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Liu CH, Chang YP, Kao JH. Cutting-edge pharmacotherapy for hepatitis C virus infection: a comprehensive review. Expert Opin Pharmacother 2024; 25:1691-1706. [PMID: 39169665 DOI: 10.1080/14656566.2024.2396024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/17/2024] [Accepted: 08/20/2024] [Indexed: 08/23/2024]
Abstract
INTRODUCTION Pharmacotherapy against hepatitis C virus (HCV) infection has tremendously improved since the advent of interferon (IFN)-free direct-acting antivirals (DAAs). Additionally, fixed-dose pangenotypic DAAs, which are safe, potent, easy for use, and can cover a wide spectrum of patients, have been recommended by professional guidelines for DAA-naïve and DAA-experienced patients with HCV. AREAS COVERED We review the pharmacokinetics, pharmacodynamics, and potential drug-drug interactions (DDIs) of fixed-dose pangenotypic DAA regimens, including glecaprevir/pibrentasvir (GLE/PIB), sofosbuvir/velpatasvir (SOF/VEL), and sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX). Additionally, we summarize the efficacy and safety of these regimens in clinical trials as well as real-world studies for treating different populations. Lastly, we discuss unmet medical needs in managing HCV in the era of fixed-dose pangenotypic DAAs. EXPERT OPINION Protease inhibitors (PIs), including GLE and VOX, are prone to have more frequent DDIs, compared to the non-structural (NS) 5A and 5B inhibitors. These regimens are generally well tolerated and can be applied to different populations, except for the contraindicated use of PI-containing DAA regimens in decompensated cirrhosis. Using the first-line GLE/PIB and SOF/VEL can eradicate HCV in more than 95% of DAA-naïve patients across different populations. The viral cure usually exceeds 95% when using the rescue SOF/VEL/VOX regimen for prior DAA failures.
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Affiliation(s)
- Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan
| | - Yu-Ping Chang
- Department of Internal Medicine, National Taiwan University Biomedical Park Hospital, Hsin-Chu, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
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Chang YP, Liu CH, Huang CB, Lee JY, Liu CJ, Su TH, Huang SC, Tseng TC, Chen PJ, Kao JH. Serum Mac-2 binding protein glycosylation isomer dynamics in patients achieving sustained virologic response for hepatitis C virus. J Gastroenterol Hepatol 2024. [PMID: 38987197 DOI: 10.1111/jgh.16680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/10/2024] [Accepted: 07/02/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND AND AIM Understanding the dynamics of serum Mac-2 binding protein glycosylation isomer (M2BPGi) remains pivotal for hepatitis C virus (HCV) patients' post-sustained virologic response (SVR12) through direct-acting antivirals (DAAs). METHODS We compared areas under receiver operating characteristic curves (AUROCs) of M2BPGi, FIB-4, and APRI and assess M2BPGi cutoff levels in predicting fibrosis stages of ≥F3 and F4 utilizing transient elastography in 638 patients. Variations in M2BPGi levels from pretreatment to SVR12 and their association with pretreatment alanine transaminase (ALT) levels and fibrosis stage were investigated. RESULTS The AUROCs of M2BPGi were comparable to FIB-4 in predicting ≥F3 (0.914 vs 0.902, P = 0.48) and F4 (0.947 vs 0.915, P = 0.05) but were superior to APRI in predicting ≥F3 (0.914 vs 0.851, P = 0.001) and F4 (0.947 vs 0.857, P < 0.001). Using M2BPGi cutoff values of 2.83 and 3.98, fibrosis stages of ≥F3 and F4 were confirmed with a positive likelihood ratio ≥10. The median M2BPGi change was -0.55. Patients with ALT levels ≥5 times ULN or ≥F3 demonstrated more pronounced median decreases in M2BPGi level compared to those with ALT levels 2-5 times ULN and <2 times ULN (-0.97 vs -0.68 and -0.44; P < 0.001) or with < F3 (-1.52 vs -0.44; P < 0.001). CONCLUSIONS Serum M2BPGi is a reliable marker for advanced hepatic fibrosis. Following viral clearance, there is a notable M2BPGi decrease, with the extent of reduction influenced by ALT levels and fibrosis stage.
