Friday, July 28, 2017

We can cure hepatitis C. But we’re now making the same mistake we did with AIDS

The Washington Post

We can cure hepatitis C. But we’re now making the same mistake we did with AIDS

 
Three years ago, we wrote about the wide gap in access to hepatitis C treatment, hoping that mistakes made in the world’s response to AIDS would not be repeated in another epidemic of a lethal, blood-borne disease.
Our worst fears have been realized. The World Health Organization now reports that 4 out of 5 people infected with hepatitis C aren’t even aware of it. Of those who do know, fewer than 1 in 50 have received treatment. These numbers are far worse in parts of South Asia and sub-Saharan Africa, where the majority of the global extreme poor live. In many places, such as Rwanda, infected patients remain on waiting lists for treatment, without which many succumb early to liver failure, cancer and other related complications.
Continue reading....

European Commission Grants AbbVie's MAVIRET® (glecaprevir/pibrentasvir) Marketing Authorization for the Treatment of Chronic Hepatitis C in All Major Genotypes (GT1-6)

European Commission Grants AbbVie's MAVIRET® (glecaprevir/pibrentasvir) Marketing Authorization for the Treatment of Chronic Hepatitis C in All Major Genotypes (GT1-6)

- MAVIRET is a new 8-week, pan-genotypic treatment for hepatitis C patients without cirrhosis and who are new to treatment*
- Marketing authorization is supported by 97.5 percent cure** rate across this group of patients(1)
- MAVIRET is a pan-genotypic treatment approved for use in patients across all stages of chronic kidney disease(1)
- AbbVie's investigational, pan-genotypic HCV treatment is also under Priority Review by the U.S. FDA

NORTH CHICAGO, Ill., July 28, 2017 /PRNewswire/ -- AbbVie (NYSE: ABBV), a global biopharmaceutical company, today announced that the European Commission has granted marketing authorization for MAVIRET® (glecaprevir/pibrentasvir), a once-daily, ribavirin-free treatment for adults with chronic hepatitis C virus (HCV) infection across all major genotypes (GT1-6). MAVIRET is a new 8-week, pan-genotypic treatment for patients without cirrhosis and who are new to treatment,* who comprise the majority of the 71 million people living with HCV globally.2,3

"MAVIRET represents an innovation in HCV care as an 8-week, pan-genotypic option that combines two distinct antiviral agents and has high efficacy even against most genotypes commonly associated with resistance to treatment," said Michael Severino, M.D., executive vice president, research and development and chief scientific officer, AbbVie. "This new treatment advancement has the potential to meet the diverse needs of patients in as short as 8 weeks across Europe."

MAVIRET is also indicated for patients with specific treatment challenges, including those with compensated cirrhosis across all major genotypes, and those who previously had limited treatment options, such as patients with severe chronic kidney disease (CKD) or those with genotype 3 (GT3) chronic HCV infection.1 MAVIRET is a pan-genotypic treatment approved for use in patients across all stages of CKD.1

The approval of MAVIRET is supported by data from eight registrational studies in AbbVie's clinical development program, which evaluated more than 2,300 patients in 27 countries across all major HCV genotypes (GT1-6) and special populations.

"MAVIRET is an 8-week, pan-genotypic treatment for non-cirrhotic patients new to treatment with chronic hepatitis C that met all primary efficacy endpoints in its extensive HCV clinical trial program, achieving high cure rates," said Stefan Zeuzem, M.D., chief of the department of medicine at the J.W. Goethe University Hospital in Frankfurt, Germany. "MAVIRET offers a new therapy for the majority of HCV patients and removes many complexities of pre-treatment patient evaluation."

Authorization is supported by 97.5 percent (n=779/799)† cure** rate with just 8 weeks of treatment in GT1-6 patients without cirrhosis and who were new to treatment.1 This high cure rate was achieved in patients with varied patient and viral characteristics and including those with CKD.1 For compensated cirrhotic patients, a 98 percent (n=201/205)‡ cure rate was achieved with 12 weeks of treatment.1 For GT3 treatment-experienced patients with or without compensated cirrhosis, a 96 percent (n=66/69) cure rate was achieved with 16 weeks of treatment.1 In registrational studies for MAVIRET, less than 0.1 percent of patients discontinued treatment due to adverse reactions.1 The most commonly reported adverse reactions (incidence greater than or equal to 10 percent) were headache and fatigue.1

MAVIRET combines two new, potent§ direct-acting antivirals that target and inhibit proteins essential for the replication of the hepatitis C virus. The presence of most genotypes or baseline mutations that are commonly associated with resistance have been shown to have minimal impact on efficacy of MAVIRET.

