HepCInfo Update 8.8
Welcome to CATIE's HepCInfo Update 8.8 for April 1 to April 14, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.
New and noteworthy
Alberta has expanded access to six hepatitis C medications. New hepatitis C drugs added to the Alberta formulary are asunaprevir, daclatasvir, Epclusa and Zepatier. In addition, coverage is expanding for Harvoni and sofosbuvir.
In February 2017, the pan-Canadian Pharmaceutical Alliance (pCPA), the body that represents provinces and territories in drug pricing agreements, negotiated an agreement with several pharmaceutical companies to lower prices for six hepatitis C medications.
After a pCPA deal is reached each province and territory decides how it will implement the changes to its formulary. (globalnews.ca, April 2017)
On April 7, 2017, the U.S. Food and Drug Administration (FDA) approved Harvoni and sofosbuvir for youth aged 12 to 17 who weigh over 35 kilograms. These are the first direct-acting antiviral medications (DAAs) approved for people under the age of 18.
Prior to this approval, peg-interferon and ribavirin was the only available treatment. This treatment is less effective than currently available DAAs and causes difficult side effects.
In a study of 12 weeks of Harvoni in 100 youth aged 12 to 17 with genotype 1 virus, the cure rate was 97%. Similar to clinical trials with adults, headache and fatigue were the most common side effects.
In a study of 50 youth (age 12 to 17) with genotype 2 or 3 virus who took sofosbuvir and ribavirin for either 12 weeks (genotype 2 virus ) or 24 weeks (genotype 3 virus), the cure was 100% for genotype 2 virus and 97% for genotype 3 virus. (HIVandhepatitis.com, April 2017)
Almost all participants in a specialised treatment program for homeless people with hepatitis C were cured of hepatitis C, reported researchers in JAMA Internal Medicine.
The hepatitis C treatment team at the Boston Health Care for the Homeless Program treated 64 people with direct-acting anti-viral medications (DAAs) between February 2014 and 2015. The treatment team consisted of a care coordinator, a nurse, two nurse practitioners and two primary care doctors.
The average of participants was 55.5 years. The majority (77%) were men and 47% were white. Most patients (49) had genotype 1 virus, three patients had genotype 2 virus, three had genotype 4 virus and seven had mixed genotypes. Participants accessing treatment through Medicaid were required to have moderate liver injury (F2 fibrosis) to qualify for treatment due to state requirements.
Participants took one of the following treatments: Harvoni (50 people), sofosbuvir and ribavirin (4 people), ledipasvir and ribavirin (5 people) or simeprevir and sofosbuvir (5 people).
Participants had an initial evaluation that included hepatitis C testing and discussion of a treatment plan. During treatment, participant received weekly calls from the care coordinator and follow up appointments, including one 12 weeks after the end of treatment.
Overall cure rate was 97% (62 of 64 participants were cured). According to the researchers, “These findings demonstrate that with a dedicated program for treating hepatitis C in [homeless and marginally housed] adults in the primary care setting, it is possible to achieve outcomes similar to those of clinical trials…” (Healio.com, April 2017)
Straight to the source for new science
Long-term effect of sustained virological response on hepatocellular carcinoma in patients with hepatitis C in Canada, Journal of Hepatology, March 2017