Are All Treatments Created Equal?
The last five years have seen a flurry of drug approvals for new and highly effective hepatitis C (HCV) medications that don't require peginterferon and ribavirin (Rebetol) for most patients. These approvals have come at an almost breakneck pace. For example, simeprevir (Olysio), one of the first new direct-acting antivirals (DAAs), has fallen out of favor less than four years after its approval.
In a major milestone, recent approvals of the two-drug combination sofosbuvir/velpatasvir (Epclusa) and the three-drug combo sofosbuvir/velpatasvir/voxilaprevir (Vosevi) mean the addition of new drugs that can treat all six HCV genotypes.
In addition to new treatments, new side effects have recently become apparent. In 2016, the U.S. Food and Drug Administration (FDA) warned that all DAAs carry the risk of reactivating hepatitis B, after two patients died and 24 cases of reactivation were reported. Physicians are now advised to screen for hepatitis B, and patients are urged to watch for side effects.
Considering the variety of treatments now available, what's the best DAA for each patient? Even with sofosbuvir/velpatasvir/voxilaprevir on the market, picking the right drug will depend on each patient's medical history, level of liver damage, coinfections and, to some extent, insurance coverage.
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