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Affiliation(s)
- Yu-Ping Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan
| | - Chiuan-Bo Huang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ji-Yuh Lee
- Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Douliou, Taiwan
| | - Chun-Jen Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tung-Hung Su
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Shang-Chin Huang
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Tai-Chung Tseng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
| | - Pei-Jer Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan
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Ruiz-Cobo JC, Llaneras J, Forns X, Gallego Moya A, Conde Amiel I, Arencibia A, Diago M, García-Samaniego J, Castellote J, Llerena S, Rodríguez-Seguel E, Mateos B, Rodríguez M, Rosales Zabal JM, Fernández I, Calleja JL, Morillas RM, Montoliu S, Andrade RJ, Badia Aranda E, Hernández-Guerra M, Maté CJ, González-Santiago JM, de Cuenca B, Bernal-Monterde V, Delgado M, Turnes J, Lens S, Buti M. Real-life effectiveness of sofosbuvir/velpatasvir/voxilaprevir in hepatitis C patients previously treated with sofosbuvir/velpatasvir or glecaprevir/pibrentasvir. Aliment Pharmacol Ther 2024; 60:201-211. [PMID: 38695095 DOI: 10.1111/apt.18020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/04/2024] [Accepted: 04/14/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Sofosbuvir, velpatasvir and voxilaprevir (SOF/VEL/VOX) is the recommended rescue therapy for patients with chronic hepatitis C infection who fail direct-acting antivirals (DAAs). Data are limited on the effectiveness of this treatment after the current first-line therapies. Our aim was to analyse the effectiveness and safety of SOF/VEL/VOX among patients failing sofosbuvir/velpatasvir (SOF/VEL) or glecaprevir/pibrentasvir (GLE/PIB). METHODS Retrospective multicentre study (26 Spanish hospitals), including chronic hepatitis C patients unsuccessfully treated with SOF/VEL or GLE/PIB, and retreated with SOF/VEL/VOX ± ribavirin for 12 weeks between December 2017 and December 2022. RESULTS In total, 142 patients included: 100 (70.4%) had failed SOF/VEL and 42 (29.6%) GLE/PIB. Patients were mainly men (84.5%), White (93.9%), with hepatitis C virus genotype (GT) 3 (49.6%) and 47.2% had liver cirrhosis. Sustained virological response (SVR) was evaluated in 132 patients who completed SOF/VEL/VOX and were followed 12 weeks after end of treatment; 117 (88.6%) achieved SVR. There were no significant differences in SVR rates according to initial DAA treatment (SOF/VEL 87.9% vs. GLE/PIB 90.2%, p = 0.8), cirrhosis (no cirrhosis 90% vs. cirrhosis 87.1%, p = 0.6) or GT3 infection (non-GT3 91.9% vs. GT3 85.5%, p = 0.3). However, when considering the concurrent presence of SOF/VEL treatment, cirrhosis and GT3 infection, SVR rates dropped to 82.8%. Ribavirin was added in 8 (6%) patients, all achieved SVR. CONCLUSION SOF/VEL/VOX is an effective rescue therapy for failures to SOF/VEL or GLE/PIB, with an SVR of 88.6%. Factors previously linked to lower SVR rates, such as GT3 infection, cirrhosis and first-line therapy with SOF/VEL were not associated with lower SVRs.
