Hepatitis C treatment can be shortened in 50% of patients, study finds



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MAYWOOD, IL – Hepatitis C drugs heal more than 90% of patients, but can cost more than $ 50,000 per patient.

Findings from a new study can lead to significant savings. Preliminary data from the study, co-led by a theoretical modeling researcher at Loyola University of Chicago's Stritch School of Medicine and Loyola Medicine, found that in 50 percent of patients, standard 12-week treatment could be shortened to only six weeks without compromise effectiveness.

"There is a potential to save up to 20 percent of the costs of hepatitis C drugs," said Harel Dahari, PhD, a researcher at Loyola, co-lead author of the study, along with Ohad Etzion, MD, Soroka University Medical Center, in Israel. The senior author is Amir Shlomai, MD, PhD, of Beilinson Hospital in Israel.

The study was presented Nov. 12 at the annual meeting of the American Association for the Study of Liver Diseases in San Francisco.

Dr. Dahari is co-director of the Experimental and Theoretical Modeling Program (PETM) in the hepatology division of Loyola Medicine and the Loyola University Chicago Stritch School of Medicine. Two other authors of Loyola are Susan Uprichard, PhD, co-director of PETM and associate professor in the department of microbiology and immunology and Scott Cotler, MD, chief of the hepatology division of Loyola Medicine and professor of medicine at Loyola University. Chicago Stritch School of Medicine.

Hepatitis C is an infection caused by a virus spread by contaminated blood. It can lead to liver damage, liver failure and liver cancer. It is estimated that 70 million people worldwide, including about three million in the United States, are chronically infected with hepatitis C.

A class of oral drugs called direct-acting anti-viral drugs (AADs) have revolutionized the treatment of hepatitis C. In more than 90% of patients, the drugs eliminate the virus and heal the patient with minimal side effects. But the high cost limits access and is a substantial financial burden for Medicare, Medicaid and private insurers.

"The treatment is currently standardized to be given for a certain period of time, usually 12 weeks, rather than being tailored for the individual patient," said Dr. Cotler.

In the new study, the researchers used a personalized medicine technique called model-based response-oriented therapy to reduce treatment times when possible. After patients underwent treatment for a few weeks, the researchers measured how much hepatitis C virus levels had declined. They used mathematical modeling to estimate how long it would take to completely eliminate the virus.

The study included 22 patients so far. The mathematical modeling predicted that the treatment could be shortened for 10 weeks in one patient (five percent of the total patients), eight weeks in eight patients (36 percent) and six weeks in two patients (nine percent). The other 11 patients (50 percent) had to be treated by the 12-week standard.

Twenty-one patients remained virus-free. The only patient who relapsed had the most difficult form of treating the hepatitis C virus, known as genotype 3.

The proof-of-concept pilot study showed that the use of response-guided therapy to reduce treatment times is feasible. To validate the results, a large multicenter study is under way in Israel.

Dr. Dahari said that in addition to reducing costs, shorter treatment regimens would facilitate the treatment of patients with hepatitis C who have limited health insurance benefits.

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The study was conducted with David Yardeni, MD, Anat Nevo-Shor, MD, Daniela Munteanu, MD, and Naim Abufreha, MD, Department of Gastroenterology and Hepatopathy, Soroka University Medical Center, Beesheba, Israel; Assaf Issachar, MD, Michal Cohen-Naftaly, MD, Orly Sneh Arbib, MD, and Marius Braun, MD, from the Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel; and Orna Mor, PhD, from the Central Laboratory of Virology, Ministry of Health, Sheba Medical Center, Israel.

The study is titled "Response-guided therapy with DAA shortens treatment durations in 50% of patients treated with HCV."

The study was supported in part by Clalit, a health services organization in Israel and the US National Institutes of Health.

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