Approval of MAVIRET follows a review under accelerated assessment by the European Medicines Agency, which is granted to new medicines of major public health interest. MAVIRET is now licensed for use in all 28 member states of the European Union, as well as Iceland, Liechtenstein and Norway. AbbVie's investigational, pan-genotypic treatment has also been granted accelerated review designations by other regulatory authorities including the U.S. Food and Drug Administration and Japanese Ministry of Health, Labour and Welfare and is not yet approved in those countries.

*Patients without cirrhosis and new to treatment [either treatment-naive or not cured with previous IFN-based treatments ([peg]IFN +/- RBV or SOF/RBV +/- pegIFN)].
**Patients who achieve a sustained virologic response at 12 weeks post treatment (SVR12) are considered cured of hepatitis C.
†Data were pooled from 8-week arms of the ENDURANCE-1 and 3, and SURVEYOR-2 studies.
‡Data were pooled from 12-week GT3 treatment-naive, compensated cirrhotic arm of the SURVEYOR-2 and EXPEDITION-1 studies.
§Based on EC50 values of glecaprevir and pibrentasvir against full-length or chimeric replicons encoding NS3 or NS5A from laboratory strains and chimeric replicons from clinical isolates.1

About MAVIRET® (glecaprevir/pibrentasvir)
MAVIRET® is approved in the European Union for the treatment of chronic hepatitis C virus (HCV) infection in adults across all major genotypes (GT1-6). MAVIRET is a pan-genotypic, once-daily, ribavirin-free treatment that combines glecaprevir (100mg), an NS3/4A protease inhibitor, and pibrentasvir (40mg), an NS5A inhibitor, dosed once-daily as three oral tablets.

MAVIRET is an 8-week, pan-genotypic option for patients without cirrhosis and who are new to treatment,* who comprise the majority of people living with HCV. MAVIRET is also approved as a treatment for patients with specific treatment challenges, including those with compensated cirrhosis across all major genotypes, and those who previously had limited treatment options, such as patients with severe chronic kidney disease (CKD) or those with genotype 3 chronic HCV infection. MAVIRET is a pan-genotypic treatment approved for use in patients across all stages of CKD.

Glecaprevir (GLE) was discovered during the ongoing collaboration between AbbVie and Enanta Pharmaceuticals (NASDAQ: ENTA) for HCV protease inhibitors and regimens that include protease inhibitors.

EU Indication
MAVIRET is indicated for the treatment of chronic hepatitis C virus (HCV) infection in adults.

Important EU Safety Information
Contraindications:
MAVIRET is contraindicated in patients with severe hepatic impairment (Child-Pugh C). Concomitant use with atazanavir containing products, atorvastatin, simvastatin, dabigatran etexilate, ethinyl oestradiol-containing products, strong P-gp and CYP3A inducers, such as rifampicin, carbamazepine, St. John's wort, phenobarbital, phenytoin, and primidone.

Special warnings and precautions for use:
Hepatitis B virus reactivation
Cases of hepatitis B virus (HBV) reactivation, some of them fatal, have been reported during or after treatment with direct-acting antiviral agents. HBV screening should be performed in all patients before initiation of treatment.

Hepatic impairment
MAVIRET is not recommended in patients with moderate hepatic impairment (Child-Pugh B).

Patients who failed a prior regimen containing an NS5A- and/or an NS3/4A-inhibitor
MAVIRET is not recommended for the re-treatment of patients with prior exposure to NS3A/4A and/or NS5A-inhibitors.

Adverse Reactions
Most common (≥10%) adverse reactions for MAVIRET were headache and fatigue.

About AbbVie
AbbVie is a global, research-driven biopharmaceutical company committed to developing innovative advanced therapies for some of the world's most complex and critical conditions. The company's mission is to use its expertise, dedicated people and unique approach to innovation to markedly improve treatments across four primary therapeutic areas: immunology, oncology, virology and neuroscience. In more than 75 countries, AbbVie employees are working every day to advance health solutions for people around the world. For more information about AbbVie, please visit us at www.abbvie.com. Follow @abbvie on Twitter, Facebook or LinkedIn.

For more information, please visit www.abbvie.com/HCV.

