 |
|
|
| |
Total HCV patients treated with direct acting antivirals since 2014: Generics of Latest DAAs Are Key to Continuing Global Expansion of HCV Therapy
|
| |
| |
AASLD 2023, The Liver Meeting, November 10-14, 2023, Boston
Mark Mascolini
Because 9 in 10 HCV infections worldwide occur in lower-middle-income counties, those countries need immediate access to generic forms of the latest direct-acting antivirals (DAAs) if the world wants to reach current global HCV elimination targets [1]. That conclusion by Alexis Voeller and colleagues at the Center for Disease Analysis (CDA) Foundation (https://cdafound.org) in Lafayette, Colorado, stems from scrutiny of the latest HCV treatment data from national databases and other sources.
CDA researchers aimed to measure the growth of cumulative HCV treatment worldwide from 2014 through 2022 because of changing HCV treatment patterns seen globally due to second-generation DAAs. They estimated numbers of treated people by analyzing national databases, drug sales tallies, government records, reports from treatment centers and drug suppliers, and surveys of more than 100 countries through annual Polaris Observatory expert surveys [2]. Before 2019 the CDA team used average sustained virologic response (SVR) rates to estimate percentages of people treated with DAAs from country to country. National registration data informed proportions of people using specific DAAs: sofosbuvir, ombitasvir + paritaprevir + ritonavir, glecaprevir + pibrentasvir, and elbasvir + grazoprevir-based regimens.
Voeller and colleagues figured that 13.2 million people across the globe got treated with DAAs from 2014 through 2022. In 2014-2018 most treated people lived in high-income countries. But that changed over more recent years. For the whole 2014-2022 span, 8 million DAA treatments (61%) took place in lower-middle-income countries and 3.7 million (28%) in high-income countries.
Sofosbuvir-based regimens accounted for 82% of all DAA treatments across the 2014-2022 study period. That dominance peaked in 2019 during the Egyptian HCV elimination program. Starting in 2020 use of other DAA regimens began to climb, rising from 1.6 million cumulative people in 2019 to 2.4 million in 2022.
Cumulative total people treated with DAAs since 2014 leaped from 11.7 million in 2020 to 13.2 million in 2022. CDA investigators tallied shifting trends from 2020 through 2022 depending on country income bracket. Totals treated in 2020 and 2022 fell from 315,800 to 266,660 in high-income countries, rose from 150,600 to 188,390 in upper-middle-income countries, dropped from 380,600 to 257,950 in lower-middle-income countries, and climbed from 24,840 to 28,480 in low-income countries.
The researchers concluded that expansion of DAA use in lower- middle-income countries "had a profound impact" on totals treated globally since 2014. "With 89% of all HCV infections" in these countries, they argued, "immediate access to generic versions of the latest treatments is needed to achieve global elimination targets." Wide use of DAAs in high-income countries, Voeller and coworkers observed, depended partly on removing all treatment restrictions. Removing fibrosis restrictions in lower-middle-income countries would spur continued expansion of DAA use there.
References
1. Voeller A, Razavi-Shearer D, Gamkrelidze I, et al. Total HCV patients treated with direct acting antivirals since 2014. AASLD 2023, The Liver Meeting, November 10-14, 2023, Boston.
2. Polaris Observatory. The authoritative resource for epidemiological data, modeling tools, training, and decision analytics to support global elimination of hepatitis B and C by 2030. 2023. https://cdafound.org/polaris/
|
| |
|
|
|
|
|
