Medical Observer Gastroenterology Update

PBS listing of new hep C drug (EPCLUSA) will make treatment easier

The PBS listing of a new Hepatitis C combination antiviral will make treating hepatitis C even easier, experts say.

A combination of sofosbuvir and velpatasvir (Epclusa) will be available on the PBS from 1 August, for the treatment of adults with all strains of chronic hepatitis C virus infection (known as genotypes  1-6)  in combination with ribavirin in patients with cirrhosis.

The new drug will be easier to use because unlike other direct-acting antivirals, it does not require doctors to match a particular antiviral to a patient’s hepatitis C strain , says Stuart Loveday of Hepatitis NSW.

“There are six different subtypes of hepatitis C and until now, the doctor had to work out and choose which is the best combination of treatment depending on the person’s genotype and stage of liver disease,” he said.

“The beauty of these new drugs is that it covers all genotypes, therefore it making  prescribing much simpler,” he said.

Mr Loveday said new PBS figures revealing a decline in uptake of antiviral use for hepatitis C showed there was an urgent need to increase detection and management of the condition.

About 120,000 of the 220,000 Australians with hepatitis C were going“under the radar” because they contracted the infection years ago, but were getting on with their lives and did not appear as high-risk individuals, he said.

“This is the group of people we believe where GPs can help because these people are not visiting any health services except their GP — and this is where non-judgemental questioning about history can help, he said.

According to recent PBS data, the number of prescriptions for Hepatitis C antivirals has progressively fallen each month, following an initial spike after March 2016 when the PBS listed the treatments.

Use of Hepatitis C antivirals peaked in June 2016 with about 13,500 people using the drugs, then declined every month to 6300 in February 2017.

About 40,000 people were treated in the first 12 months of subsidised medications and there was now a need to reach the remainder, said infectious diseases physician Dr Joseph Doyle, deputy program director (disease elimination) at the Burnet Institute, Melbourne.

“The people in the first wave of treatment uptake were motivated and ready, but now we need to encourage and facilitate, and make it as easy as possible for people living with hepatitis C to get onto treatment.

“Most of these people probably know that they’re infected, but there’s a sizeable minority who won’t have been tested recently, so it’s not front of mind, or they may never have been tested, or might have recently acquired it,” he said.

“We need people to be treated as soon as they are positive; and for people who have been positive for a long time, we need to leverage all of the health services, not just hospitals and specialists, but bring GPs into the fold to get people tested and treated.”

More information:

Hepatitis Australia press release

Author: Michael Woodhead, Medical Observer