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Dobrowolska K, Brzdęk M, Rzymski P, Flisiak R, Pawłowska M, Janczura J, Brzdęk K, Zarębska-Michaluk D. Revolutionizing hepatitis C treatment: next-gen direct-acting antivirals. Expert Opin Pharmacother 2024; 25:833-852. [PMID: 38768013 DOI: 10.1080/14656566.2024.2358139] [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: 04/11/2024] [Accepted: 05/17/2024] [Indexed: 05/22/2024]
Abstract
INTRODUCTION With the introduction of highly effective and safe therapies with next-generation direct-acting antivirals (DAAs), that act without interferon, hepatitis C virus (HCV) infection remains the only treatable chronic infectious disease. AREAS COVERED The review aims to provide an overview of the therapy revolution with a description of specific DAAs, their mechanisms of action, a summary of the safety and efficacy of specific regimens, and a discussion of populations requiring special therapeutic approaches. EXPERT OPINION DAAs are highly effective, safe, and easy to use. However, challenges such as access to health services and loss of patients from the cascade of care, especially in groups disproportionately affected by HCV infection, such as substance abusers, make it difficult to achieve the WHO's goal of HCV elimination. The proposed strategy to combat these difficulties involves a one-step approach to diagnosing and treating the infection, the availability of long-lasting forms of medication, and the development of an effective vaccine. The aforementioned opportunities are all the more important as the world is facing an opioid epidemic that is translating into an increase in HCV prevalence. This phenomenon is of greatest concern in women of childbearing age and in those already pregnant due to treatment limitations.
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Affiliation(s)
| | - Michał Brzdęk
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland
| | - Małgorzata Pawłowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Jakub Janczura
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
| | - Kinga Brzdęk
- Collegium Medicum, Jan Kochanowski University, Kielce, Poland
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Gupta N, Swindells S, Scarsi KK, Furl R, Thomas DL, Weld ED, Ofimboudem JD, Desalegn H, Hamid S, Rosas ADLT, Miranda AE, Owen A, Rannard S, Hiebert L, Sun K, Ward JW. Preferences and feasibility of long-acting technologies for treatment of hepatitis C virus in low- and middle-income countries: A survey of providers and policymakers. J Viral Hepat 2024; 31:221-232. [PMID: 38545826 DOI: 10.1111/jvh.13921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/15/2023] [Accepted: 01/10/2024] [Indexed: 04/18/2024]
Abstract
Long-acting technologies (LATs) for hepatitis C virus (HCV) are under development as a strategy to improve linkage to care, treatment adherence and outcomes. We conducted a survey of HCV treatment prescribers and HCV policymakers in low- and middle-income countries (LMICs) regarding acceptability and feasibility of HCV LATs. We included one-time intramuscular injection, subdermal implant and transdermal patch as potential LAT options. We surveyed participants regarding optimal health system and patient characteristics, concerns, potential barriers, overall feasibility and preferences for HCV LAT as compared to daily oral medication. Overall, 122 providers and 50 policymakers from 42 LMICs completed the survey. Among providers, 93% (113/122) expressed willingness to prescribe LAT and 72% (88/120) of providers preferred LAT if provided at comparable efficacy, safety and cost as current oral treatments. Of providers preferring HCV LAT to daily oral medication, 67% (59/88) preferred injection, 24% (21/88) preferred patch and 9% (8/88) preferred implant. Only 20% (24/122) would prescribe LAT if it were more costly than oral treatment. In regression analysis, no provider characteristics were associated with preference for LAT over oral treatment. Policymakers reported high likelihood that LAT would be included in treatment guidelines (42/50; 84%) and national drug formularies (39/50; 78%) if efficacy, safety and cost were similar to oral treatment. HCV LATs could advance progress to HCV elimination in LMICs by diversifying treatment options to improve treatment coverage and outcomes. Provider preferences from LMICs are a critical consideration in the development of HCV LATs to ensure its early and equitable availability in LMICs.
