HepCInfo Updates

HepCInfo Update 8.15  

Welcome to CATIE's HepCInfo Update 8.15 for July 8 to July 21, 2017. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

FDA approves a new DAA combination for hepatitis C re-treatment

On July 18th, the U.S. Food and Drug Administration (FDA) approved Vosevi, a direct-acting antiviral (DAA) combination for people previously treated but not cured from hepatitis C treatment.

Vosevi includes three DAAs: sofosbuvir, an NS5B polymerase inhibitor, velpatasvir, an NS5A inhibitor and voxilaprevir, a protease inhibitor. These medications are combined into one tablet that is taken once per day for 12 weeks. Vosevi fills an unmet need for people who have been previously treated but not cured. This group can be harder to cure because the hepatitis C virus they have may have developed resistance to one or more classes of DAAs, which can reduce the effectiveness of treatment.

In a late-stage trial of Vosevi in 263 people with genotypes 1 to 6 virus who had previously been treated with an NS5A inhibitor, 96% of participants were cured.

Vosevi was generally safe and well tolerated in clinical trials. The most common side effects were headache, fatigue, diarrhea and nausea.

Vosevi is approved for people with or without compensated cirrhosis but is not approved for people with severe decompensated cirrhosis. Vosevi is not currently approved in Canada. (HIVandhepatitis.com, July 2017)

Sofosbuvir and ribavirin cures youth with genotype 2 or 3 hepatitis C virus

Sofosbuvir and ribavirin cured almost all youth with genotype 2 or 3 virus, reported researchers at the Pediatric Academic Societies meeting in San Francisco, U.S.

New hepatitis C treatments have not been extensively tested in children and youth and until recently, interferon-based treatments were the standard of care for this group.

The study included 50 youth from the U.S., U.K., Europe, Russia, Australia and New Zealand. Participants with genotype 2 virus took sofosbuvir and ribavirin for 12 weeks and participants with genotype 3 virus took the combination for 24 weeks.

None of the participants with genotype 2 virus had been previously treatment but 24% of the participants with genotype 3 virus had been previously treated.

The cure rates for participants with genotype 2 virus was 100%. The cure rate for participants with genotype 3 virus was 97%. The most common side effects were headache and nausea.

According to the researchers, "sofosbuvir plus ribavirin represents an important treatment option for adolescents with chronic HCV genotype 2 or 3 infection.” (HIVandhepatitis.com, May 2017)

Being cured of hepatitis C reduces the risk of non-liver related diseases

The risks of having several non-liver related complications related to hepatitis C are reduced after a person is cured of hepatitis C, reported researchers in the journal Gut.

This was a retrospective study of data from patients in the U.S. Veterans Affairs HCV Clinical Case Registry. Each person had tested positive for hepatitis C RNA between 1999 and 2009. People who received hepatitis C treatment took interferon-based therapy.

The study population comprised 161,000 HCV RNA-positive people, of whom 31,000 received treatment and 10,500 were cured.

The researchers evaluated the risk of having eight different non-liver related conditions in people treated and cured of hepatitis C compared to people who were not treated for hepatitis C.

Compared to participants who were not treated, participants who were treated and cured of hepatitis C were less likely to have the following conditions:

  • Mixed cryoglobulinaemia (a blood disorder), adjusted hazard ration (aHR) = 0.61
  • Glomerulonephritis (a type of kidney disease), aHR = 0.62
  • Porphyria cutanea tarda or PCT (a build up of chemicals that affects the skin and nervous system), aHR = 0.41
  • Non-Hodgkin lymphoma (a cancer that starts in blood cells), aHR = 0.64
  • Diabetes mellitus, aHR = 0.82
  • Stroke, aHR = 0.84

The researchers also examined the likelihood of having lichen planus (an itchy rash) and coronary heart disease but did not find a reduced risk in people who were cured of hepatitis C.

When people who were treated and cured were compared to people who were treated but not cured, people who were cured had a lower risk of mixed cryoglobulinaemia (aHR = 0.55), glomerulonephritis (aHR = 0.75), PCT (aHR = 0.31) and diabetes (aHR = 0.72).

Treatment was only protective against the risk of glomerulonephritis and stroke if started within one or two years of a hepatitis C diagnosis. Treatment was only beneficial in reducing the risk of non-Hodgkin lymphoma if started within a year of diagnosis.

According to the researchers, “we observed a significant reduction in the risk of several extra-hepatic manifestations (EHMs) of chronic hepatitis C with [treatment] and attainment of sustained virological response (SVR).” (infohep.org, July 2017)

Straight to the source for new science

Direct-acting antiviral therapy decreases hepatocellular carcinoma recurrence rate in cirrhotic patients with chronic hepatitis C, Liver International, August 2017

Acceptability and design preferences of supervised injection services among people who inject drugs in a mid-sized Canadian city, Harm Reduction Journal, July 2017