Paul Y. Kwo, MD, on the current and future state of HCV therapy

CHICAGO — In this video, HCV Next Editorial Board member Paul Y. Kwo, MD, medical director of liver transplantation in the Gastroenterology/Hepatology division at Indiana University, discusses research and symposia presented at Digestive Disease Week related to hepatitis C, and outlines future goals for treatment as favorable results from trials of direct-acting antiviral agents continue to emerge.

Kwo noted high rates of sustained virologic response (SVR) occurred in both the SAPPHIRE-II and ION-2 trials presented here, both of which assessed direct-acting agents among patients with HCV who had failed prior treatment with peginterferon and ribavirin. The SAPPHIRE-II trial assessed ABT-450 (AbbVie) administered in combination with NS5A inhibitor ombitasvir (AbbVie) and non-nucleoside NS5B polymerase inhibitor dasabuvir (AbbVie), and yielded SVR rates above 95% with a 12-week regimen in patients with HCV genotype 1a or 1b. The ION-2 study assessed a 12- to 24-week regimen of sofosbuvir (Sovaldi, Gilead) and ledipasvir (Gilead), and yielded SVR rates ranging from 94% to 99%, with or without the addition of ribavirin.

Overall, Kwo said, one of the messages from DDW 2014 is that many of the therapeutic challenges related to HCV have been solved, with well-tolerated, highly effective oral therapies on the horizon for all genotypes of the disease. The challenge for the future, he added, will be to ensure access for patients, as well as to explore treatment for new patient populations that had previously been neglected due to an inability to respond to therapy with peginterferon and ribavirin. He also noted, however, that patients with genotype 3 remain more difficult to treat than those of other genotypes, and that patients with advanced fibrosis will continue to require additional therapeutic strategies, as early data indicates lower rates of SVR in response to direct-acting antiviral therapy in this population.