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Affiliation(s)
- Juan Carlos Ruiz-Cobo
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Llaneras
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clínic, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- University of Barcelona (UB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Adolfo Gallego Moya
- Servicio de Patología Digestiva, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Isabel Conde Amiel
- Hepatology and Liver Transplantation Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Instituto de Investigación Sanitaria La Fe (IIS La Fe), Valencia, Spain
| | - Ana Arencibia
- Gastroenterology Department, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Moises Diago
- Hospital General Universitario Valencia, Valencia, Spain
- Medicine Department, Universidad de Valencia, Valencia, Spain
| | - Javier García-Samaniego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Liver Unit, Hospital Universitario La Paz, Madrid, Spain
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Jose Castellote
- University of Barcelona (UB), Barcelona, Spain
- Hepatology Unit, Gastroenterology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universitat de Barcelona, Barcelona, Spain
| | - Susana Llerena
- Gastroenterology and Hepatology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Elisa Rodríguez-Seguel
- Liver Diseases, Instituto de Biomedicina de Sevilla (IBiS)/Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain
- Hospital Universitario Virgen del Rocío, Seville, Spain
- Digestive Diseases Research Unit, Virgen Del Rocío University Hospital, Seville, Spain
- Cell Biology Department, Faculty of Biology, University of Seville, Seville, Spain
| | - Beatriz Mateos
- Gastroenterology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
- University of Alcala, Madrid, Spain
| | - Manuel Rodríguez
- Liver Unit, Gastroenterology and Hepatology Division, Hospital Universitario Central de Asturias, Oviedo, Spain
- University of Oviedo, Oviedo, Spain
| | | | - Inmaculada Fernández
- Gastroenterology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jose Luis Calleja
- Universidad Autónoma de Madrid, Madrid, Spain
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Instituto de Investigación Sanitaria Puerta de Hierro (IDIPHIM), Madrid, Spain
| | - Rosa María Morillas
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Hepatology Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain
- Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain
| | - Silvia Montoliu
- Gastroenterology Department Hospital, Universitari Joan XXIII, Tarragona, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Tarragona, Spain
| | - Raul J Andrade
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
- University Hospital-IBIMA Platform BIONAND, Málaga, Spain
- University of Malaga, Málaga, Spain
| | - Ester Badia Aranda
- Gastroenterology Department, Hospital Universitario de Burgos, Burgos, Spain
| | | | - Carlota Jimeno Maté
- Gastroenterology Department, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Jesús M González-Santiago
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Gastroenterology and Hepatology Department, University Hospital of Salamanca, Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | | | - Vanesa Bernal-Monterde
- Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain
- Instituto de Investigación Sanitaria de Aragón (IISA), Zaragoza, Spain
| | | | - Juan Turnes
- Department of Gastroenterology and Hepatology, Complejo Hospitalario Universitario Pontevedra & IIS Galicia Sur, Pontevedra, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clínic, Barcelona, Spain
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRCB-IDIBAPS), Barcelona, Spain
- University of Barcelona (UB), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - María Buti
- Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- Liver Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Wang DS, Phu A, McKee K, Strasser SI, Sheils S, Weltman M, Sellar S, Davis JS, Young M, Braund A, Farrell GC, Blunn A, Harding D, Ralton L, Muller K, Davison SA, Shaw D, Wood M, Hajkowicz K, Skolen R, Davies J, Tate-Baker J, Doyle A, Tuma R, Hazeldine S, Lam W, Edmiston N, Zohrab K, Pratt W, Watson B, Zekry A, Stephens C, Clark PJ, Day M, Park G, Kim H, Wilson M, McGarity B, Menzies N, Russell D, Lam T, Boyd P, Kok J, George J, Douglas MW. Hepatitis C Virus Antiviral Drug Resistance and Salvage Therapy Outcomes Across Australia. Open Forum Infect Dis 2024; 11:ofae155. [PMID: 38651137 PMCID: PMC11034952 DOI: 10.1093/ofid/ofae155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/15/2024] [Indexed: 04/25/2024] Open
