Pushing the Limits: Could Just 6 Weeks of Treatment Cure Hepatitis C?

A new study shows that adding a third drug to the ingredients in Harvoni could cure hepatitis C in half the ordinary time.

Currently, most treatment courses with direct-acting antivirals are 12 weeks in length, with the shortest duration being eight weeks in select patients receiving treatment with Harvoni (ledipasvir/sofosbuvir). However, with the addition of a third agent, researchers believe that the eight-week treatment can be reduced even further to just six weeks of therapy.

In a 50-patient trial published in the journal Clinical Infectious Diseases published online October 26, 2015, researchers Kattakuzhy and colleagues reported a high rate of sustained viral response with patients receiving a short course of treatment.

Researchers followed patients over more than one year from April 2014 to June 2015. All patients were aged 18 or older, and had stage 3 or 4 liver fibrosis resulting from chronic hepatitis C genotype 1 infection.

Of the 50 patients, more than three-fourths (76%) receiving the medications in Harvoni (ledipasvir and sofosbuvir) with a third agent codenamed GS-9451, achieved sustained viral response 12 weeks after the end of treatment (SVR12). Attaining this end point constitutes a functional cure of the virus.

Although half of patients were treatment-naïve individuals, and half were treatment-experienced, unexpectedly, there were no significant differences in cure rates between the two populations (72% with treatment-naive patients, and 80% with treatment-experienced patients; P = .51).

This result is the opposite of what would be expected, as treatment-experienced patients typically have lower rates of response to anti-HCV treatment than treatment-naïve patients.

With a shorter treatment course for hepatitis C, patients could maintain better adherence over a shorter course of therapy, and fewer patients would have limited access to therapy due to the lower cost of a shorter treatment regimen.

The potential for savings with this three-drug regimen is enormous, although the benefits of a shorter treatment regimen must be balanced with the lower cure rates associated with this three-drug regimen (approximately 75%) when regimens offering 90% or higher cure rates are currently available.

Reference

Kattakuzhy S, Wilson E, Sidharthan S, et al. Six-week Combination Directly Acting Anti-HCV Therapy Induces Moderate Rates of Sustained Virologic Response in Patients with Advanced Liver Disease. Clin Infect Dis. 2015.