Urgency to treat patients with chronic hepatitis C in Asia

Abstract

Chronic hepatitis C (CHC) infection poses a global healthcare burden, being associated with serious complications if untreated. The prevalence of hepatitis C virus (HCV) infection is highest in areas of Central, South, and East Asia; over 50% of HCV patients worldwide live in the region, where HCV genotypes 1b, 2, 3, and 6 are the most prevalent. Treatment outcomes for chronic hepatitis C vary by ethnicity, and Asian patients achieve higher sustained virologic response rates following interferon (IFN)-based therapy than non-Asians. However, low efficacy, poor safety profile, and subcutaneous administration limit the use of IFN-based therapies. Superior virologic outcomes have been observed with different classes of direct-acting antivirals (DAAs) alone or in combination, and several alloral DAA regimens are available in Asia. These regimens have shown excellent efficacy and favorable tolerability in clinical trials, yet there is a need for further studies of DAAs in a real world context, particularly in Asia. Furthermore, IFN-free treatment may not be accessible for many patients in the region, and IFN-based regimens remain an option in some countries. There is a need to improve current clinical practices for HCV management in Asia, including effective screening, disease awareness, and prevention programs, and to further understand the cost-effectiveness of IFN-free regimens. The evolution of potent treatments makes HCV eradication a possibility that should be available to all patients. However, access to these therapies in Asian countries has been slow, primarily because of economic barriers that continue to present a hurdle to optimal treatment.

Systematic review with meta‐analysis: effectiveness and tolerability of interferon‐free direct‐acting antiviral regimens for chronic hepatitis C genotype 1 in routine clinical practice in Asia

“…Our study had several strengths. It is the largest meta‐analysis done so far on SVR of DAA in genotype 1 patients in Asia, which represent the largest group of CHC patients in the world . In total, we identified 41 studies from 37 separate cohorts including 8574 individuals, which allowed us to accurately estimate the pooled SVR rates of different DAA regimens, particularly among many special populations relevant to real‐life practice.…”

“…Chronic hepatitis C (CHC) can lead to the development of liver cirrhosis, hepatic decompensation and hepatocellular carcinoma (HCC) . Asia has the highest total HCV disease burden in the world with more than 50% of HCV‐infected patients in the world living in Asia, and HCV genotype 1/1b (GT1/1b) is the most prevalent genotype and genotype subtype here . Asian patients with GT1 have a higher sustained virological response (SVR) rates with interferon (IFN)‐based therapy than non‐Asians because they have higher prevalence of the favourable IL28B CC alleles .…”

Efficacy and safety outcomes of sofosbuvir-based treatment regimens for hepatitis C virus-infected patients with or without cirrhosis from phase III clinical trials

“…In addition, although the prevalence of HCV infection is highest in Asia, access to peg-IFN-free regimens may be difficult in Asian countries. Furthermore, peg-IFN-based regimens may be a treatment option for HCV infection only in some Asian countries 43. Therefore, there is still a need for more clinical studies with Asian populations in order to improve current practices in the management of HCV infection in Asia.…”

Direct‐acting antiviral agents for liver transplant recipients with recurrent genotype 1 hepatitis C virus infection: Systematic review and meta‐analysis

“…HCV genotype 1 (GT1) is the most prevalent recurrence affecting the majority of patients post LT . However, the effectiveness and tolerability of various of combinations of DAAs on specific genotype of HCV recurrence in LT recipients remain largely unknown .…”

“…HCV genotype 1 (GT1) is the most prevalent recurrence affecting the majority of patients post LT. 10,11 However, the effectiveness and tolerability of various of combinations of DAAs on specific genotype of HCV recurrence in LT recipients remain largely unknown. 12 In this study, we performed a systematic review and meta-analysis in order to provide a comprehensive, reliable, and up-to-date assessment of DAA treatment for GT1 HCV recurrence post transplantation.…”