HepCInfo Updates

HepCInfo Update 9.11  

Welcome to CATIE's HepCInfo Update 9.11 for May 12 to May 25, 2018. Read on to learn more about new and updated scientific findings in hepatitis C prevention, care, treatment and support.

We sometimes report on experimental use of hepatitis C drugs. For information on the approved use of hepatitis C treatment in Canada, see the Hepatitis C drugs approved in Canada for adults chart and fact sheets on each hepatitis C treatment.

New and noteworthy

Cannabis use does not impact hepatitis C cure rates

People who used cannabis had similar cure rates to people who did not use cannabis, while people who used alcohol were just as likely to complete treatment as those who didn’t but were more likely to be lost to follow up, reported German researchers at the International Liver Congress in Paris.

The 7,747 participants who received hepatitis C treatment with direct-acting antivirals (DAAs) were part of a German national multicenter non-interventional real-world registry.

Participants were broken into groups in relation to drug use experience:

  • People using opioid substitution therapy (OST), 739
  • People with a history of drug use but not using OST, 1,500
  • People without history of drug use, 5,508

In the group of people without a history of drug use, 13.9% consumed alcohol above recommended limits and 1.2% used cannabis. In the group with a history of drug use but not using OST, 22% used alcohol above limits and 9.6% used cannabis. In the group using OST, 25% consumed alcohol above the limit and 19.2% used cannabis.

People who used cannabis had a very similar cure rate (91.2%) to those did not use cannabis (92.3%).

Of the people who consumed alcohol, the group of people who did not have a history of drug use had a higher cure rate of 91.2% compared to 83.4% and 83.5% in people using OST and people with a drug use history but not using OST, respectively. However, people who consumed alcohol above the limit were more likely to be lost to follow up, lowering the cure rate. Most of these people were lost to follow up after the end of their course of treatment so there is a high likelihood they were also cured.  

According to the researchers, “High [cure] rates can be achieved in all patient groups ... especially in the group of patients on opioid substitution therapy and patients with former or current drug use.” (Healio.com, April 2018)

DAA treatment effective in people with advanced cirrhosis

People with advanced cirrhosis have high cure rates with direct-acting antiviral treatment, reported researchers at the International Liver Congress in Paris.

The study included 473 people from the HCV-TARGET study with advanced cirrhosis using the Model of End-Stage Liver Disease (MELD), which uses results from blood tests to predict the chances of survival in the short-term.  Participants with a MELD score higher than 10 were the focus of this analysis.

The higher the MELD score the greater the risk of death in the short-term. Each participant received direct-acting antiviral (DAA) treatment which contained an NS5A inhibitor between March 2014 and June 2017. Of the 473 participants there was information on the cure rate 12-weeks post-treatment for 373 people.

The cure rate in relation to the severity of cirrhosis was stratified by model for end-stage liver disease (MELD) score,

Cure rates stratified by MELD SCORE range:

  • 10 and 15 - 90% cure rate
  • 16 and 21 without ribavirin - 90% cure rate
  • 16 and 21 with ribavirin - 100% cure rate
  • greater than 21 – 100% cure rates

Presence of ascites, history of liver cancer and having a low level of albumin less than 3.5 predicted treatment failure when adjusted for age and gender.
Serious adverse events occurred in 20% of participants during treatment or within 30 days after treatment and 15 people died during treatment or within three months after.

According to the researchers,”…despite achieving SVR, patients with advanced liver disease may still be at considerable risk of decompensation and [hepatocellular carcinoma]. Studies evaluating long-term transplant free survival are needed to better understand the benefits of treatment among patients with advanced liver disease.” (Healio.com, April 2018)

Fewer non-liver cancers in people treated with DAA’s compared to interferon treatment

The risk of non-liver cancers is lower in people treated with direct-acting antivirals compared to people treated with interferon, reported researchers at the International Liver Congress in Paris.

Using U.S. health insurance claims databases, the researchers compared people treated for hepatitis C in two periods:

  1. January 2006 to May 2011, when people would have been exposed to interferon or peg-interferon only (10, 989 people)
  2. December 2013 to March 2017, when people would have been exposed to direct-acting antiviral (DAA) treatment (22, 894 people)

These periods exclude the first generation of DAAs that were used in combination with interferon.

The risk of cancers strongly associated with hepatitis C, such as non-Hodgkin lymphoma and bile duct cancer were not lower in people treated with DAAs.

Prostate cancer, lung cancer, bladder cancer and leukemia occurred less frequently in people treated with DAAs.

The percentage reduction in risk included:

  • Overall risk of any major cancer – 14%
  • Leukemia- 62%
  • Prostate cancer – 29%

According to the researchers, “The overall reduction in the risk of major cancers may reflect the difference in cure rates between people treated with interferon-based regimens and people treated with much more effective DAA regimens.” (infohep.org, May 2018)

Straight to the source for new science

New virological tools for screening, diagnosis and monitoring of hepatitis B and C in resource-limited settings, Journal of Hepatology, May 2018