From "Contagion Live - Infectious Diseases Today":

Hepatitis C Treatment Time Could Be Cut in Half in Some Patients: A Proof of Concept Study

NOV 14, 2018 | EINAV KEET

A personalized medicine technique may shorten the duration and reduce the cost of treatment for hepatitis C virus infection, according to the results of a new proof-of-concept pilot study from investigators at the Loyola University Chicago Stritch School of Medicine and Loyola Medicine, both in Chicago, Illinois.

Hepatitis C virus-related hospitalizations have increased by nearly 50% in the United States in recent years, due in large part to the opioid epidemic in the country. The blood-borne virus is most often spread through the sharing of needles for drug injection, causing an acute liver infection that, if left untreated, can become chronic and eventually lead to cirrhosis and liver cancer. The US Centers for Disease Control and Prevention (CDC) estimates that 2.7 million to 3.9 million people in the United States have a chronic form of the disease.

Direct-acting antivirals are a costly but highly-effective class of drugs for the treatment of hepatitis C that can cure most cases, and individuals in the United States with the virus have seen increased access to direct-acting antiviralsbecause of Medicaid expansion. In 2017 the US Food and Drug Administration (FDA) approved 2 new drug therapies for hepatitis C, welcome news for patients with hard-to-treat forms of the virus, including genotype 3.

Now in the new study presented on November 12 at the annual meeting of the American Association for the Study of Liver Diseases (AASLD) in San Francisco, investigators from Loyola say that a new approach to hepatitis C treatment could reduce both treatment time - from the current standard of 12 weeks - and cost.

For the new proof-of-concept pilot study, investigators enrolled 22 patients to test a personalized medicine technique called modeling-based response-guided therapy (RGT). Using this approach, the team tracked hepatitis C virus infection in patients receiving treatment for a few weeks and measured their decrease in viral levels. They then used mathematical modeling to estimate how long it would take to fully clear the infection.

Modeling predicted the shortening of treatment to 10 weeks in 1 patient, to 8 weeks in 8 patients, and to 6 weeks in 2 patients. For the remaining 11 patients, the standard 12-week treatment was needed. A total of 21 patients achieved cure at the end of the study period, while 1 patient with genotype 3 relapsed.

As a result of this treatment approach, the study team estimated that patients could see an overall reduction of 20% in treatment costs. A large multicenter trial is currently underway in Israel to validate the study's results.

In an interview with Contagion®, study co-first author Harel Dahari, PhD, explained that despite the study's promising results, there would be challenges to replacing today's standard of treatment with the personalized technique.

"First, before implementing our modeling-based RGT as a standard of care, policy results of our proof-of-concept study need to be validated on a larger scale," Dr. Dahari said. "A second challenge would be to convince stakeholders - payers, physicians, and patients - to commit to a more frequent sampling of hepatitis C virus viral load at an earlier stage of treatment."