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Talal and colleagues reported on the rate of contraindications to pegylated-interferon (PegIFN) and ribavirin (Rbv) therapy in a large population of hepatitis C virus (HCV)-infected patients in the US.[1] By analysing a database of 45,690 HCV patients, the authors were able to identify 17% of patients with chronic HCV infection in whom PegIFN/Rbv was contraindicated. Moreover, most contraindications were relative and potentially modifiable.

This information has major clinical implications as it shows that contraindications to anti-HCV therapy are not the major limiting factor in the low treatment rates that have been reported in developed countries.[2] It also points out that the introduction of IFN-free regimens, which is expected in the next 2–3 years, will only increase the number of anti-HCV treatment eligible patients by 10–15%.[3]

This is somewhat disappointing, as it suggests that the increased sustained virological response (SVR) rates that will be attainable with IFN-free regimens, which could impact positively on both disease progression and survival of HCV-infected patients at the individual level,[4] might not translate into any benefit from an epidemiological point of view. This paradox can only be solved by measures aimed at increasing awareness to HCV infection, improving current screening programmes, increasing referral to liver specialists and containing costs of innovative anti-HCV regimens through a concerted action with pharmaceutical companies.

This joint effort by clinicians, stakeholders and drug companies can provide significant benefits as several analyses based on Markov models have shown that a 75% increase in the number of patients treated with a regimen achieving a 75% SVR rate will reduce liver-related deaths in the US by a staggering 57% in 2030.[5, 6]

Acknowledgement

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  2. Acknowledgement
  3. References

Declaration of personal interests: A. Aghemo has received grant and research support from Roche and Gilead Sciences. Speaking and teaching: Roche, Janssen, Merck. P. Lampertico has been on the advisory board and speaking bureau for BMS, Roche, Gilead Sciences, GSK and Merck.

Declaration of funding interests: None.

References

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  2. Acknowledgement
  3. References