April 12th, 2014

Unwittingly, HCV “News” Brackets Our Current Treatment Era on Successive Days

I’ve already told you what a fan I am of Physician’s First Watch, the daily email summary of hot medical news provided by my colleagues here at the Massachusetts Medical Society.

If you haven’t signed up, you must do so — let’s play a short tune (always a favorite) for background music while you head over there and take care of it. I’ll still be here when you get back:

Linus and Lucy by Vince Guaraldi on Grooveshark

Finished? Great.

Anyway, this week the diligent First Watchers sent me this on Thursday:

The World Health Organization has issued its first recommendations on screening for and treating hepatitis C infection … Pegylated interferon with ribavirin is the recommended treatment.

Interferon plus ribavirin? Blast from the past.

Now of course the WHO guidelines are much more nuanced than that — the full document includes discussions of telaprevir, boceprevir, simeprevir, and sofosbuvir.

But on a day-to-day basis right now, in places lucky enough to have access to the newest drugs, sofosbuvir is part of every recommended regimen, so it’s startling to see interferon and ribavirin listed alone. And barely mentioned at all is the sofosbuvir plus simeprevir combination — a regimen astoundingly free of side effects, and arguably the treatment of choice today for virtually everyone with genotype 1 if drug costs were no issue. (Which they most emphatically are.)

By contrast, First Watch sent this off the very next day:

An 8-week course of sofosbuvir and ledipasvir was not inferior to a 12-week course, or to an 8-week course that also added ribavirin … Another research group studied the combination of a protease inhibitor (ABT-450)… plus two inhibitors of hepatitis C virus replication (ombitasvir and dasabuvir) for 12 weeks … [Both studies had] response rates of roughly 95%.

They were referring, of course, to two remarkable studies (here and here) just published in the New England Journal of Medicine, showing us what’s soon to come: both a sofosbuvir/ledipasvir single pill regimen for just 8 weeks, and an interferon-free approach that doesn’t include sofosbuvir at all.

So in the future we’ll have choices between several excellent options.

Now get over to the First Watch site and sign up. You won’t regret it.

One Response to “Unwittingly, HCV “News” Brackets Our Current Treatment Era on Successive Days”

  1. Federico says:

    I registered to physician First watch a long time ago and let me say its a great way of being up-to-date on the latests information on medical news. And i also follow your blog daily since you have an astonishing way of aproaching a subject. Many thanks for your time and dedication Dr. Sax.
    Now, about the Who recommendations on HCV its understandable that they were made on the basis of costs. In underdeveloped countries like Argentina even telaprevir nor boceprevir are aproved for treatment of HCV. If you ask my opinión, its basically due to drug costs but an 8 week interferon free régimen with SVR above 90% would definately be the treatment of choice, especially for the patient due to eficacy, tolerability, low adverse effects and adherence. Unfortunately, we are far away from those novel treatments and have to deal with interferon-riba. As you comment above, we are sadly still in a “blast from the past” enviroment.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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