HepCInfo Updates

HepCInfo Update 9.8 

Welcome to CATIE's HepCInfo Update 9.8 for March 31 to April 13, 2018. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

New and noteworthy

Eight weeks of Epclusa cures most participants with moderate liver injury taking OST

Eight weeks of Epclusa cured 93% of participants with moderate liver injury who were taking opiate substitution therapy reported researchers at the 2018 International Liver Congress in Paris.

Twelve weeks of Epclusa is highly effective in curing people with genotype 3 virus. One study found high cure rates for eight weeks of Epclusa in people with no cirrhosis who had not been treated. This study was investigating if eight weeks of Epclusa would be effective in people with genotype 3 virus who did not have cirrhosis.   

The study took place in Glasgow, Scotland and included 90 participants with genotype 3 virus who had a moderate level of liver injury (F2 or F3) who had never been treated for hepatitis C. The researchers reported on the interim results of 45 participants who had completed treatment and were undetectable for the hepatitis C virus 12 weeks after treatment (known as SVR12 or a cure).

Most participants were male (80%) and the average age was 46 years old. Six participants were treated in prison. Under half (42%) were receiving opiate substitution therapy (OST) daily.

Epclusa is a combination of two direct-acting antiviral medications (DAAs), sofosbuvir and velpatasvir. The medications are combined into one pill that is take once daily.

Epclusa was given as daily directly observed treatment along with OST for those injecting drugs or in the early stages of recovery. People who were considered stable received medication and OST two to three times a week to take home. All medication was dispensed by community pharmacies with the exception of treatment provided to people in prison.

Forty-three people were cured (93%). Of the three people who were not cured, one person discontinued treatment, one person died and one person was re-infected.

According to the researchers, “Patients on daily supervised OST have excellent SVR rates when given DAAs along with OST. Widespread adoption of 8 weeks treatment would reduce drug acquisition costs, and increase clinic treatment capacity, without sacrificing SVR.”

Eight weeks of Zepatier cures most people with acute hepatitis C

An eight week treatment of Zepatier cured 94% of participants with acute hepatitis C reported researchers at the 25th Conference on Retroviruses and Opportunistic Infections (CROI 2018) in Boston.

Zepatier consists of two direct-acting antiviral medications, grazoprevir and elbasvir. The medications are combined into one pill that is take once daily.

The Dutch Acute HCV in HIV study (DAHHS2) included 80 participants from the Netherlands and Belgium. The interim results presented at the conference involved 63 participants who completed treatment and had an undetectable hepatitis C viral load 12 weeks after treatment. This is considered a cure.

All participants were gay and bisexual men with either genotype 1 or 4 virus. The average age of participants was 47 years and more than 90% also had HIV. All of the participants with HIV were taking HIV treatment and most had an undetectable viral load.

Treatment was started a maximum of 26 weeks after the estimated date of hepatitis C infection. Treatment was generally safe and well tolerated.
Most people (59/63) were cured. Of the four people that were not cured, one person relapsed and the hepatitis C virus returned and three people became re-infected.

According to the researchers, “…prompt, brief treatment during acute infection could halt onward transmission and contribute to the elimination of [hepatitis C] among HIV-positive men who have sex with men, given that spontaneous clearance is uncommon in this population.” (infohep.org, April 2018)

Real-world study shows eight weeks of Maviret effective in people without cirrhosis

Interim results from a real-world study of eight weeks of Maviret demonstrated high cure rates in people without cirrhosis, reported researchers at the 2018 International Liver Congress in Paris.

Before this study, available research on the effectiveness of eight weeks of Maviret were only completed as late-stage clinical trials so it was unclear how these results would compare to results in the real-world.

Participants were from the German Hepatitis C-Registry which is a registry of all German people with hepatitis C who are being treated by a private doctor.

Participants in this study were mostly male (68%), with a mid-range in age of 47 years and had never been previously treated (90%). The majority of participants had minimal liver injury (93%).

Maviret consists of two direct-acting antiviral medications, glecaprevir and pibrentasvir. This treatment combination is effective against all genotypes of the virus.

Since the treatment was approved in Germany in July 2017, 317 people in the present study have begun treatment with Maviret. Data was available for 96 people who completed treatment and had a viral load test 12 weeks post-treatment. Most of these people (97%) were cured from treatment. One person was lost to follow-up and two people discontinued treatment due to adverse events that were determined to not be related to Maviret.

According to the researchers, “Eight weeks of therapy is possible for all naïve, non-cirrhotic patients, regardless of genotype.” (infohep.org, April 2018)

Straight to the source for new science

Longitudinal injecting risk behaviours among people with a history of injecting drug use in an Australian prison setting: The HITS-p study, The International Journal of Drug Policy, April 2018