HEPATITIS C TREATMENT
Goals of treatment:
Treatment of chronic HCV infection has 2 goals.
- The first is to achieve sustained eradication of HCV (i.e., SVR), which defined as the continued absence of detectable HCV RNA at least 12 weeks after completion of therapy.
- The second goal is to prevent progression to cirrhosis, hepatocellular carcinoma (HCC), and decompensated liver disease requiring liver transplantation.
Patients who are cured of their HCV infection experience numerous health benefits, including a decrease in liver inflammation as reflected by improved aminotransferase (i.e., alanine aminotransferase [ALT], aspartate aminotransferase [AST]) levels and a reduction in the rate of progression of liver fibrosis. Cure of HCV infection also reduces symptoms and mortality from severe extrahepatic manifestations, including cryoglobulinemic vasculitis, a condition affecting 10% to 15% of HCV-infected patients.
Treatment for Chronic Hepatitis C Infection
Progression in HCV treatment
- PegInterferon and Ribavirin
In the past, Hepatitis C treatment was based on therapy with interferon and Ribavirin, which required weekly injections for 48 weeks, cured approximately half of treated patients, but caused frequent and sometimes life-threatening adverse reactions. However, only around 50% of people taking PegInterferon and Ribavirin for 12 months were cured.
Recently, new antiviral drugs have been developed. These medicines, called direct antiviral agents (DAA) are much more effective, safer and better-tolerated than the older therapies. Therapy with DAAs can cure most persons with HCV infection and treatment is shorter (usually 12 weeks) and safer.
December 2013, FDA had approved for Sofosbuvir in Hepatitis C treatment. With new medicine, treatment duration has reduced from 48 weeks to 12-24 weeks, increased cured rate, reduced side effects. Sofosbuvir uses oral, hence more convenience for patients.
- Ledipasvir and Sofosbuvir
On October 10, 2014, the fixed-dose combination Ledipasvir-Sofosbuvir (Harvoni) was approved by the FDA for the treatment of chronic Hepatitis C Geno-type 1 infection in adults. On November 12, 2015 the FDA expanded the approval of Ledipasvir-Sofosbuvir to include (a) treatment of chronic Hepatitis C Geno-types 4, 5, and 6 and (b) patients co-infected with HIV. On February 12, 2016 the FDA further expanded the approval of Ledipasvir-Sofosbuvir to include (a) treatment of chronic Hepatitis C Geno-types 1 and 4 in liver transplant recipients without cirrhosis or compensated cirrhosis, and (b) patients with Geno-types 1 infection who have decompensated cirrhosis.
- Velpatasvir and sofosbuvir
- A pan-genotypic regimen of sofosbuvir and velpatasvir produces significantly higher SVR rates among patients with HCV genotypes 1 to 6 supported by Class 1A or 1B strength of evidence (AASLD Guidelines April 2017)
- Combination of sofosbuvir-velpatasvir shows a significant improvement of the patient reported outcomes during treatment and after achieving SVR in patients with genotype 1, 2,3, 4, 5 and 6
- The once daily, single fixed-dose combination of sofosbuvir (400 mg) and velpatasvir (100 mg) has been approved by US FDA for the treatment of chronic HCV genotype 1 to 6 in adults
- Sofosbuvir (400 mg) and velpatasvir (100 mg) is approved in combination with ribavirin for patients with decompensated cirrhosis
- The single tablet regimen of SOF/VPV administered for 12 weeks was well tolerated in HCV/HIV co-infected patients with GT 1–4, regardless of past treatment experience or presence of cirrhosis.