Can Hepatitis C be cured?

From the Guidelines

Hepatitis C can be cured with modern direct-acting antiviral (DAA) medications, which can eliminate the virus from the body in more than 95% of cases, resulting in a sustained virologic response (SVR), considered a cure. According to the most recent evidence from 1, the European Association for the Study of the Liver (EASL) position paper on clinical follow-up after HCV cure, published in 2024, patients can be cured of HCV infection with the use of DAAs. The treatment regimens, such as combinations like Epclusa (sofosbuvir/velpatasvir), Mavyret (glecaprevir/pibrentasvir), or Harvoni (ledipasvir/sofosbuvir), can achieve SVR rates of 95% or higher, as mentioned in the previous guidelines 1.

The key points to consider in the treatment of Hepatitis C include:

• Determining the viral genotype and assessing liver damage before starting treatment
• Regular monitoring during treatment to ensure effectiveness and manage side effects
• Follow-up testing after completing treatment to confirm if the virus has been eliminated
• Continued regular monitoring for liver cancer and other complications in patients with advanced liver disease, even after being cured, as recommended by 1

It is essential to note that the treatment duration and specific medication used may vary depending on the viral genotype, liver condition, and prior treatment history. The medications work by directly targeting different steps in the hepatitis C virus life cycle, preventing viral replication. With the advent of DAAs, the management of HCV infection has improved significantly, and the focus has shifted to the optimal management of patients after treatment, including follow-up and monitoring for potential complications, as outlined in 1.

From the FDA Drug Label

The SVR12 rate was 98% overall (98% [78/80] in treatment-naïve subjects and 100% [20/20] in treatment-experienced subjects). The SVR12 rate was 99% (86/87) in subjects with genotype 1 HCV infection, and 100% (2/2) in subjects with genotype 4 HCV infection. The SVR12 rate was 97% (32/33) in subjects with genotype 1 HCV infection, and the one subject with genotype 4 HCV infection also achieved SVR12.

Hepatitis C can be cured with certain treatments, such as ledipasvir and sofosbuvir, as evidenced by the high SVR12 rates in clinical trials 2.

• Key points:
  • High SVR12 rates were observed in treatment-naive and treatment-experienced subjects.
  • SVR12 rates were high across different genotypes (1 and 4) and age groups.
  • These results suggest that Hepatitis C can be effectively treated and cured with ledipasvir and sofosbuvir.

From the Research

Hepatitis C Treatment Options

• Hepatitis C can be cured with available antiviral therapies, but only a minority of infected persons has ever been treated 3.
• The current standard of therapy is a combination of PEG-IFNalpha and ribavirin, which produces high rates of SVRs (absence of detectable HCV RNA at least 24 weeks after cessation of therapy): 42% to 56% in genotype 1 and 75% to 84% in genotypes 2 and 3 3.
• Interferon-free regimes are now the treatment of choice for patients with chronic hepatitis C; previously patients who were 'difficult-to-treat' using interferon-containing treatments can now safely be treated with such therapies 4.
• More than 90% of patients infected with HCV genotype 1 or 4, compensated cirrhosis, or who have had liver transplantation, can be cured with the use of sofosbuvir combined with simeprevir, daclatasvir or ledipasvir, or by the combination of paritaprevir with ritonavir, ombitasvir and with or without dasabuvir 4.

Treatment Outcomes

• The combination of ledipasvir, sofosbuvir, and ribavirin for 12 weeks produced high rates of SVR12 in patients with advanced liver disease, including those with decompensated cirrhosis before and after liver transplantation 5.
• Eight-week courses of ledipasvir/sofosbuvir (LDV/SOF) have been supported in some studies, and data show that SVR 12 was virtually identical at 93.6 and 93.5%, respectively, for 8 and 12 weeks of treatment 6.
• Treatment with the NS5A inhibitor ledipasvir, the nucleotide polymerase inhibitor sofosbuvir, and ribavirin in patients infected with HCV genotypes 1 or 4 resulted in SVR12 rates of 86%-89% in non-transplant patients and 96%-98% in transplant recipients without cirrhosis or with compensated cirrhosis 5.

Special Patient Populations

• The optimal use of interferon-free regimes in patients with renal failure or after kidney transplantation is currently being studied 4.
• New and improved drugs are needed to treat patients infected with HCV genotype 3 4.
• The safety of interferon-free drugs is not fully explored in patients with decompensated cirrhosis, and protease inhibitors should not be used in this group 4.