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The Success of All-Oral Direct-Acting Antiviral Treatments

Stephen Holt, MD, PhD, FACP November 25, 2019

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Leading research indicates vastly improved outcomes for HCV and liver cancer patients using all-oral direct-acting antiviral treatments.
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The hepatitis C Virus (HCV) chronically affects roughly 71 million people worldwide – with complications like cirrhosis, liver disease, and hepatocellular carcinoma (HCC) tripling over the last 15 years. (1) Projections suggest we won’t hit the peak of HCV destruction until roughly 2035, painting a grim future for our collective livers.

HCV Call to Action

Luckily, the medical and scientific communities have answered the looming HCV epidemic with a multitude of support and research pouring into the HCV space. Some of the largest medical, scientific, and governmental bodies have dedicated efforts to eradicating HCV, and it truly feels as though we’re slowly approaching a moment in time when hepatitis, in all its undesirable and alphabetical variations, will be 100% cured. It’s not unrealistic that, in 20 years, HCV will be remembered as a momentary thorn in humanity’s side, alongside diseases like Cholera and Polio whose cures stand as markers of humanity’s ingenuity and perseverance.

The most recent progress in HCV research comes to the benefit of hepatocellular carcinoma and liver disease sufferers.

At a recent conference in Boston hosted by The American Association for the Study of Liver Diseases, researcher Mindie Nguyen presented the findings of a multinational study conducted by research teams in the U.S., Korea, Japan, and Taiwan looking at data from 1,676 mono-infected HCV-related HCC patients. (1) The findings were not only largely positive but not so surprising given the scope and contributing body of researchers.

Nguyen and her colleagues found that utilizing an all-oral direct-acting antiviral (DAA) over a 5-year period of time greatly improved outcomes in hepatocellular carcinoma sufferers by 60-70 percent, accounting for all-cause and liver-related cancers where the alternative group represented untreated HCV sufferers whose HCV life cycle progresses unchecked. (1) That’s an extremely high and encouraging hep c treatment success rate.

Similar research investigated new hep c treatment recently published in the March 2019 issue of Hepatology found that “in the short term, all-oral DAA treatment for HCV infection was associated with a decreased risk of developing hepatocellular carcinoma and decompensated cirrhosis, resulting in decreased health care costs, especially in patients with cirrhosis.” (2)

Practical Hep C Treatment Guidelines

When you add these findings to the growing mountain of research around antivirals and HCV, it seems clear that hepatitis C treatment guidelines should indicate DAA for anyone diagnosed with HCV-related HCC. And anyone who is a candidate for HCC therapy should also be considered for direct-acting oral antiviral therapy.

When it comes to antivirals, the only ones with FDA approval for treating all six hepatitis C genotypes are Mavyret (glecaprevir/pibrentasvir), Epclusa (sofosbuvir/velpatasvir), and Vosevi (sofosbuvir, velpatasvir and voxilaprevir). (3, 4)

Of course there are other medications to treat Hepatitis C for specific genotypes with very very high hepatitis C treatment success rates that range between 90-100 percent according to the FDA, and take between 6-12 weeks to run their full treatment course.

The Cost of Hepatitis C Treatment

Now that DAAs are proving so effective, the next step in eradicating HCV is lowering their cost to patients in order to make them more widely available. If research indicates 70% improved outcomes for those who have access to DAAs, the next hurdle in the war on HCV is financial.

While some of the most effective DAA regimens can cost hundreds of thousands of dollars, it’s nice to see some states and organizations taking on the financial burden of hepatitis by offering realistic payment options for costly DAAs.