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Affiliation(s)
- Neil Gupta
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
| | - Susan Swindells
- Section of Infectious Diseases, Department of Internal Medicine, The University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kimberly K Scarsi
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Renae Furl
- Section of Infectious Diseases, Department of Internal Medicine, The University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - David L Thomas
- Division of Infectious Diseases, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ethel D Weld
- Division of Infectious Diseases, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Clinical Pharmacology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Hailemichael Desalegn
- Medical Department, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Saeed Hamid
- Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Angelica E Miranda
- Post-Graduation Program in Infectious Diseases, Federal University of Espirito Santo, Vitória, Brazil
| | - Andrew Owen
- Department of Pharmacology and Therapeutics, Centre of Excellence in Long acting Therapeutics (CELT), University of Liverpool, Liverpool, UK
| | - Steve Rannard
- Department of Chemistry, Centre of Excellence in Long acting Therapeutics (CELT), University of Liverpool, Liverpool, UK
| | - Lindsey Hiebert
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
| | - Katherine Sun
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
| | - John W Ward
- Coalition for Global Hepatitis Elimination, The Task Force for Global Health, Decatur, Georgia, USA
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Pertinez H, Kaushik A, Curley P, Arshad U, El-Khateeb E, Li SY, Tasneen R, Sharp J, Kijak E, Herriott J, Neary M, Noë M, Flexner C, Nuermberger E, Owen A, Ammerman NC. Hyaluronidase impacts exposures of long-acting injectable paliperidone palmitate in rodent models. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.03.03.583160. [PMID: 38496644 PMCID: PMC10942359 DOI: 10.1101/2024.03.03.583160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
A significant challenge in the development of long-acting injectable drug formulations, especially for anti-infective agents, is delivering an efficacious dose within a tolerable injection volume. Co-administration of the extracellular matrix-degrading enzyme hyaluronidase can increase maximum tolerable injection volumes but is untested for this benefit with long-acting injectable formulations. One concern is that hyaluronidase could potentially alter the tissue response surrounding an injection depot, a response known to be important for drug release kinetics of long-acting injectable formulations. The objective of this pilot study was to evaluate the impact of co-administration of hyaluronidase on the drug release kinetics, pharmacokinetic profiles, and injection site histopathology of the long-acting injectable paliperidone palmitate for up to four weeks following intramuscular injection in mouse and rat models. In both species, co-administration of hyaluronidase increased paliperidone plasma exposures the first week after injection but did not negate the overall long-acting release nature of the formulation. Hyaluronidase-associated modification of the injection site depot was observed in mice but not in rats. These findings suggest that further investigation of hyaluronidase with long-acting injectable agents is warranted.
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Affiliation(s)
- Henry Pertinez
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Amit Kaushik
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD, 21287, USA
| | - Paul Curley
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Usman Arshad
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Eman El-Khateeb
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Si-Yang Li
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD, 21287, USA
| | - Rokeya Tasneen
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD, 21287, USA
| | - Joanne Sharp
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Edyta Kijak
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Joanne Herriott
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Megan Neary
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Michaël Noë
- Department of Pathology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, Netherlands
| | - Charles Flexner
- Departments of Medicine and Pharmacology and Molecular Sciences, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
| | - Eric Nuermberger
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD, 21287, USA
| | - Andrew Owen
- Center of Excellence for Long-Acting Technologies (CELT), William Henry Duncan Building, University of Liverpool, Crown Street, Liverpool L7 8TX, UK
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, William Henry Duncan Building, Crown Street, Liverpool L69 7BE, UK
| | - Nicole C. Ammerman
- Center for Tuberculosis Research, Johns Hopkins University School of Medicine, 1550 Orleans Street, Baltimore, MD, 21287, USA
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, Netherlands
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Tuan J, Okoli A, Ogbuagu O. Pharmacokinetic evaluation of sofosbuvir/velpatasvir for the treatment of Chronic Hepatitis C in pediatrics aged 3 and older. Expert Opin Drug Metab Toxicol 2023; 19:881-888. [PMID: 38058292 DOI: 10.1080/17425255.2023.2292736] [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: 05/12/2023] [Accepted: 12/05/2023] [Indexed: 12/08/2023]
Abstract
INTRODUCTION The World Health Organization proposed targets to eliminate hepatitis C virus (HCV) by 2030, aiming to treat ≥80% of people with HCV, decreasing new chronic infections by 90% and liver-related mortality by 65%. While children/adolescents represent a minority of cases, the true burden is underestimated. Advances in drug development have resulted in simplified treatments that are well-tolerated, effective, and pangenotypic in activity. Sofosbuvir/velpatasvir, a combined nucleotide analog NS5B polymerase inhibitor and NS5A inhibitor, respectively, is approved for HCV treatment for individuals ≥3 years, supported by safety data using lower-dose, novel formulations. AREAS COVERED This review discusses chemistry, pharmacokinetics/pharmacodynamics, dosing, efficacy, and safety of sofosbuvir/velpatasvir highlighting pediatric data. Literature review included publications/conference abstracts from PubMed, Google, and Google Scholar. Information from key clinical trials/regulatory approvals is reviewed. EXPERT OPINION Sofosbuvir/velpatasvir is a safe and effective therapy for the treatment of pangenotypic chronic HCV infection with limited cases of virologic relapse and adverse events among pediatric populations aged 3 years and older. However, the tolerability among children less than 6 years could be improved by alternative formulations, if not, shorter treatment durations. An aspirational role of direct-acting antivirals (DAAs) that should be explored is for the prevention of infection in exposed and at-risk pediatric populations.
