Second Generation DAA Agents Have Increased Hep C Treatment Globally

Homie Razavi, PhD
Credit: CDA Foundation

An analysis of global data is providing hepatologists and other care providers insight into how the introduction of second-generation direct-acting antivirals has impacted the treatment of hepatitis C virus.

Presented at The Liver Meeting 2023 from the American Association for the Study of Liver Diseases, results of the study demonstrate the addition of next-generation direct-acting antivirals has contributed to increased uptake of hepatitis C treatments, with this impact most apparent in low- and middle-income countries.

“For the global elimination of [hepatitis C virus] there needs to be a continued exponential increase in cumulative treated patients in [low- and middle-income countries] along with continued expansion of generic access to medications,” investigators wrote.

The most common chronic viral infection found in blood among people in the US, hepatitis C virus represents a challenge for management as well as for public health systems. The National Institutes of Health estimate the prevalence of chronic hepatitis C to be between 2.7 to 3.9 million people in the US, with this figure increasing since 2006. According to recent estimates, the economic burden of chronic hepatitis C might exceed $10 billion annually in the United States alone.2,3

From 2011 through 2016, the community witnessed an explosion in new therapies, with 10 different agents receiving an indication for at least 1 genotype of hepatitis C during the period. To the chagrin of the medical community, a common theme in healthcare is a notable lag between the introduction of new therapies and optimal uptake.2

In the current study, a team led by Homie Razavi, PhD, founder and managing director at the Center for Disease Analysis Foundation, and colleagues sought to determine how the advent of these second-generation direct-acting antiviral treatments might have impact the treatment of hepatitis C virus. With this in mind, investigators designed their study as an analysis of data from multiple national databases, drug sales data, government reports, reporting from treatment centers, and drug supplier reports.¹

For the purpose of analysis, investigators specifically sought data related to treatment-receiving regimens including sofosbuvir, ombitasvir/paritaprevir/ritonavir-, glecaprevir/pibrentasvir- , and elbasvir/grazoprevir-based treatments.¹

Overall, investigators identified 13.2 million patients with hepatitis C who had been treated with direct acting antivirals between 2014 and 2022. Among this cohort, 10.9 million were treated with sofosbuvir-based regimens, which accounted for 82% of all hepatitis C virus treatments. The most dominant form of direct-acting antiviral treatment was generic sofosbuvir/daclatasvir.¹

Investigators pointed out 89% of all hepatitis C virus infections included in the study occurred in low- to middle-income countries, with just 3.7 million treatments occurring in high-income countries. Investigators also pointed out the peak percentage of sofosbuvir-based regimens observed in 2019 was the result of substantial uptake in hepatitis C virus treatment in the Egyptian elimination program. Following this peak in 2019, an increase in use of other direct-acting antivirals was observed, with the number of patients treated rising from 1.6 million in 2019 to 2.4 million in 2022.¹

“With 89% of all [hepatitis C virus] infections in [low- and middle-income countries], immediate access to generic versions of the latest drugs is needed to achieve the global elimination targets. The high-income countries have been very proactive in treating their [hepatitis C virus] infected populations and removing all restrictions,” investigators added.¹

References:

1. Voeller A, Razavi-Shearer D, Gamkrelidze I, Razavi-Shearer K, Blach S, Razavi H. Total HCV patients treated with direct acting antivirals since 2014. Paper Presented at: AASLD The Liver Meeting, November 10-14, 2023. Accessed November 21, 2023.
2. Hepatitis C - NIDDK. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed November 21, 2023. https://www.niddk.nih.gov/health-information/liver-disease/viral-hepatitis/hepatitis-c.
3. Geddawy A, Ibrahim YF, Elbahie NM, Ibrahim MA. Direct Acting Anti-hepatitis C Virus Drugs: Clinical Pharmacology and Future Direction. J Transl Int Med. 2017;5(1):8-17. Published 2017 Mar 31. doi:10.1515/jtim-2017-0007