Real-Life Results of Sofosbuvir Based Therapy for Egyptian Patients with Hepatitis C and Advanced Fibrosis-Cirrhosis

Doss, Wahid; Esmat, G.; El-Serafy, Magdi; Elakel, Wafaa; Yosry, Ayman; El-Sayed, Manal Hamdy; Hassany, Mohamed; El-Kassas, M.; Kabil, Khaled; Waked, Imam

doi:10.1016/s0168-8278(16)01505-1

Cited by 6 publications

(6 citation statements)

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“…As part of this plan, the NCCVH negotiated the price of DAAs down to 1% of the US price, 222 without precluding local production of generics. The introduction of locally produced generics in late 2015 reduced the cost of 12 weeks' treatment with sofosbuvir and daclatasvir to about US$80, resulting in a massive treatment uptake of about 1m patients in 2016 and 2017 219,223 . As a result, Egypt is on the path to meet elimination targets for HCV by 2030 or even earlier.…”

Section: Success Stories and Ongoing Challenges [H3]mentioning

confidence: 99%

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Cooke

Andrieux-Meyer

Applegate

et al. 2019

The Lancet Gastroenterology & Hepatology

445

391

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investments to support countries with greatest burden of viral hepatitis All heavily burdened countries to have fully funded elimination plans by 2019 Recognition of need to focus on high burden countries and support for national policy development (All) Funding for national elimination plans Creation of fiscal space for new programmes with costed investment programmes Adopt domestic innovative finance tools where appropriate Support national policy makers in their activity (WHO, UNITAID, NGOs) Provide international support for financing measures (UNITAID, GFATM, bilaterial donors) Prevention Ensure all WHO elimination targets addressed in plans Address operational challenges in delivery of birth dose HBV vaccine Ensure provision of harm reduction services and engage with marginalised group (e.g. prisoners, PWIDs). Ensure clear public health messages to encourage testing and treatment Support countries to decriminalise injecting drug use and ensure equitable access to services for all (NGOs, WHO, civil society) Ensure appropriate funding for HBV vaccine, including birth dose (GAVI, WHO) Support R&D into HCV vaccine development (Research funders and pharma) Testing and Models of Care Focus on substantially scaling up testing for HBV and HCV Create and evaluate simplified care pathways relevant to local setting, integrating with existing services. Promote task sharing and decentralisation of care through capacity building, training and removal of Support operational research into simplified pathways (Research funders, UNITAID) requirements for specialised prescribing Diagnostics Ensure testing is integrated into the wider healthcare system, rather than centralised facilties Ensure access to quality diagnostics through Essential Diagnostic List and prequalification (WHO, funders) Support implementation science for models of care and R&D into novel diagnostics suitable for decentralised settings. (Research funders, FIND, industry) Access to treatment Ensure all Essential Medicines for viral hepatitis are included in national programmes, with an emphasis on pan-genotypic regimens Apply comprehensive policy approach to promoting access, including compulsory licensing Ensure all essential medicines are pre-qualified and either available through voluntary licensing or Medicines Patent Pool (WHO, NGOs, civil society, funders) Support shared procurement mechanisms for treatment (PAHO) Monitor Progress National plans need clearly defined, measurable objectives Develop new indices of national progress Progress of individual countries needs to be closely monitored towards elimination goals (Polaris, WHO, Creation of Elimination Index) Develop greater capacity for advocacy in high burden regions (all) Viral hepatitis is one of the leading causes of death in the world. 96% of those deaths are due to hepatitis B and C, which are the focus of this commission. Unlike many other major diseases, the tools exist to eliminate viral hepatitis. A highly effective vaccine is available to prevent hepatitis B, and a revolution in HCV treat...

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Section: Success Stories and Ongoing Challenges [H3]mentioning

confidence: 99%

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Cooke

Andrieux-Meyer

Applegate

et al. 2019

The Lancet Gastroenterology & Hepatology

445

391

View full text Add to dashboard Cite

show abstract

“…The guidelines were modified based on the results of a local clinical trial 45 to include SOF–SMV for 12 weeks in patients with or without Child-Pugh A cirrhosis. When the results of SOF–RBV for 24 weeks were published, 46 the regimen was replaced by SOF–SMV. This was followed by the availability of locally produced generic SOF in the following 6 months and generic DCV 3 months later.…”

