New Hepatitis C Drugs Recommended for Nearly All Chronic Cases

Liver disease experts suggest how to prioritize the treatment of different HCV patient groups.

The high cost and tight restrictions to access the new generation of highly effective hepatitis C virus (HCV) drugs have been well documented.

But the difficulties the majority of patients face in gaining approval for treatment with these HCV drugs may soon be amplified after an expert panel recently recommended these drugs for nearly all cases of chronic HCV.

The group of liver disease experts issued new industry guidelines for HCV treatment that eliminates priority tables for a recommendation that nearly all patients with chronic infection are treated with direct-acting drugs.

The updates, issued on HCVguidelines.org, are supported by the American Association for the Study of Liver Diseases, the Infectious Diseases Society of America, and the International Antiviral Society-USA,.

The site provides an outlet for updates to HCV Guidance: Recommendations for Testing, Managing and Treating Hepatitis C.

“The goal is to treat all patients as promptly as feasible to improve health and to reduce HCV transmission,” said panel member Henry Masur, MD.

Approximately 3 million people are estimated to be infected with HCV in the United States, with an additional 130 million to 150 million people infected worldwide.

The update eliminates tables that recommend how to prioritize the treatment of different patient groups in the section “When and in Whom to Initiate HCV Therapy,” after real world evidence showed the safety and efficacy of the new antiviral HCV drugs.

“When the direct-acting medications were first introduced, all our knowledge about how these drugs worked came from clinical trials,” said panel member David Thomas, MD. “We needed to gain more experience with their safety before we encouraged all infected persons to initiate therapy. We now have that experience.”

The guidance previously prioritized treatment for patients with the greatest need, specifically in cases of severe liver disease. Physicians subsequently gained the opportunity to better evaluate these drugs in the treatment of the highest risk patient groups.

“There are also expanding data on the benefits of HCV treatment for patients with all stages of disease, including mild liver disease,” said panel member Raymond Chung, MD.

The guidance noted that ultimately determining which patients will actually be treated will most likely remain dependent on regional availability and the price tag for these medications.

As a result, caregivers may still have to determine which patients receive treatment first.

The updates to the guidance also stated that the new medications are not recommended for HCV patients with shorter life expectancies unrelated to HCV infection. This update suggests patients with short life expectancies from liver disease are managed in consultation with an expert.

“A good relationship between doctor and patient is crucial to achieving the best outcomes with direct-acting therapies,” said panel member Gary Davis, MD.