Research into new HCV drugs
Although DAAs work for nearly everyone, a small percentage of people need new HCV drugs.
Many other new oral HCV drugs are in development and some of these are already in advanced stage research (in phase 3 studies).
Next DAAs in advanced development
The following two fixed dose combinations (FDCs) that work for all genotypes are in late stages of development.
They are both expected to be approved (in the EU and the US) in mid-2017.
- Glecaprevir/pibrentasvir
This is a once daily, fixed-dose combination of an HCV protease inhibitor with an NS5A inhibitor.
- Sofosbuvir/velpatasvir/volipaprevir This is a once daily, fixed-dose combination of a nucleotide polymerase inhibitor, an NS5A inhibitor and an HCV protease inhibitor.
Other triple class combinations are in earlier (phase 2) development.
Keeping up-to-date on research
A list of community organisations that report on new drugs are included below.
HCV treatment guidelines change when there is new information, or when new DAAs are approved.
Check them often.
Guidelines produced for Europe and the US are more likely to be updated than those produced in the UK.
EASL – European HCV guidelines
www.easl.eu
EACS – European coinfection guidelines
www.eacsociety.org
AASLD/IDSA – US hepatitis guidelines
www.hcvguidelines.org
BHIVA – UK coinfection guidelines (from 2013) are due to be updated in 2017.
www.bhiva.org
NICE – NICE publishes cost effectiveness recommendations for each new DAA that is approved in the EU.
www.nice.org.uk
NHS Scotland – updated DAA guidelines
www.hps.scot.nhs.uk/bbvsti/guidelines.aspx
Current studies
Although DAAs are now approved and recommended, the high cost means not everyone has access to them.
For some people, the only way to access DAAs will be by joining a clinical trial.
The advantage of joining a study includes the chance to use promising drugs several years before they are approved. As these drugs will have been studied in HIV negative people, there should already be promising results about how well they work and how safely.
Disadvantages include that the study drug may not turn out to be most effective. There is likely to be little or no data on a drug on coinfection and potential drug interactions may not yet be known. If you develop resistance to either your HIV or HCV medications, this may limit the benefit or other similar drugs in the future.
Joining a study may limit the chance to join others studies in the future – though if the treatment works this will not be something to worry about.
Although the first studies are in HIV negative people, some coinfection studies are already running and others are expected to start soon.
Results from studies in HIV negative people will provide information to decide on which of these compounds may be more appropriate for your situation.
Clinical trials with DAAs also use different strategies:
- Using early responses to decide length of treatment (response-guided therapy).
- Using shorter treatment but with a fixed-duration – ie 12 or 24 weeks.
- Using DAAs without ribavirin.
- Rescue therapy – in the few cases where approved DAAs are unsuccessful.
Keeping up-to-date on research
The following websites provide a range of information and news on the latest developments.
The annual i-Base/TAG Pipeline Report reviews the latest information about HIV and HCV drugs in development.
http://www.pipelinereport.org
A wealth of reports from journals, meetings and conferences are posted on the National AIDS Treatment Advocacy Project (NATAP) website.
http://www.natap.org
An updated list of HCV drugs in development is available on the HCV Advocate Website.
http://hcvadvocate.blogspot.ca
HIVandHepatitis.com covers medical conferences and HCV-related news.
http://www.hivandhepatitis.com
Hepatitis news and information (for patient advocates and people working in Europe) is available at: www.infohep.org
Clinical Care Options is a medical site that reports from most conferences.
http://www.clinicaloptions.com/Hepatitis/Topics/HCV.aspx
Last updated: 17 August 2017.