Abstract
Background Hepatitis C virus (HCV) infection can now be cured with well-tolerated direct-acting antiviral (DAA) therapy. However, a potential barrier to HCV elimination is the emergence of resistance-associated substitutions (RASs) that reduce the efficacy of antiviral drugs, but real-world studies assessing the clinical impact of RASs are limited. Here, an analysis of the impact of RASs on retreatment outcomes for different salvage regimens in patients nationally who failed first-line DAA therapy is reported. Methods We collected data from 363 Australian patients who failed first-line DAA therapy, including: age, sex, fibrosis stage, HCV genotype, NS3/NS5A/NS5B RASs, details of failed first-line regimen, subsequent salvage regimens, and treatment outcome. Results Of 240 patients who were initially retreated as per protocol, 210 (87.5%) achieved sustained virologic response (SVR) and 30 (12.5%) relapsed or did not respond. The SVR rate for salvage regimens that included sofosbuvir/velpatasvir/voxilaprevir was 94.3% (n = 140), sofosbuvir/velpatasvir 75.0% (n = 52), elbasvir/grazoprevir 81.6% (n = 38), and glecaprevir/pibrentasvir 84.6% (n = 13). NS5A RASs were present in 71.0% (n = 210) of patients who achieved SVR and in 66.7% (n = 30) of patients who subsequently relapsed. NS3 RASs were detected in 20 patients (20%) in the SVR group and 1 patient in the relapse group. NS5B RASs were observed in only 3 patients. Cirrhosis was a predictor of relapse after retreatment, as was previous treatment with sofosbuvir/velpatasvir. Conclusions In our cohort, the SVR rate for sofosbuvir/velpatasvir/voxilaprevir was higher than with other salvage regimens. The presence of NS5A, NS5B, or NS3 RASs did not appear to negatively influence retreatment outcomes.
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Affiliation(s)
- Dao Sen Wang
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - Amy Phu
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - Kristen McKee
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - Simone I Strasser
- AW Morrow Gastroenterology and Liver Centre, The University of Sydney and Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Sinead Sheils
- AW Morrow Gastroenterology and Liver Centre, The University of Sydney and Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Martin Weltman
- Department of Gastroenterology and Hepatology, Nepean Hospital, Kingswood, NSW, Australia
| | - Sue Sellar
- Department of Gastroenterology and Hepatology, Nepean Hospital, Kingswood, NSW, Australia
| | - Joshua S Davis
- Department of Infectious Diseases, University of Newcastle and John Hunter Hospital, Newcastle, NSW, Australia
| | - Mel Young
- Department of Infectious Diseases, University of Newcastle and John Hunter Hospital, Newcastle, NSW, Australia
| | - Alicia Braund
- Department of Gastroenterology and Hepatology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Geoffrey C Farrell
- Department of Gastroenterology and Hepatology, Australian National University and The Canberra Hospital, Canberra, ACT, Australia
| | - Anne Blunn
- Department of Gastroenterology and Hepatology, Australian National University and The Canberra Hospital, Canberra, ACT, Australia
| | - Damian Harding
- Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Lucy Ralton
- Department of Gastroenterology and Hepatology, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
| | - Kate Muller
- Department of Gastroenterology and Hepatology, Flinders Medical Centreand Flinders University, Adelaide, SA, Australia
| | - Scott A Davison
- Department of Gastroenterology and Hepatology, University of New South Wales and Liverpool Hospital, Liverpool, NSW, Australia
| | - David Shaw
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Marnie Wood
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Krispin Hajkowicz
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Richard Skolen
- Infectious Diseases Unit, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Jane Davies
- Menzies School of Health Research and Royal Darwin Hospital, Darwin, NT, Australia
| | - Jaclyn Tate-Baker
- Menzies School of Health Research and Royal Darwin Hospital, Darwin, NT, Australia
| | - Adam Doyle
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, WA, Australia
| | - Rhoda Tuma
- Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, WA, Australia
| | - Simon Hazeldine
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Wendy Lam
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Natalie Edmiston
