FDA Approves AbbVie Combo Hepatitis C Treatment

  • Friday, December 19, 2014
  • Posted by HCV New Drugs

FDA News Release

FDA approves Viekira Pak to treat hepatitis C

For Immediate Release

December 19, 2014
The U.S. Food and Drug Administration today approved Viekira Pak (ombitasvir, paritaprevir and ritonavir tablets co-packaged with dasabuvir tablets) to treat patients with chronic hepatitis C virus (HCV) genotype 1 infection, including those with a type of advanced liver disease called cirrhosis.
Hepatitis C is a viral disease that causes inflammation of the liver that can lead to reduced liver function, liver failure or liver cancer. Most people infected with HCV have no symptoms of the disease until liver damage becomes apparent, which may take decades. According to the Centers for Disease Control and Prevention, about 3.2 million Americans are infected with HCV, and without proper treatment, 15-30 percent of these people will go on to develop cirrhosis.
Viekira Pak contains three new drugs—ombitasvir, paritaprevir and dasabuvir—that work together to inhibit the growth of HCV. It also contains ritonavir, a previously approved drug, which is used to increase blood levels of paritaprevir. Viekira Pak can be used with or without ribavirin, but it is not recommended for patients whose liver is unable to function properly (decompensated cirrhosis).
“The new generation of therapeutics for hepatitis C virus is changing the treatment paradigm for Americans living with the disease,” said Edward Cox, M.D., M.P.H., director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research. “We continue to see the development of new all-oral treatments with very high virologic response rates and improved safety profiles compared to some of the older interferon-based drug regimens.”
Viekira Pak is the fourth drug product approved by the FDA in the past year to treat chronic HCV infection. The FDA approved Olysio (simeprevir) in November 2013, Sovaldi (sofosbuvir) in December 2013 and Harvoni (ledipasvir and sofosbuvir) in October 2014.
Viekira Pak’s efficacy was evaluated in six clinical trials enrolling 2,308 participants with chronic HCV infection with and without cirrhosis. In different trials, participants were randomly assigned to receive Viekira Pak or placebo (sugar pill); Viekira Pak with or without ribavirin; or Viekira Pak with ribavirin for 12 or 24 weeks.
The trials were designed to measure whether the hepatitis C virus was no longer detected in the blood at least 12 weeks after finishing treatment (sustained virologic response, or SVR), indicating that a participant’s HCV infection has been cured. Results from multiple populations, including those considered difficult to treat, showed 91 to 100 percent of participants who received Viekira Pak at the recommended dosing achieved SVR. The recommended dosing for Viekira Pak is two ombitasvir, paritaprevir, ritonavir 12.5 milligrams (mg)/75 mg/50 mg tablets once daily and one dasabuvir 250 mg tablet twice daily.
The most common side effects reported in clinical trial participants were feeling tired, itching, feeling weak or lack of energy, nausea and trouble sleeping.
Viekira Pak is the eleventh new drug product with breakthrough therapy designation to receive FDA approval. The FDA can designate a drug as a breakthrough therapy at the request of the sponsor if preliminary clinical evidence indicates the drug may demonstrate a substantial improvement over available therapies for patients with serious or life-threatening diseases. Viekira Pak was reviewed under the FDA’s priority review program, which provides for an expedited review of drugs that treat serious conditions and, if approved, would provide significant improvement in safety or effectiveness.
Viekira Pak is marketed by AbbVie Inc., based in North Chicago, Illinois. Olysio is marketed by Raritan, New Jersey-based Janssen Pharmaceuticals. Sovaldi and Harvoni are marketed by Gilead Sciences, based in Foster City, California.
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

In Hepatitis C, Treatment Rationing Has Already Begun

  • Wednesday, December 17, 2014
  • Posted by HCV New Drugs

To curb an estimated 6% to 11% increase in Medicare Part D spending, 3 states have already placed limitations on which patients with chronic hepatitis C are candidates for treatment with novel antiviral agents. 

The debate about which patients with hepatitis C are appropriate treatment candidates is a contentious issue, according to Marc G. Ghany, MD, MHSc, in an editorial published in JAMA Internal Medicine.  

 With nearly 30% of cirrhosis cases and 1 in 4 cases of hepatocellular carcinoma caused by hepatitis C, a clear opportunity for prevention of expensive public health issues exists. However, the cost of treatments is also expensive.   

According to a recent study by the Division of Viral Hepatitis at the Centers for Disease Control and Prevention analyzing more than 18,000 patients, a minority of patients with chronic hepatitis C virus infection are receiving treatment—just 7% to 11% of eligible patients.   This low treatment rate may initially have been be due to delays in treatment, or “siloing” patients with the hope that effective treatments would become available, and possibly at a lower cost. With the approval of ledipasvir/sofosbuvir, and the COSMOS trial indicating efficacy of a simeprevir/sofosbuvir combination, the time for treatment may be at hand.   

These new regimens have response rates in excess of 90%, defined by sustained viral response 12 weeks after the end of treatment. With these highly efficacious, all-oral treatments, Ghany argues for universal treatment of all patients with chronic hepatitis C infection, but notes that the high cost of treatment is an impediment to universal use. For instance, a 12-week course of sofosbuvir, as has often been quoted, costs approximately $84,000 to insurers. Similarly, a 12-week course of simeprevir costs $66,000.   

The high cost of these 2 medications alone are expected to increase Part D spending by 6% to 11% over 2015. To curb this trend, 3 states, Colorado, Illinois, and Pennsylvania, have already limited treatment to patients with chronic hepatitis C who are experiencing advanced-stage liver disease.   With limitations on treatment likely to be put in place in other states, it is important for patients with hepatitis C to receive treatment as soon as possible. Limitations on treatment for patients who are not candidates mean that close monitoring is crucial to ensure that limitations on access to treatment do not ultimately result in the spread of hepatitis C, and progression of infection to preventable cases of hepatocellular cancer or cirrhosis due to a lack of monitoring.   

Reference: Ghany MG. The Ongoing Debate of Who to Treat for Chronic Hepatitis C Virus. JAMA Intern Med. 2014. - 

See more at: http://www.specialtypharmacytimes.com/news/In-Hepatitis-C-Treatment-Rationing-Has-Already-Begun#.dpuf