  • Take Louisiana for example who, in January of 2019, began offering a Netflix-style payment option whereby HCV patients could get unlimited access to DAAs for five years in Louisiana if they were enrolled in Medicaid or are incarcerated. (5)
  • Oregon, the state with the highest rates of HCV mortality in the country, adopted a similar payment plan for those enrolled in Medicaid. Advocates for Oregon’s plan of attack also note that making treatment affordable and accessible will alleviate the burden of HCV healthcare costs on the entire system to the tune of roughly 3.8 billion in overall savings. (6)

Between the release of Mavyret in 2017 (for just $26,400 per round of treatment), bad press, and legal action, a bit of a price war escalated and Merck lowered its price of Zepatier by 60%. Additionally, Gilead authorized a generic version of Epclusa and Harvoni in 2019 which can significantly decrease the cost to patients. All positive moves to more affordable treatments. (7)

Alleviating the Symptoms of HCV

Not surprisingly, many of the symptoms of liver damage and the side-effects of DAAs can overlap.

The most common symptoms include:

  • Nausea
  • Fatigue
  • Headaches
  • Vomiting
  • Abdominal pain

Some natural remedies, such as milk thistle, can help fight HCV symptoms by detoxifying your liver and relieving inflammation that occurs. Another efficient natural supplement option is to take a more inclusive clinical liver support supplement. Natural supplements like these can help reduce fat and scarring in the liver, protect liver cells, and improve its function.

As always, consult your doctor about new supplements and treatment options and run any changes in diet or behavior by them before implementing. Some natural supplements such as valerian and kava can actually lead to liver damage or interact adversely with previously prescribed medications. According to the Mayo Clinic, there are a handful of herbs and natural remedies that can cause liver damage and are to be avoided by HCV sufferers, including aloe vera, black cohosh, cascara, chaparral, comfrey, and ephedra. (8) It’s critical to be as informed and safe as possible.

Conclusion

As 2020 looms overhead, things are continuing to trend upward when it comes to new hep C treatment guidelines, DAAs, and hep c treatment success rates. With the effort of the medical and scientific communities surging in conjunction with political action at the state level in the form of financial aid for those who need access to costly DAAs, 2035 may not be the peak of HCV prevalence, but a time where our grasp and understanding of hepatitis has finally seen its eradication.

  1. All-Oral Direct-Acting Antiviral Treatments Improve Survival in Patients with HCV-Related Hepatocellular Carcinoma: AASLD. (2019). Retrieved November 18, 2019 from https://www.aasld.org/all-oral-direct-acting-antiviral-treatments-improve-survival-patients-hcv-related-hepatocellular
  2. Park, H., Wang, W., Henry, L., & Nelson, D. R. (2019, March). Impact of All-Oral Direct-Acting Antivirals on Clinical and Economic Outcomes in Patients With Chronic Hepatitis C in the United States. Retrieved November 18, 2019 from https://www.ncbi.nlm.nih.gov/pubmed/30289989
  3. Lovering, C. (2018, September 13). Doctor Discussion Guide: New Treatment Options for Hep C. Retrieved November 19, 2019 from Healthline website: https://www.healthline.com/health/hepatitis-c/ddg-new-treatment-options#1
  4. Highlights of Prescribing Information - Vosevi (2019). Retrieved November 26, 2019 from https://www.gilead.com/~/media/Files/pdfs/medicines/liver-disease/vosevi/vosevi_pi.pdf.
  5. ‌Hamm, N. (2019). The First Hep C Value-Based Bundled Payment Plan. Managed Healthcare Executive. https://doi.org/https://www.managedhealthcareexecutive.com/node/33719
  6. 2019 Brings End to Hepatitis C Virus Treatment Rationing in Oregon. (2019). Retrieved November 19, 2019 from ContagionLive website: https://www.contagionlive.com/news/2019-brings-end-to-hepatitis-c-virus-treatment-rationing-oregon
  7. Holt, S. (2019, January). Hepatitis C Drug News - 2019. Retrieved November 26, 2019 from https://www.hepatitiscentral.com/news/hepatitis-c-drugs-in-2019-price-drops-and-generic-pipeline-in-place/.
  8. Toxic hepatitis - Symptoms and causes. (2019). Retrieved from Mayo Clinic website: https://www.mayoclinic.org/diseases-conditions/toxic-hepatitis/symptoms-causes/syc-20352202
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