- Department of Gastroenterology and Hepatology, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Krista Zohrab
- Department of Gastroenterology and Hepatology, School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - William Pratt
- Department of Medicine, Shoalhaven Hospital, Nowra, NSW, Australia
| | - Belinda Watson
- Department of Medicine, Shoalhaven Hospital, Nowra, NSW, Australia
| | - Amany Zekry
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, NSW, Australia
| | - Carlie Stephens
- Department of Gastroenterology and Hepatology, St George Hospital, Kogarah, NSW, Australia
| | - Paul J Clark
- Rockhampton Blood Borne Virus & Sexual Health Service and School of Medicine, University of Brisbane, Brisbane, QLD, Australia
| | - Melany Day
- Rockhampton Blood Borne Virus & Sexual Health Service and School of Medicine, University of Brisbane, Brisbane, QLD, Australia
| | - Gordon Park
- Department of Gastroenterology and Hepatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Hami Kim
- Department of Gastroenterology and Hepatology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Mark Wilson
- Department of Gastroenterology and Hepatology, Royal Hobart Hospital, Hobart, TAS, Australia
| | | | | | - Darren Russell
- Cairns Sexual Health Service and James Cook University Cairns, St Cairns City, QLD, Australia
| | - Thao Lam
- Department of Drug Health, Western Sydney Local Health District, Westmead, NSW, Australia
| | - Peter Boyd
- Department of Medicine, Cairns Hospital, Cairns, QLD, Australia
| | - Jen Kok
- Centre for Infectious Diseases and Microbiology Laboratory Services, NSW Health Pathology-Institute of Clinical Pathology and Medical Research, Westmead Hospital, Westmead, NSW, Australia
| | - Jacob George
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
| | - Mark W Douglas
- Storr Liver Centre, The Westmead Institute for Medical Research, The University of Sydney and Westmead Hospital, Sydney, NSW, Australia
- Centre for Infectious Diseases and Microbiology, Sydney Infectious Diseases Institute, The University of Sydney at Westmead Hospital, Sydney, NSW, Australia
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Tu Y, Tang X, Zhou D, Shao H, Liang L, Tang W. Is it time for China to prioritize pan-genotypic regimens for treating patients with hepatitis C? COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:11. [PMID: 38321475 PMCID: PMC10848349 DOI: 10.1186/s12962-024-00519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION The treatment of hepatitis C has entered the pan-genotypic era, but the effectiveness is not good for the genotype 3b patients who have a large proportion in China. The guidelines for hepatitis C recommend the use of gene-specific regimens when the regional 3b prevalence rate greater than 5%. This study is to explore rationality of this proportion and the cost-effectiveness to implement pan-genotypic regimens in China. METHODS A decision Markov model was developed from the health system perspective to evaluate the effectiveness and cost-effectiveness between pan-genotypic and gene-specific treatment regimens for hepatitis C patients. Additionally, we set a regional genotype 3b patient proportion of 0-100% to explore at which proportion it is necessary to perform genotype identification and typing therapy on patients. Model parameters were derived from published literature and public databases. Effectiveness was measured by cured patient numbers, newly diagnosed cases of decompensated cirrhosis, hepatocellular carcinoma, need for liver transplantation, and quality-adjusted life years (QALYs). Cost-effectiveness outcomes included costs and the incremental cost-effectiveness ratio (ICER). The 1-3 times 2022 Chinese per capita gross domestic product was used as the willingness-to-pay threshold. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty of the model parameters. RESULTS Compared with gene-specific regimens, pan-genotypic regimens resulted in an additional 0.13 QALYs and an incremental cost of $165, the ICER was $1,268/QALY. From the view of efficacy, the pan-genotypic regimens cured 5,868 more people per 100,000 patients than gene-specific regimens, avoiding 86.5% of DC cases, 64.6% of HCC cases, and 78.2% of liver transplant needs. Identifying 3b patients before treatment was definitely cost-effectiveness when their prevalence was 12% or higher. The results remained robust in sensitivity analyses. CONCLUSIONS In China, the prioritized recommendation of pan-genotypic therapeutics proves to be both cost-effective and efficacious. But, in regions where the prevalence of genotype 3b exceeds 12%, it is necessary to identify them to provision of more suitable therapies.
