What is the Best Treatment for Hepatitis C?

Those of you who read my blog posts on a regular basis will know that for a long time I have been “banging the drum ” about Sofosbuvir + Daclatasvir being the best Hepatitis C treatment.

Better than Epclusa, better than Mavyret, better than Harvoni AND much cheaper than all of them.

A recent study published only a few weeks ago in the Journal of Hepatology proves again that Sofosbuvir 400 mg + Daclatasvir 60 mg, as well as being the best treatment for genotype 1, Sof + Dac is also is the best treatment for Hepatitis C genotype 2 and genotype 3.

Adding Ribavirin

Importantly this study shows that Sofosbuvir + Daclatasvir is equally effective with or without Ribavirin.

In fact adding Ribavirin appears to REDUCE the cure rate!!!!

In other words it shows that there is no point in including Ribavirin when treating Hep C G2 or G3.

This is very important because Ribavirin is very toxic and (particularly for women) can produce serious side effects.

The Best and the Cheapest

The fact is that the best Hepatitis C treatment is also the cheapest. Strangely it is also the treatment least likely to be prescribed in Western Countries such as the USA, Canada and Europe. The reason for this is that BIG Pharma does not make any money for Sofosbuvir  + Daclatasvir because the patent for Sofosbuvir is owned by Gilead and the patent for Daclatasvir is owned by BMS and the two Big Pharma giants could not come to an agreement on cooperation.

So it happens that the best and cheapest treatment for Hepatitis C is not being used in many countries simply because Big Pharma has let its greed block what is best for people with Hepatitis C

Here is the Abstract of the research results:

This graph shows that there is no significant difference in cure rates between Sofosbuvir + Velaptasvir (Epclusa) and Sofosbuvir + Daclatasvir. The exception is where liver cirrhosis is present, in which case Sof + Vel is slightly superior and where a patient has failed previous treatment, where Sof + Dac is significantly superior

J Hepatol. 2019 Jan;70(1):15-23. doi: 10.1016/j.jhep.2018.09.018. Epub 2018 Sep 26.

Real-world effectiveness of Daclatasvir/Sofosbuvir and Velpatasvir/Sofosbuvir in hepatitis C genotype 2 and 3.

Belperio PS¹, Shahoumian TA¹, Loomis TP¹, Mole LA¹, Backus LI².

BACKGROUND & AIM:

Understanding the real-world effectiveness of all-oral hepatitis C virus (HCV) regimens informs treatment decisions. We evaluated the effectiveness of daclatasvir + sofosbuvir ± ribavirin (DCV + SOF ± RBV) and velpatasvir/sofosbuvir (VEL/SOF) ± RBV in patients with genotype 2 and genotype 3 infection treated in routine practice.

METHODS:

This observational analysis was carried out in an intent-to-treat cohort of patients with HCV genotype 2 and genotype 3. Sustained virologic response (SVR) analysis was performed in 5,400 patients initiated on DCV + SOF ± RBV or VEL/SOF ± RBV at any Department of Veterans Affairs facility.

RESULTS:

For genotype 2, SVR rates did not differ between DCV + SOF (94.5%) and VEL/SOF (94.4%) or between DCV + SOF + RBV (88.1%) and VEL/SOF + RBV (89.5%). For genotype 3, SVR rates did not differ between DCV + SOF (90.8%) and VEL/SOF (92.0%) or between DCV + SOF + RBV (88.1%) and VEL/SOF + RBV (86.4%). In multivariate models of patients with genotype 2 and 3 infection, the treatment regimen was not a significant predictor of the odds of SVR. For genotype 3, significant predictors of reduced odds of SVR were prior HCV treatment-experience (odds ratio [OR] 0.51, 95% CI 0.36-0.72; p <0.001), FIB-4 >3.25 (OR 0.60; 95%CI 0.43-0.84; p = 0.002) and a history of decompensated liver disease (OR 0.68; 95%CI 0.47-0.98; p = 0.04). For patients with genotype 2 and 3, treated with VEL/SOF ± RBV, 89% and 85% received 12-weeks of treatment, respectively. For DCV + SOF ± RBV, 56% and 20% of patients with HCV genotype 2 received 12-weeks and 24-weeks of treatment, respectively; while 53% and 23% of patients with HCV genotype 3 received 12-weeks and 24-weeks, with most direct-acting antiviral experienced patients receiving 24-weeks.

CONCLUSIONS:

In patients infected with HCV genotype 2 and 3, DCV + SOF ± RBV and VEL/SOF ± RBV produced similar SVR rates within each genotype, and the regimen did not have a significant impact on the odds of SVR. For patients with genotype 3, prior treatment-experience and advanced liver disease were significant predictors of reduced odds of SVR regardless of regimen.

LAY SUMMARY:

In clinical practice, cure rates for hepatitis C virus (HCV) genotype 2 were 94% and cure rates for HCV genotype 3 were 90%. The chance of achieving cure was the same whether a person received daclatasvir plus sofosbuvir or velpatasvir/sofosbuvir. Ribavirin did not affect cure rates. The chance of a cure was lowest in people who had received HCV medication in the past.

Published by Elsevier B.V.

Hepatitis C Treatment Times

It is important to remember that the results above are for 12 weeks treatment. By increasing the treatment time the cure rate will improve significantly. Below is a rough scale showing how increasing treatment time improves cure rate percentages. For more information on Hepatitis C Treatment times please click this link

4 Weeks <50%

12 Weeks 90%>

16 Weeks 95%>  (+5%)

20 Weeks 97%>  (+2%)

24 Weeks 98%>  (+1%)

KEYWORDS:

Daclatasvir; Hepatitis C; Sofosbuvir; Sustained virologic response; Velpatasvir

The study can be found on this link to the Journal of Hepatology 2019;70(1):

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