Antiviral Combo Eliminates Hepatitis C in Many Patients

In a large clinical trial, investigators have found that a combination of antiviral medications can stamp out hepatitis C infection (HCV) in a vast majority of advanced liver disease patients.

Led by a team including researchers from Beth Israel Deaconess Medical Center (BIDMC) and Intermountain Medical Center, the ASTRAL-4 trial included 267 patients with liver failure caused by hepatitis C. These patients participated in the randomized Phase 3 clinical study at 47 sites across the United States. More than half of the participants had failed a prior course of treatment for hepatitis C infection, according to the authors. The researchers note that the trial showed using a daily combination of the antiviral medications Sofosbuvir and Velpatasvir—either with or without the addition of Ribavirin for 12 weeks or 24 weeks—successfully treated hepatitis C in anywhere from 83% to 94% of patients.
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The results signify “another advance in the treatment of HCV, in that now we can treat patients of all genotypes with a simple regimen of medications and with very good success rates,” says Michael Curry, MD, associate professor of medicine at BIDMC, and lead author of the study.

In addition, “it is a move toward a regimen that will require very little in the way of pre-treatment assessment, as the regimen worked in all genotypes and in patients with prior treatment,” says Curry. “So we are moving toward a regimen that can be used broadly.”

At the present time, however, “it is still early, and these individuals with this degree of advanced liver failure should be under the care of a hepatologist or a GI specialist,” he cautions. “So, while this regimen will be available for broad use, including use by primary care practitioners, this cohort of patients with liver failure should be under the case of specialists.”

—Mark McGraw

Reference

Curry M, O'Leary J, et al. Sofosbuvir and Velpatasvir for HCV in Patients with Decompensated Cirrhosis. NEJM. 2015.