Shorter treatment showed no difference in outcomes,
including in black patients, and could allow more patients access to
highly effective medications to treat hepatitis C
Oakland, Calif.— Current hepatitis C treatment guidelines
state that black patients should not be treated with a shorter 8-week
course of direct-acting antiviral agents, even if they are otherwise
eligible, and instead should be given the full 12-week regimen.
A new study from the Kaiser Permanente Northern California Division
of Research shows that a treatment regimen of 8 weeks for hepatitis C
may be just as effective as 12 weeks in black patients. The study also
showed that more people overall can take advantage of the shorter
treatment durations, which has important implications for access given
the medication’s high cost. The study, “No Difference in Effectiveness of 8 vs 12 Weeks of Ledipasvir and Sofosbuvir for Treatment of Hepatitis C in Black Patients,” was published online March 12 in the journal Clinical Gastroenterology and Hepatology.
“We found that treatment was equally effective for black patients who
were treated for 8 and 12 weeks. The 8-week regimen was also generally
underused for all patients, with 26 percent of those eligible for 8
weeks receiving 12 weeks of therapy,” said senior author Michael J. Silverberg, PhD, MPH, of the Division of Research.
Kaiser Permanente’s Michael Silverberg, PhD
Treatments for hepatitis C have come a long way, and the debilitating
illness is now being cured with highly effective, direct-acting
antiviral agents. The most common type of hepatitis C infection in the
United States can be eliminated with a combination of ledipasvir and
sofosbuvir for 12 weeks.
According to clinical guidelines from the American Association for the Study of Liver Diseases and Infectious Diseases Society of America,
a shorter, 8-week course of ledipasvir/sofosbuvir can be considered for
patients who meet certain clinical criteria, but the recommendation
excludes black patients. Shorter courses are less costly and allow
health care systems to increase the number of patients that receive the
treatment.
In this new study, researchers from Kaiser Permanente Northern
California, a large integrated healthcare system, compared the
effectiveness of 8- and 12-week courses of hepatitis C treatment among
those who were eligible to receive 8 weeks of ledipasvir/sofosbuvir. The
study found that the effectiveness of 8 or 12 week regimens of
ledipasvir/sofosbuvir was over 95% in most subgroups evaluated,
including black patients. These findings implied that shorter courses
should be strongly considered for all patients, including black
patients, who meet other eligibility criteria for 8-week regimens.
“Our findings do not support current hepatitis C treatment guidelines
that recommend against the use of a shorter course of treatment in
black patients,” said the paper’s lead author, Julia L. Marcus, PhD, MPH,
now at Harvard Medical School and Harvard Pilgrim Health Care Institute
but formerly of the Division of Research where she initiated this work.
The study authors also suggest that clinicians should consider using
8-week courses of ledipasvir/sofosbuvir in more patients who are
otherwise eligible for shorter courses of therapy, which can benefit
patients, providers, and healthcare systems.
“We have known for some time that a shorter treatment duration is
effective, but these data highlight that we could offer this option to
more patients,” said co-author, David J. Witt, MD, at Kaiser Permanente
San Rafael Medical Center. “Given the high cost of these medications,
more widespread use of shorter courses could result in more patients
receiving treatment without compromising treatment effectiveness.”
This work was supported by the Kaiser Permanente Delivery Science
Research Program and the National Institute of Allergy and Infectious
Diseases.
Other contributors on the paper included Leo B. Hurley, MPH, Jennifer
O. Lam, PhD, MPH, and Charles P. Quesenberry, Jr., PhD, all of the
Division of Research; and co-authors Scott Chamberland, PharmD, Kaiser
Permanente Regional Pharmacy, Oakland; Jamila H. Champsi, MD, and Varun
Saxena, MD, Kaiser Permanente South San Francisco Medical Center; Laura
C. Gittleman, RN, MBA, Kaiser Permanente Northern California, Medical
Group Support Services; Daniel G. Korn, MD, Kaiser Permanente Oakland
Medical Center; Jennifer B. Lai, MSc, PharmD, Kaiser Permanente San
Rafael Medical Center; Mary Patricia Pauly, MD, Kaiser Permanente
Sacramento Medical Center; Joanna Ready, MD, Kaiser Permanente Santa
Clara Medical Center; and Suk Seo, MD, Kaiser Permanente Antioch Medical
Center.
# # #
About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and
disseminates epidemiologic and health services research to improve the
health and medical care of Kaiser Permanente members and society at
large. It seeks to understand the determinants of illness and
well-being, and to improve the quality and cost-effectiveness of health
care. Currently, DOR’s 550-plus staff is working on more than 350
epidemiological and health services research projects. For more
information, visit divisionofresearch.kaiserpermanente.org or follow us
@KPDOR.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health
care. We are recognized as one of America’s leading health care
providers and not-for-profit health plans. Founded in 1945, Kaiser
Permanente has a mission to provide high-quality, affordable health care
services and to improve the health of our members and the communities
we serve. We currently serve more than 11.8 million members in eight
states and the District of Columbia. Care for members and patients is
focused on their total health and guided by their personal Permanente
Medical Group physicians, specialists and team of caregivers. Our expert
and caring medical teams are empowered and supported by
industry-leading technology advances and tools for health promotion,
disease prevention, state-of-the-art care delivery and world-class
chronic disease management. Kaiser Permanente is dedicated to care
innovations, clinical research, health education and the support of
community health. For more information, go to: kp.org/share.
