Prof Thompson
Keeping up the good work in hepatitis C management will include continuing to identify and encourage people with hepatitis C into treatment at one end of the DAA pipeline and utilising salvage treatment to ‘mop up’ the small number of patients who fail initial therapy at the other end.
Professor Alex Thompson, director of gastroenterology at St Vincent’s Hospital Melbourne, tells the limbic a lot of effort is going into general community education as well as targeted education for clinicians and services that cater for marginalised groups of patients.
“The drugs are all approved for use in the community. GPs can prescribe them, it doesn’t take long to upskill with these drugs, and the challenge now is to identify people who are not currently engaged with care for their hepatitis C.”
“And often they are quite marginalised patients such as people who inject drugs, prisoners, and people who have other priorities in their lives.”
He acknowledged treatment numbers had fallen since DAAs first listed on the PBS in March 2016, but the consensus was that numbers had now plateaued.
“And the challenge is to maintain treatment at the current rate.”
“Absolute treatment numbers have been decreasing since the drugs were first listed, largely due to the fact that all the major liver clinics around the country had been waiting and waiting for the first DAA treatment to be listed.”
“So once they became available we started treating an enormous amount of people – what we call a warehouse of people who had been waiting for the new drugs. So we’ve cleared that out and now we are actively looking for new patients.”
Professor Thompson said currently available drugs were extremely effective with cure rates above 90%. More than 50,000 people had been treated since March 2016.
“But that also means a small number of people fail treatment. So even though it is a small percentage of people, it is actually a moderate total number of people and they are preferentially people with advanced liver disease.”
He said response rates from retreating people with the same agent were suboptimal because, like all antiviral drugs, the DAAs select for resistant variants.
However a new combination treatment, sofosbuvir with velpatasvir and voxilaprevir (Vosevi), has recently been added to the Australian Register of Therapeutic Goods.
“The principles of treating viral resistance are that you need multiple drugs or next generation drugs. So the advantage of this treatment regimen is that it involved three different drugs and it has been shown in phase 3 registration studies to be very effective treatment for people who have failed one of the first DAA treatment regimens.”
He said the cure rates in the clinical trials of Vosevi were more than 95%, it was effective for all HCV genotypes, well tolerated and involved just one pill per day for 12 weeks.
Professor Alex Thompson has served on advisory boards and been involved in clinical trials sponsored by Gilead for which compensation was received. In relation to the Gilead media announcement re: Vosevi on the ARTG, no compensation was provided to Professor Thompson.