Comprehensive review of DAA research at EASL

The rapid pace of development of effective and safe oral treatment for HCV was a major focus for the European Liver Conference (EASL) held from 22-26 April in Vienna.

The link to this comprehesive personal overview by Professor Jurgen Rockstroh makes compelling reading for clarifiy not only what what we know about these exciting new drugs, but the important gaps in the research that need to be addressed in order to understand how to best use them in practice.

All oral HCV DAA therapy on its way to optimisation: still much to learn – by Jurgen Rockstroh, for NATAP.org

Introduction

The introduction of all oral DAA based HCV therapy has dramatically changed HCV treatment paradigms and promises HCV cure in more than 95% of patients. Nevertheless special challenging patient populations remain which until now have only scarcely been addressed such as patients with renal impairment or on hemodialysis.

At this year EASL results from larger treatment trials in exact that patient population were presented for the first time. Other more challenging patient groups addressed included patients with decompensated cirrhosis and patients post-transplant. Considering that not all patients with decompensated cirrhosis benefit from HCV therapy despite becoming HCV-RNA negative, the question arises whether there may be a point of no return for very advanced liver disease stages.

Also for patients on the transplant list the question remains whether decreases in MELD score following HCV cure may impact the position on the organ waiting list, delay transplantation considerably and thereby increase risk for HCC development while on the waiting list. Furthermore, new data on treatment of HCV genotype 3 were eagerly awaited as there are still many questions about what the most effective treatment strategy, particularly in the cirrhotic patients who are treatment-experienced. This goes hand in hand with the quest for developing new HCV pan-genotypic drugs that would also simplify diagnostic work-up prior to starting HCV treatment.

Large interest was generated around all oral DAA treatment in compassionate use programs and real-life cohorts in order to better understand the risk of virological failure in real-life clinical settings. The question remains on the impact that the emergence of DAA resistance associated variants may have after failing all oral DAA therapy and whether there is a need for genotypic resistance testing at least after failure of DAA therapy.

Finally the new set of EASL guidelines for management of hepatitis C was presented at the conference publically for the first time.