at least 8 weeks of an interferon-free regimen including at least two FDA-approved DAAs.

The researchers, from John Hopkins University (MD, USA), discovered that DAA regimens produced high sustained virologic response rates against all six genotypes of hepatitis C. They demonstrated that six DAA regimens produced sustained virologic response rates of >95% in patients with HCV genotype 1 without cirrhosis. Rates were similarly high for the remaining genotypes, although genotype 2 saw fewer effective regimens.

Sustained virological response rates were high even for those with HIV co-infection; a patient population historically considered challenging to treat.

The authors suggest their findings provide hope that hepatitis C is now fully treatable and therefore could potentially be eliminated. However, they highlight that barriers to treatment, such as cost and access to care, are still present in the USA and must be addressed.

Sources: Falade-Nwulia O, Suarez-Cuervo C, Nelson DR, Fried MW, Segal JB & Sulkowski MS. Oral Direct-Acting Agent Therapy for Hepatitis C Virus Infection: A Systematic Review . Ann Intern Med. doi:10.7326/M16-2575 (2017) (Epub ahead of print);


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