Section: Treatment Strategy and Outcomementioning

confidence: 99%

“… Note: El Raziky et al and Doss et al 45 , 46 Abbreviations: DAA, direct-acting antivirals; SOF, sofosbuvir; PEG, pegylated interferon; RBV, ribavirin; SMV, simeprevir; DCV, daclatasvir; SVR, sustained virologic response. …”

Section: Figurementioning

confidence: 99%

Hepatitis C infection in Egypt: prevalence, impact and management strategies

Gomaa

Allam

Elsharkawy

et al. 2017

HMER

162

101

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Hepatitis C virus (HCV) infection is a major public health burden in Egypt, where it bears the highest prevalence rate in the world. Estimates for prevalence are based upon data reported from the 2008 and 2015 Egypt Demographic Health Surveys. In this review, we demonstrate the prevalence results of both surveys and analyze the difference in the results. The overall HCV prevalence is estimated to be declining. However, the clinical impact of chronic HCV infection is expected to grow considerably. A mathematical model shows that by increasing the rate of treatment, the expected number of patients will decline significantly in 2030. The current and expected future burden of chronic HCV infection to the Egyptian economy, including direct and indirect costs due to disability and loss of lives, has been estimated and discussed in this review. The economic burden will continue to grow, but a model shows that the introduction of highly effective therapies will result in a significant reduction in the cumulative total economic burden of HCV by 2030. In recognition of the HCV tremendous health and economic burden, the Egyptian government established the National Committee for Control of Viral Hepatitis to implement an integrated nationwide strategy to provide patient care and ensure global treatment access. This review illustrates the epidemiological and disease burden aspects of HCV in Egypt in addition to introducing the national plan and program for managing HCV, which has been successful so far in treating a large number of patients, with the aim of achieving disease control and eventual elimination in Egypt.

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“…5 Nevertheless, most patients with cirrhosis are not candidates for IFN therapy, and the risk of HCC persists in cirrhosis even after SVR, especially in elderly patients. 6,7 Since the introduction of directly acting antivirals (DAAs), tremendous advancement in the treatment of HCV patients has occurred, with SVR rates >90% in real-life settings [8][9][10][11] and excellent safety profiles, which has enabled their use even in patients with decompensated liver disease, who had not been eligible for IFN-based regimens. 12 Patients with cirrhosis who reach a DAA-induced SVR have shown lower rates of cirrhosis progression and downstream complications, especially decompensation, and all-cause mortality.…”

Section: Introductionmentioning

confidence: 99%

Decreased Incidence of Hepatocellular Carcinoma after Directly Acting Antiviral Therapy in Patients with Hepatitis C–Related Advanced Fibrosis and Cirrhosis

Kilany

Ata

Gomaa

et al. 2021

JHC

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Background and Aim Existing data are controversial regarding the incidence of hepatitis C (HCV)–related hepatocellular carcinoma (HCC) following directly acting antiviral (DAA) therapy. This prospective study aimed to assess incidence, and risk factorss of HCC following DAA therapy in patients with HCV-related advanced fibrosis (F3) and cirrhosis (F4). Methods Incidence of HCC was calculated in 1,630 patients with HCV-related F3 and F4 treated with DAA prospectively followed for up to 43 months in a single tertiary referral center and compared to historical controls. Risk factors of incident HCC were also determined. Results The crude outcome rate was 2.15/100 person-years, significantly lower than a similar historical cohort (5.57/100 person-years). Risk of developing HCC was higher with the presence of cirrhosis (F4 vs F3, AHR 3.59) and treatment failure (vs achieving SVR, AHR 3.37). Presence of decompensated cirrhosis, platelet count <100×10 3 /mL, and high AFP were independent risk factors of developing HCC. Conclusion Incidence of HCC was significantly lower in patients with HCV-related advanced fibrosis and cirrhosis treated with DAAs than in a historical cohort of untreated patients. Decompensated cirrhosis, baseline AFP ≥10 ng/mL, diabetes, and nonresponse to DAA were independent risk factors of incident HCC.

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Real-Life Results of Sofosbuvir Based Therapy for Egyptian Patients with Hepatitis C and Advanced Fibrosis-Cirrhosis

Cited by 6 publications

References 0 publications

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Accelerating the elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission

Hepatitis C infection in Egypt: prevalence, impact and management strategies

Decreased Incidence of Hepatocellular Carcinoma after Directly Acting Antiviral Therapy in Patients with Hepatitis C–Related Advanced Fibrosis and Cirrhosis

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