HepCInfo Updates

HepCinfoUpdate 7.22 

Welcome to CATIE's HepCInfo Update 7.22 for November 12 to November 25, 2016. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

Eight-week, triple-drug treatment cures most participants, but cure rate lower than 12 weeks of Epclusa

A three-drug combination of sofosbuvir, velpatasvir and voxilaprevir taken for eight weeks cured 95% of participants with genotype 1 to 6 virus but failed to match the cure rate of 12 weeks of Epclusa in a head-to-head trial, reported researchers at the 2016 American Association for the Study of Liver Diseases (AASLD) Liver Meeting.

The study included 941 participants from North America, Europe, Australia and New Zealand. 

Participants had either not been treated before (75%) or had been treated with interferon based treatment (25%). About 19% of participants had cirrhosis, but people with genotype 3 virus and cirrhosis were enrolled in a different study.

Participants with genotypes 1 to 4 virus received either the triple combination for eight weeks or Epclusa for 12 weeks. All participants with genotype 5 and 6 virus received the triple combination. Epclusa is approved in Canada.

Overall, the cure rate across all genotypes was 95% for the eight week triple therapy compared to 98% for the 12-week double therapy. The lower cure rate with the triple combination was mainly due to 14 relapses in people with genotype 1a virus.

 Additionally, participants with cirrhosis had a lower cure rate with the eight-week triple therapy (91%) compared to the 12-week dual therapy (98%).

The comparison of two combinations teased out a higher relapse rate for genotype 1a virus infections that wasn’t apparent in mid-stage clinical trials. According to the researchers, “this demonstrates the value of large controlled trials to compare highly effective regimens.” (HIVandhepatitis.com, November 2016)

Harvoni effective for people with HIV and hepatitis C in real world studies

Real world studies of Harvoni in people co-infected with HIV and hepatitis C had similar cure rates to people in clinical trials, reported researchers at the 2016 American Association for the Study of Liver Diseases (AASLD) Liver Meeting.

With newer direct-acting antiviral (DAAs) treatments, cure rates in clinical trials for people co-infected with hepatitis C and HIV are similar to those for people who have hepatitis C alone.  However, cure rates in real life clinical practise do not always match those from clinical trials.

The current analysis compared results from three clinical trials (Gilead Sciences' ION-4 trial, The National Institute of Health ERADICATE trial and The French ANRS HC31 SOFTRIH trial) to four real world studies (The TRIO cohort, The Institute of Human Virology's ASCEND cohort, a cohort from Portugal and a U.S. Veterans Affairs (VA) cohort).

All participants had genotype 1 virus and well controlled HIV.  The majority were men, and most did not have cirrhosis.

Participants in the clinical trials received Harvoni with or without ribavirin for 12 weeks, while participants in the real world studies received Harvoni for eight, 12 or 24 weeks.

Overall, cure rates were 97% for the clinical trials and 94% for the real world studies.

These findings show that HIV/hepatitis C co-infected patients with HCV genotype 1 can do as well in real world clinical practice as in clinical trials. (HIVandhepatitis.com, November 2016)

Mail outreach doubles liver cancer screening in people with cirrhosis

Mail outreach strategies were effective at increasing liver cancer screening rates in people with cirrhosis, reported researchers in Gastroenterology.

People with cirrhosis are at risk for developing liver cancer even if they have been cured of hepatitis C and need to be screened regularly using ultrasound.

Patients from a hospital in Dallas, Texas with proven or suspected cirrhosis were randomized to receive one of three interventions:

  1. Mailed invitation for an ultrasound screening (600 people)
  2. Mailed invitation for an ultrasound screening and patient navigation (600 people)
  3. Usual care: screening at a regular appointment (600 people)

Patient navigation consisted of receiving phone calls from research staff to explore barriers to attending the screening and motivational education to encourage screening.

Participants who didn’t respond to the invitation received up to three reminder phone calls.

Ultrasound screening was higher in people who received one of the first two interventions (47% and 44.5% respectively) compared to people who received usual care (24%). There was no statistical difference between the first two interventions.

Although mail outreach strategies were effective, liver cancer screening in both groups was still below 50%. According to researchers, “this highlights the need for more intensive intervention.” (Healio.com, November, 2016)

Straight to the source for new science

Use of transient elastography in patients with HIV–HCV coinfection: A systematic review and meta-analysis, Journal of Gastroenterology and Hepatology, October 2016)