All FDA-Approved, Oral Direct-Acting Antivirals for Hepatitis C Safe and Effective for Genotype 1

By Kelly Young

Edited by Jaye Elizabeth Hefner, MD

The FDA-approved interferon-free regimens for treating hepatitis C appear to be safe and effective, suggests an Annals of Internal Medicine review.

Researchers examined 42 randomized trials of oral hepatitis C treatments that included at least two direct-acting antivirals. Among the findings:

• For genotype 1 infection, the most common HCV type, sustained virologic response rates were above 95% for six regimens.

• For patients with HCV genotype 3 and without cirrhosis, sofosbuvir plus velpatasvir or daclatasvir for 12 weeks seemed to be most effective.

• For genotype 3 with cirrhosis, velpatasvir-sofosbuvir had higher response rates. That drug combination was also highly effective (99% response rate) for genotypes 2, 4, 5, and 6.

• Patient groups traditionally considered difficult to treat — including those with HIV, severe kidney disease, or liver transplant — had high response rates and limited adverse events.

Editorialists conclude that "hepatitis C is down but not out," noting that screening for HCV is not yet routine, and the drugs are still priced high.