Protease inhibitors for hepatitis C: economic implications

The Cascade of Care for Hepatitis C Treatment in Rwanda: A Retrospective Cohort Study of the 2017–2019 Mass Screening and Treatment Campaign

Access to hepatitis C (HCV) testing and treatment is still limited globally. To address this, the Government of Rwanda launched a voluntary mass screening and treatment campaign in 2017. We studied the progression of patients through the cascade of HCV care during this campaign. We conducted a retrospective cohort study and included all patients screened at 46 hospitals between April 2017 and October 2019. We used hierarchical logistic regression to assess factors associated with HCV positivity, gaps in care, and treatment failure. A total of 860,801 people attended the mass screening during the study period. Some 5.7% tested positive for anti-HCV, and 2.9% were confirmed positive. Of those who were confirmed positive, 52% initiated treatment, and 72% of those initiated treatment, completed treatment and returned for assessment 12 weeks afterward. The cure rate was 88%. HCV positivity was associated with age, socio-economic status, sex, marital status, and HIV coinfection. Treatment failure was associated with cirrhosis, baseline viral load, and a family history of HCV. Our results suggest that future HCV screening and testing interventions in Rwanda and other similar settings should target high-risk groups. High dropout rates suggest that more effort should be put into patient follow-up to increase adherence to care.

Paritaprevir in patients with chronic hepatitis C genotype 1

ABSTRACT 

Chronic hepatitis C is found worldwide. According to the WHO, it affects approximately 184 million patients around the globe. For the past decade, the standard-of-care treatment of chronic hepatitis C consisted of IFN-based regimens. However, IFN has its own limitations and is not always well tolerated in all patients. In addition, it yields unsatisfactory rates of virologic response especially in difficult-to-treat genotype 1 patients. Recent scientific advances led to the development of new IFN-free antiviral agents that are more effective, better tolerated and with shorter treatment duration. An all-oral regimen (paritaprevir/ritonavir and ombitasvir, copackaged with dasabuvir) has recently received the US FDA approval and the European Commission marketing authorizations for treatment of patients with chronic hepatitis C genotype 1 infection, including those with cirrhosis. In this article, we sought to review the pharmacokinetics, clinical efficacy and side-effect profile pertaining to paritaprevir-containing regimens with special emphasis on Phase III clinical trials.

Emerging treatments for hepatitis C

INTRODUCTION

About 2.35% of the world population can be infected with hepatitis C virus (HCV) responsible for chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Currently available interferon-based medication is successful in up to 75% of the patients infected with HCV genotypes 1, 2 or 3 and lower efficacy in other genotypes. Unfortunately sustained virologic response (SVR) rate in genotype 1 infected non-responders to previous therapy with advanced hepatic fibrosis even after retreatment with the first generation direct acting antivirals (DAA) is about 40% only.

AREAS COVERED

The second generation DAA, which have recently been submitted for registration (Sofosbuvir and Simeprevir) still need combination with PegIFNα and RBV in patients infected with HCV genotype 1. There is a need for more effective antiviral therapy for difficult to treat patients who are interferon intolerant, developed liver cirrhosis or non-responders to previous therapies. Therefore, IFN-free regimens are step for future therapies consisting of combinations of novel investigational DAA and host targeting agents.

EXPERT OPINION

The introduction of novel DAA with a good safety profile and high barrier to resistance can lead to SVR rates exceeding 90% in treatment naïve patients and non-responders to previous therapy infected with different genotypes.