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Affiliation(s)
- Jessica Tuan
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, USA
- Yale AIDS Program, 135 College St, New Haven, CT, USA
| | - Adaora Okoli
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Onyema Ogbuagu
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, New Haven, CT, USA
- Yale AIDS Program, 135 College St, New Haven, CT, USA
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Sheehan Y, Cunningham EB, Cochrane A, Byrne M, Brown T, McGrath C, Lafferty L, Tedla N, Dore GJ, Lloyd AR, Grebely J. A 'one-stop-shop' point-of-care hepatitis C RNA testing intervention to enhance treatment uptake in a reception prison: The PIVOT study. J Hepatol 2023; 79:635-644. [PMID: 37116714 DOI: 10.1016/j.jhep.2023.04.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/26/2023] [Accepted: 04/11/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND & AIMS Prisons are key venues for scaling-up hepatitis C virus (HCV) testing and treatment. Complex clinical pathways and frequent movements of people in prison remain barriers to HCV care. This study evaluated the impact of a 'one-stop-shop' point-of-care HCV RNA testing intervention on treatment uptake compared with standard of care among people recently incarcerated in Australia. METHODS PIVOT was a prospective, non-concurrent, controlled study comparing HCV treatment uptake during 'standard of care' (n = 239; November 2019-May 2020) and a 'one-stop-shop' intervention (n = 301; June 2020-April 2021) in one reception prison in Australia. The primary endpoint was uptake of direct-acting antiviral treatment at 12 weeks from enrolment. Secondary outcomes included the time taken from enrolment to each stage in the care cascade. RESULTS A total of 540 male participants were enrolled. Median age (29 vs. 28 years) and history of injecting drug use (48% vs. 42%) were similar between standard of care and intervention phases. Among people diagnosed with current HCV infection (n = 18/63 in the standard of care phase vs. n = 30/298 in the intervention phase), the proportion initiating direct-acting antiviral treatment within 12 weeks from enrolment in the intervention phase was higher (93% [95% CI 0.78-0.99] vs. 22% [95% CI 0.64-0.48]; p <0.001), and the median time to treatment initiation was shorter (6 days [IQR 5-7] vs. 99 days [IQR 57-127]; p <0.001) compared to standard of care. CONCLUSIONS The 'one-stop-shop' intervention enhanced treatment uptake and reduced time to treatment initiation among people recently incarcerated in Australia, thereby overcoming key barriers to treatment scale-up in the prison sector. IMPACT AND IMPLICATIONS This study provides important insights for policymakers regarding optimal HCV testing and treatment pathways for people newly incarcerated in prisons. The findings will improve health outcomes in people in prison with chronic HCV infection by increasing testing and treatment, thereby reducing infections, liver-related morbidity/mortality, and comorbidities. The findings will change clinical practice, clinical guidelines, and international guidance, and will inform future research and national and regional strategies, in particular regarding point-of-care testing, which is being rapidly scaled-up in various settings globally. The economic impact will likely include health budget savings resulting from reduced negative health outcomes relating to HCV, and health system efficiencies resulting from the introduction of simplified models of care. CLINICAL TRIALS REGISTRATION This study is registered at Clinicaltrials.gov (NCT04809246).
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Affiliation(s)
- Yumi Sheehan
- The Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Evan B Cunningham
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amanda Cochrane
- Justice Health and Forensic Mental Health Network (Justice Health NSW), NSW Health, Sydney, Australia
| | - Marianne Byrne
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Tracey Brown
- Justice Health and Forensic Mental Health Network (Justice Health NSW), NSW Health, Sydney, Australia
| | - Colette McGrath
- Justice Health and Forensic Mental Health Network (Justice Health NSW), NSW Health, Sydney, Australia
| | - Lise Lafferty
- The Kirby Institute, University of New South Wales, Sydney, Australia; Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Nicodemus Tedla
- School of Biomedical Sciences, University of New South Wales, Sydney, Australia
| | - Gregory J Dore
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Andrew R Lloyd
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Jason Grebely
- The Kirby Institute, University of New South Wales, Sydney, Australia
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