The 51st International Liver Congress, the annual meeting of the European Association of the Study of the Liver (EASL), took place from April 13 to 17 in Barcelona. As in recent years, hepatitis C virus (HCV) news dominated. However, a smaller share of the news this year concerned the success rates of upcoming therapies—many of the revolutionary treatments described during previous conferences are now on the market. Instead, larger hep C–related care issues rose to the forefront.
To follow are brief summaries of highlights of the hep C news at the conference. Click on any of the links for more detailed information.
Short Hep C Treatments:
Gilead Sciences has yet another new fixed-dose combination tablet hep C regimen in the works, which will likely gain approval at the end of June. A combination of Sovaldi (sofosbuvir) and the pangenotypic NS5A inhibitor velpatasvir, the tablet is designed to work for all genotypes of the virus 1 through 6. New research presented at EASL found that a combination of the tablet plus the NS3/4A protease inhibitor GS-9857 cured 96 percent of 99 people with all genotypes treated for just eight weeks.
Meanwhile, another study has found that just six weeks of Gilead’s Harvoni (ledipasvir/sofosbuvir) can cure acute, or very recent, hep C infections. All 20 acutely infected individuals in a pilot study were cured with the regimen.
Looking further into the future, researchers have made early progress developing a hep C regimen that could cure the virus in just one month. Investigators reported interim findings from a Phase II study of 79 people with genotype 1 or 3 of the virus who were new to treatment and who received injections with a drug known as RG-101 before and after four weeks of daily oral direct-acting antivirals. RG-101 targets microRNA-122, which hep C needs to replicate.
Of those participants who had undergone sufficient follow-up post-treatment, a respective 97 percent and 100 percent maintained an undetectable viral load eight and 12 weeks after completing treatment (an undetectable viral load 12 weeks after finishing treatment is considered a cure).
AbbVie’s Viekira Pak (ombitasvir/paritaprevir/ritonavir; dasabuvir) works well in the real world. An ongoing trial of 9,000 people receiving treatment with the regimen in Germany has found that those with enough follow-up were cured at a rate of 96 percent among those with genotype 1 of the virus and 100 percent among those with genotype 4.
People with genotype 1b of the virus who have resistance to the NS5A inhibitor class of hep C drugs still do well with Viekira Pak according to an analysis of five Phase III trials of the regimen. (The ombitasvir component of the regimen is an NS5A inhibitor.) Regardless of the presence of such resistance, the cure rate remained the same among participants, at 97 percent.
AbbVie’s investigational combo, the NS3/4A protease inhibitor ABT-495, and the NS5A inhibitor ABT-530, with or without ribavirin, showed promise among those with genotype 3 in two small trials. All of those with cirrhosis were cured, as were 97 percent of those without cirrhosis.
General Treatment Issues:
You may not need to see a specialist to do well on hep C treatment. A Phase IV study of 304 people treated with Harvoni at U.S. community health centers found no significant difference in their cure rate based on whether they saw a specialist, primary care physician or nurse practitioner. All three groups had cure rates in the mid-90 percent range.
In less promising news, those who have had liver cancer and are treated for hep C have a high chance the cancer will recur. Looking at records of 344 individuals with hep C–related cirrhosis who did not have active hepatocellular carcinoma (HCC, the most common form of liver cancer), researchers found that 24 weeks after finishing treatment for the virus, 8 percent had active HCC, which the investigators considered a standard rate. At this point, 20 percent of those who had had HCC before had a recurrence of the cancer.
European men who have sex with men (MSM) who have HIV and are cured of hep C are reinfected with HCV at a very high rate. Sometimes they recontract the virus multiple times. Looking at a cohort of about 600 HIV-positive MSM who were cured of hep C, they found that one in four were reinfected within three years. Twenty-nine men were reinfected a second time, four were reinfected a third time and one had four reinfections.
Hep C treatment could help lessen demand on liver transplant waiting lists. Looking at records of about 103 European liver transplant candidates who did not have liver cancer and who had been treated for hep C, researchers found that 35 percent of them saw their liver health improve post-treatment to the point that they no longer urgently needed a transplant. Twenty percent of them didn’t need a new liver at all anymore.
As for people with hep C receiving a transplanted liver, whether the new liver was itself infected with the virus had no bearing on the outcome of the transplant according to analysis of data on the nearly 34,000 liver transplants conducted in the United States between 1995 and 2013. A total of 5.7 percent of the transplanted livers were infected with the virus.
The rates of long-term graft loss and mortality were the same regardless of whether the new liver was hep C infected.