Panel Recommends Treatment with New Drugs for Nearly All Who Have Chronic Hepatitis C

A joint panel of liver disease experts recently updated industry guidelines for the treatment of hepatitis C virus (HCV) to remove priority tables and stick with a recommendation that nearly all patients with chronic infection of the virus be treated with direct-acting drugs.

The updates were posted on HCVguidelines.org, which is backed by the American Association for the Study of Liver Diseases, the Infectious Diseases Society of America and the International Antiviral Society-USA, according to a news release from a panel of the organizations. Developed as a collaborative effort, the web site was launched in 2014 to offer a mechanism for timely 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,” Henry Masur, MD, a panel member, noted in the release.

Health officials estimate that about 3 million people in the US and 130 million to 150 million people worldwide are infected with chronic infection of hepatitis C virus. There is currently no vaccine for the virus, which is transmitted through exposure to hepatitis C-infected blood and can cause serious liver damage from years of chronic infection.

The most recent update changes the section “When and in Whom to Initiate HCV Therapy” to no longer include tables with recommendations on how to prioritize patients for treatment, the release states. The revision was based on expanded “real world” experience with the tolerability and efficacy of newer HCV medications.

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

The panel had previously written the guidance to prioritize direct-acting anti-viral treatment to patients with the greatest need, especially people with severe liver disease. Since then doctors have had the chance to learn more about the new drugs through treating patients in the highest risk groups.

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

Panel members acknowledge that exactly which patients will actually receive treatment may still, to some degree, depend on regional availability and of course the higher costs of the new drugs. Given this reality, a practitioner may still have to decide which patients to treat first, they said in the release.

Also, under the updated guidance, new therapies are not recommended for people who have short life expectancies that are unrelated to hepatitis C infection. The guidance further advises that patients with short life expectancies owing to liver disease should be managed in consultation with an expert.

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

The next major update to the guidance is expected in February 2016, according to AASLD spokesman Greg Bologna.