Benefits of Direct-Acting Antivirals for Hepatitis C
Authors: Anna S. Lok, Raymond T. Chung, Hugo E. Vargas, Arthur Y. Kim, Susanna Naggie, William G. Powderly
Journal: Annals of Internal Medicine (2017)

Ideas and Opinions5 December 2017Benefits of Direct-Acting Antivirals for Hepatitis CAnna S. Lok, MD, Raymond T. Chung, MD, Hugo E. Vargas, MD, Arthur Y. Kim, MD, Susanna Naggie, MD, MHS, and William G. Powderly, MDAnna S. Lok, MDFrom University of Michigan, Ann Arbor, Michigan; Massachusetts General Hospital, Boston, Massachusetts; Mayo Clinic, Phoenix, Arizona; Duke University School of Medicine, Durham, North Carolina; and Washington University School of Medicine, St. Louis, Missouri.Search for more papers by this author, Raymond T. Chung, MDFrom University of Michigan, Ann Arbor, Michigan; Massachusetts General Hospital, Boston, Massachusetts; Mayo Clinic, Phoenix, Arizona; Duke University School of Medicine, Durham, North Carolina; and Washington University School of Medicine, St. Louis, Missouri.Search for more papers by this author, Hugo E. Vargas, MDFrom University of Michigan, Ann Arbor, Michigan; Massachusetts General Hospital, Boston, Massachusetts; Mayo Clinic, Phoenix, Arizona; Duke University School of Medicine, Durham, North Carolina; and Washington University School of Medicine, St. Louis, Missouri.Search for more papers by this author, Arthur Y. Kim, MDFrom University of Michigan, Ann Arbor, Michigan; Massachusetts General Hospital, Boston, Massachusetts; Mayo Clinic, Phoenix, Arizona; Duke University School of Medicine, Durham, North Carolina; and Washington University School of Medicine, St. Louis, Missouri.Search for more papers by this author, Susanna Naggie, MD, MHSFrom University of Michigan, Ann Arbor, Michigan; Massachusetts General Hospital, Boston, Massachusetts; Mayo Clinic, Phoenix, Arizona; Duke University School of Medicine, Durham, North Carolina; and Washington University School of Medicine, St. Louis, Missouri.Search for more papers by this author, and William G. Powderly, MDFrom University of Michigan, Ann Arbor, Michigan; Massachusetts General Hospital, Boston, Massachusetts; Mayo Clinic, Phoenix, Arizona; Duke University School of Medicine, Durham, North Carolina; and Washington University School of Medicine, St. Louis, Missouri.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-1876 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail No advancement in the discipline of medicine parallels the dramatic progress of hepatitis C virus (HCV) infection, which within 30 years went from having no name to having safe and simple treatments that result in virologic cure in most patients. As of early 2011, the only treatment of chronic HCV infection was a combination of pegylated interferon (IFN) and ribavirin administered for 6 to 12 months. Interferon-based regimens resulted in rates of cure, termed sustained virologic response (SVR), of roughly 50% and necessitated subcutaneous injections with frequent and often serious adverse effects. The poor results led many patients to forgo ...References1. Jakobsen JC, Nielsen EE, Feinberg J, Katakam KK, Fobian K, Hauser G, et al. Direct-acting antivirals for chronic hepatitis C. Cochrane Database Syst Rev. 2017;6:CD012143. [PMID: 28585310] doi:10.1002/14651858.CD012143.pub2 CrossrefMedlineGoogle Scholar2. Poynard T, McHutchison J, Manns M, Trepo C, Lindsay K, Goodman Z, et al. Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C. Gastroenterology. 2002;122:1303-13. [PMID: 11984517] CrossrefMedlineGoogle Scholar3. Morgan RL, Baack B, Smith BD, Yartel A, Pitasi M, Falck-Ytter Y. Eradication of hepatitis C virus infection and the development of hepatocellular carcinoma: a meta-analysis of observational studies. Ann Intern Med. 2013;158:329-37. [PMID: 23460056]. doi:10.7326/0003-4819-158-5-201303050-00005 LinkGoogle Scholar4. van der Meer AJ, Veldt BJ, Feld JJ, Wedemeyer H, Dufour JF, Lammert F, et al. Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA. 2012;308:2584-93. [PMID: 23268517] doi:10.1001/jama.2012.144878 CrossrefMedlineGoogle Scholar5. Curry MP, O'Leary JG, Bzowej N, Muir AJ, Korenblat KM, Fenkel JM, et al; ASTRAL-4 Investigators. Sofosbuvir and velpatasvir for HCV in patients with decompensated cirrhosis. N Engl J Med. 2015;373:2618-28. [PMID: 26569658] doi:10.1056/NEJMoa1512614 CrossrefMedlineGoogle Scholar6. Saadoun D, Pol S, Ferfar Y, Alric L, Hezode C, SiAhmed SN, et al. Efficacy and safety of sofosbuvir plus daclatasvir for treatment of HCV-associated cryoglobulinemia vasculitis. Gastroenterology. 2017;153:49-52. [PMID: 28288791] doi:10.1053/j.gastro.2017.03.006 CrossrefMedlineGoogle Scholar7. Arcaini L, Besson C, Frigeni M, Fontaine H, Goldaniga M, Casato M, et al. Interferon-free antiviral treatment in B-cell lymphoproliferative disorders associated with hepatitis C virus infection. Blood. 2016;128:2527-32. [PMID: 27605512] CrossrefMedlineGoogle Scholar8. Younossi ZM, Stepanova M, Feld J, Zeuzem S, Sulkowski M, Foster GR, et al. Sofosbuvir and velpatasvir combination improves patient-reported outcomes for patients with HCV infection, without or with compensated or decompensated cirrhosis. Clin Gastroenterol Hepatol. 2017;15:421-30. [PMID: 27847279] doi:10.1016/j.cgh.2016.10.037 CrossrefMedlineGoogle Scholar9. National Academies of Sciences, Engineering, and Medicine. A National Strategy for the Elimination of Hepatitis B and C. Phase Two Report. Washington, DC: National Academies Pr; 2017. Google Scholar10. American Association for the Study of Liver Diseases; Infectious Diseases Society of America. Recommendations for testing, managing, and treating hepatitis C. 2017. Accessed at www.hcvguidelines.org on 2 July 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: From University of Michigan, Ann Arbor, Michigan; Massachusetts General Hospital, Boston, Massachusetts; Mayo Clinic, Phoenix, Arizona; Duke University School of Medicine, Durham, North Carolina; and Washington University School of Medicine, St. Louis, Missouri.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1876.Corresponding Author: Anna S. Lok, MD, 1500 East Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48109; e-mail, [email protected]edu.Current Author Addresses: Dr. Lok: Division of Gastroenterology and Hepatology, University of Michigan, 1500 East Medical Center Drive, 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48109.Dr. Chung: Liver Center and Gastroenterology Division, Warren 1007, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.Dr. Vargas: Division of Gastroenterology and Hepatology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054.Dr. Kim: Division of Infectious Diseases, Massachusetts General Hospital, Cox 5, 55 Fruit Street, Boston, MA 02114.Dr. Naggie: Division of Infectious Diseases, Duke University School of Medicine, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705.Dr. Powderly: Division of Infectious Diseases, Washington University School of Medicine, 4523 Clayton Avenue, St. Louis, MO 63110.Author Contributions: Conception and design: A.S. Lok, R.T. Chung, A.Y. Kim, S. Naggie, W.G. Powderly.Analysis and interpretation of the data: A.S. Lok, R.T. Chung.Drafting of the article: A.S. Lok, R.T. Chung, H.E. Vargas, A.Y. Kim, S. Naggie, W.G. Powderly.Critical revision for important intellectual content: R.T. Chung, H.E. Vargas, A.Y. Kim, W.G. Powderly.Final approval of the article: A.S. Lok, R.T. Chung, H.E. Vargas, A.Y. Kim, S. Naggie, W.G. Powderly.Administrative, technical, or logistic support: A.S. Lok.Collection and assembly of data: A.S. Lok, R.T. Chung.This article was published at Annals.org on 17 October 2017. 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