Treatment of hepatitis C virus (HCV) with grazoprevir plus elbasvir is effective in the acute phase of infection and therefore should be used in patients at high risk for HCV transmission, according to the results of an open-label multicenter phase 3b study published in The Lancet Gastroenterology & Hepatology.1
The World Health Organization (WHO) released a goal health sector strategy on viral hepatitis in 2016 that aimed to reduce the incidence of new HCV infections by 90% and HCV-related deaths by 65% by 2030.2 Although studies have demonstrated the efficacy of direct-acting antiviral (DAA) therapy in the treatment of chronic HCV infection,3-5 there is little data on their efficacy in acute HCV infection, which could prevent onward transmission. Therefore, researchers in The Netherlands and Belgium assessed the efficacy of grazoprevir 100 mg plus elbasvir 50 mg in the treatment of acute HCV infection and explored whether treatment can be shortened during the acute phase of HCV infection.1
They found that in 80 patients with recently acquired HCV infection who received 8 weeks of treatment with grazoprevir plus elbasvir, 79 patients (99%) achieved a sustained virologic response at 12 weeks (SVR12) after the end of treatment. However, if re-infections were considered treatment failures, then 75 patients (99%) achieved SVR12. The most common possibly drug-related adverse events were fatigue, headache, insomnia, mood changes, dyspepsia, concentration impairment, and dizziness, all of which were mild.
“In specific populations at risk of HCV transmission to others (eg, transmission to sex partners in men having sex with men or to needle-sharing partners in people who inject drugs) being able to start curative HCV therapy immediately after diagnosis of an acute HCV infection will not only prevent transmission to others but will also lead to direct (shorter treatment duration) and indirect (prevention of new infections) cost savings,” stated the investigators.1
- Boerekamps A, De Weggheleire A, van den Berk GE, et al. Treatment of acute hepatitis C genotypes 1 and 4 with 8 weeks of grazoprevir plus elbasvir (DAHHS2): an open-label, multicentre, single-arm, phase 3b trial. [published online January 16, 2019]. Lancet Gastroenterol Hepatol. doi:10.1016/S2468-1253(18)30414-X
- World Health Organization (WHO). Combating hepatitis B and C to reach elimination by 2030. Updated May 2016. Accessed February 7, 2019.
- Abergel A, Hezode C, Asselah T, et al. High efficacy and safety of grazoprevir and elbasvir for 8 weeks in treatment-naive, non-severe fibrosis HCV GT1b-infected patients: interim results of the STREAGER study. J Hepatol. 2018;68(suppl1):S110.
- Asselah T, Pol S, Hezode C, et al. Efficacy and safety of 8 weeks of elbasvir/grazoprevir in HCV GT4-infected treatment-naïve participants. Paper presented at: International Liver Congress; April 11-14, 2018; Paris, France.
- Sulkowski M, Hezode C, Gerstoft J, et al. Efficacy and safety of 8 weeks versus 12 weeks of treatment with grazoprevir (MK-5172) and elbasvir (MK-8742) with or without ribavirin in patients with hepatitis C virus genotype 1 mono-infection and HIV/hepatitis C virus co-infection (C-WORTHY): a randomised, open-label phase 2 trial. Lancet. 2015;385:1087-1097.