Eight weeks of treatment with Epclusa cured almost all people with HCV receiving opioid substitution therapy

Alison Boyle presenting at The International Liver Congress, 2018. Image credit: @katjc1

An eight-week course of sofosbuvir/velpatasvir (Epclusa) cured almost all people with hepatitis C genotype 3 without cirrhosis receiving treatment alongside opioid substitution therapy through community pharmacies or prisons in the Greater Glasgow area, Alison Boyle of Gartnavel Hospital, Glasgow, reported at the 2018 International Liver Congress in Paris on Thursday.

Genotype 3 is especially common in people who inject drugs and former drug users. It has been considered 'harder to cure' although recent studies of newer agents in people with genotype 3 have shown high cure rates.

A 12-week treatment course of sofosbuvir/velpatasvir (Epclusa) is highly effective in curing genotype 3 hepatitis C infection and an 8-week course of sofosbuvir/velpatasvir was highly effective in previously untreated people with genotype 3 infection and no cirrhosis.

Glossary

fibrosis

Scarring of the liver – the development of hard, fibrous tissue. See also ‘cirrhosis’, which is more severe scarring.

cure

To eliminate a disease or a condition in an individual, or to fully restore health. A cure for HIV infection is one of the ultimate long-term goals of research today. It refers to a strategy or strategies that would eliminate HIV from a person’s body, or permanently control the virus and render it unable to cause disease. A ‘sterilising’ cure would completely eliminate the virus. A ‘functional’ cure would suppress HIV viral load, keeping it below the level of detection without the use of ART. The virus would not be eliminated from the body but would be effectively controlled and prevented from causing any illness. 

cirrhosis

Severe fibrosis, or scarring of organs. The structure of the organs is altered, and their function diminished. The term cirrhosis is often used in relation to the liver. 

observational study

A study design in which patients receive routine clinical care and researchers record the outcome. Observational studies can provide useful information but are considered less reliable than experimental studies such as randomised controlled trials. Some examples of observational studies are cohort studies and case-control studies.

loss to follow up

In a research study, participants who drop out before the end of the study. In routine clinical care, patients who do not attend medical appointments and who cannot be contacted.

Scottish investigators carried out an observational study of an 8-week course of sofosbuvir/velpatasvir in people receiving opioid substitution therapy in the Glasgow area. The 8-week treatment course was offered to drug users receiving opioid substitution therapy if they had F2 or F3 fibrosis with the intention of maximising the number of people who could be treated within a fixed drug budget in the Greater Glasgow region.

Sofosbuvir/velpatasvir was dispensed as daily directly observed treatment along with opioid substitution therapy for those still injecting or those who were in the early stages of recovery. More stable patients received medication and opioid substitution therapy two to three times a week. All medication was dispensed by community pharmacies with the exception of treatment provided to people in prison.

Ninety people were observed in the study; 80% were male, with a mean age of 46 years. Two-thirds had F2 fibrosis, 31% had F3 fibrosis and the remainder had F1 or F0 fibrosis. Five were receiving opioid substitution therapy in prison. Forty-two per cent were receiving opioid substitution therapy daily.

Twelve-week post-treatment follow-up showed that 93% of those who began treatment achieved a sustained virological response (SVR12 or cure). Two people were lost to follow-up, two discontinued treatment prematurely, one died and one person was reinfected. There were no cases of virologic rebound after treatment. All eight people who continued to report injecting drug use during the treatment period achieved a sustained virological response.

References

Boyle A et al. 8 weeks sofosbuvir/velpatasvir in genotype 3 patients with significant fibrosis: highly effective among an OST cohort. The International Liver Congress, Paris, abstract PS-034, 2018. Journal of Hepatology 68: S20, 2018.