Viral hepatitis C treatment shortening – what is the limit?

Abstract

Successful antiviral treatment for hepatitis C virus (HCV) infection is crucial to prevent progression of the disease and its most serious complications. Therapy options have changed over the years with improvement of treatment efficacy, safety and simplification. They evolved from interferon and ribavirin combination administered for 24-72 weeks through interferon (IFN)-based triple therapies with 24-48 weeks duration to the all-oral, well-tolerated direct-acting antiviral regimens lasting for 8-16 weeks and with almost 100% cure rates. The benefits of shorter treatment duration are cost reduction, access to therapy for more patients, and lower risk of adverse events and nonadherence. This review summarizes data on treatment options, focusing on the recommended durations of different regimens depending on HCV genotype, severity of liver disease and history of previous therapy. According to currently available data, shortening treatment below 8 weeks does not provide additional benefits, although the further simplification of therapy is still a subject of study.

Glecaprevir/pibrentasvir for 8 weeks in patients with compensated cirrhosis: Safety and effectiveness data from the German Hepatitis C‐Registry

“…As countries work to achieve WHO HCV elimination targets, effective and tolerable DAA treatment options can greatly aid providers in reaching those goals. Simplified HCV algorithms allowing TN patients to receive 8 weeks of therapy, regardless of cirrhosis status, can potentially increase the number of patients providers are able to treat, expand access to care and minimise potential toxicity 10,20 …”

Efficacy of velpatasvir and sofosbuvir in treatment of chronic hepatitis C.

“…Several clinical trials have studied various combinations of direct acting oral antiviral for 4 weeks, but with uniformly disappointing results. 21 In addition, the high levels of SVR across all genotypes suggest pangenotypic use of sofosbuvir and velpatasvir.…”

An Overview on ERAP Roles in Infectious Diseases

“…The latter, when related to the immune response, may lead to different susceptibility to HCV pathogenesis among individuals. Fortunately, the availability of highly efficient direct-acting antivirals has revolutionized the treatment landscape with over 95% cure rates as accurately reviewed in [42].…”