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Affiliation(s)
- Yusi Tu
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
- Department of Public Affairs Management, School of Lnternational Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China
| | - Xiangyan Tang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
- Department of Public Affairs Management, School of Lnternational Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China
| | - Dachuang Zhou
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
- Department of Public Affairs Management, School of Lnternational Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China
| | - Hanqiao Shao
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
- Department of Public Affairs Management, School of Lnternational Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China
| | - Leyi Liang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
- Department of Public Affairs Management, School of Lnternational Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China
| | - Wenxi Tang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China.
- Department of Public Affairs Management, School of Lnternational Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China.
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Liu CH, Lin HC, Kao JH. Toward the hepatitis C virus elimination in Asia: The policy forum from the 2023 Asian Pacific Association of the Study of the Liver (APASL). J Formos Med Assoc 2023; 122:1234-1237. [PMID: 37821301 DOI: 10.1016/j.jfma.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/02/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Chen-Hua Liu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yunlin, Taiwan
| | - Han-Chieh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jia-Horng Kao
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Hepatitis Research Center, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
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Devan P, Tiong KLA, Neo JE, Mohan BP, Wijarnpreecha K, Tam YCS, Coppola N, Preda CM, Wong YJ. Treatment Outcomes of Sofosbuvir/Velpatasvir/Voxilaprevir in Direct-Acting Antiviral-Experienced Hepatitis C Virus Patients: A Systematic Review and Meta-Analysis. Viruses 2023; 15:1489. [PMID: 37515176 PMCID: PMC10384139 DOI: 10.3390/v15071489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
About 5% of chronic hepatitis C (CHC) patients experienced treatment failure with direct-acting antiviral (DAA) treatment. The global data on the practice and treatment outcomes of Sofosbuvir/Velpatasvir/Voxilaprevir (SOF/VEL/VOX) in DAA-experienced CHC patients remains sparse. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of SOF/VEL/VOX as a salvage treatment in DAA-experienced CHC patients. We searched five electronic databases from inception to 31 January 2023. The study outcomes were SVR12 and treatment-related adverse effects, with subgroup analysis performed based on genotype, cirrhosis, HCC, prior SOF/VEL exposure, and region. We identified and analyzed data from 24 studies (2877 DAA-experienced CHC patients); 17.2% had prior SOF/VEL exposure, 25% received ribavirin with SOF/VEL/VOX, and 42% had pre-treatment resistance-associated substitution (RAS) testing performed. Eastern Mediterranean had a higher pooled SVR12 than the America and Europe regions (p < 0.05). Predictors of SOF/VEL/VOX failure were genotype 3, active HCC, baseline cirrhosis, and prior SOF/VEL. Baseline RAS mutation and ribavirin supplementation were not associated with higher SVR12. Treatment discontinuation because of drug-related adverse events was uncommon (10 studies, 0.2%). In summary, SOF/VEL/VOX is efficacious and safe for retreatment in DAA-experienced CHC patients, even with RAS mutation. Our findings support SOF/VEL/VOX as a first-line rescue treatment for DAA-experienced CHC patients.
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Affiliation(s)
- Pooja Devan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Kai Le Ashley Tiong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Jean Ee Neo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
| | - Babu P Mohan
- Division of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT 84112, USA
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ 85004, USA
| | - Yew Chong Steve Tam
- Education Resource Centre, Medical Board, Singapore General Hospital, Singapore 169608, Singapore
| | - Nicola Coppola
- Department of Mental Health and Preventive Medicine, University of Campania "L. Vanvitelli", 81100 Napoli, Italy
| | - Carmen Monica Preda
- Clinical Institute of Fundeni, Gastroenterology and Hepatology, 022328 Bucharest, Romania
| | - Yu Jun Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
- Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore 529889, Singapore
- Duke-NUS Academic Medicine Programme, SingHealth, Singapore 169608, Singapore
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