Forward-Looking Statements
Some statements in this news release are, or may be considered, forward-looking statements for purposes of the Private Securities Litigation Reform Act of 1995. The words "believe," "expect," "anticipate," "project" and similar expressions, among others, generally identify forward-looking statements. AbbVie cautions that these forward-looking statements are subject to risks and uncertainties that may cause actual results to differ materially from those indicated in the forward-looking statements. Such risks and uncertainties include, but are not limited to, challenges to intellectual property, competition from other products, difficulties inherent in the research and development process, adverse litigation or government action, and changes to laws and regulations applicable to our industry.

Additional information about the economic, competitive, governmental, technological and other factors that may affect AbbVie's operations is set forth in Item 1A, "Risk Factors," of AbbVie's 2016 Annual Report on Form 10-K, which has been filed with the Securities and Exchange Commission. AbbVie undertakes no obligation to release publicly any revisions to forward-looking statements as a result of subsequent events or developments, except as required by law.

Nature - Eliminating viral hepatitis, articles and interviews

Nature - Eliminating viral hepatitis, articles and interviews

Article series: Eliminating viral hepatitis
Viral hepatitis is a global public health problem, and the burden of disease is increasing. In 2016, spurred by development of effective new treatments for hepatitis C and expanding access to hepatitis B vaccination, the 194 Member States of the WHO committed to eliminating viral hepatitis as a public health threat by 2030. Here, Nature Reviews Gastroenterology & Hepatology explores areas vital to meeting this ambitious target, from basic viral research to public policy.

2017
August 2017 Volume 14 Number 8
Eliminating viral hepatitis — momentum must keep building
doi:10.1038/nrgastro.2017.107
Abstract
Full text
PDF (235 KB)

August 2017 Volume 14 Number 8
Many European countries 'flying blind' in their efforts to eliminate viral hepatitis
doi:10.1038/nrgastro.2017.98
Abstract
Full text
PDF (255 KB)

August 2017 Volume 14 Number 8
HCV elimination — lessons learned from a small Eurasian country, Georgia
doi:10.1038/nrgastro.2017.100
Abstract
Full text
PDF (179 KB)

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For World Hepatitis Day Nature Releases Viral Hepatitis Articles and Interviews

Hugh Thomas writes an introduction to World Hepatitis Day 2017, including a mini-collection of research on viral hepatitis, in addition read an array of interviews about viral hepatitis research.

Raquel Peck CEO of the World Hepatitis Alliance explains the importance of World Hepatitis Day , Jeffrey V Lazarus and Kelly Safreed-Harmon discuss  WHO's strategy towards the elimination of viral hepatitis.

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Gilead's Vosevi® European Commission Grants Marketing Authorization

European Commission Grants Marketing Authorization for Gilead's Vosevi® (Sofosbuvir/Velpatasvir/Voxilaprevir) for the Treatment of All Genotypes of Chronic Hepatitis C

Date(s): 28-Jul-2017 5:46 AM

-- Vosevi is the First and Only Single Tablet Regimen for Patients Who Have Previously Failed Therapy with Direct-Acting Antivirals --
-- European Commission Also Extends Marketing Authorization for Harvoni® (sofosbuvir/ledipasvir), Enabling First Direct-Acting Antiviral Regimen for Adolescent Hepatitis C Patients --

FOSTER CITY, Calif.--(BUSINESS WIRE)--Jul. 28, 2017-- Gilead Sciences, Inc. (NASDAQ:GILD) today announced that the European Commission has granted marketing authorization for Vosevi® (sofosbuvir 400mg/velpatasvir 100mg/voxilaprevir 100mg), as a once-daily single tablet regimen for the treatment of adults with genotype 1-6 chronic hepatitis C virus (HCV) infection.

Vosevi was authorized as a 12-week treatment regimen for patients with any genotype of chronic HCV infection, without cirrhosis or with compensated cirrhosis, who have previously failed therapy with a direct-acting antiviral (DAA)-containing regimen. A 12-week regimen was also authorized for use in DAA-naïve patients with compensated cirrhosis infected with any HCV genotype, with an option to shorten therapy to 8 weeks for those infected with genotype 3. For DAA-naïve patients without cirrhosis, the recommended treatment duration is 8 weeks.
"DAA-based therapies have transformed our ability to treat hepatitis C. However, until now we have had limited options for patients who have failed to achieve cure with these regimens," said Professor Michael Manns, Director of the Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany. "Vosevi has demonstrated high cure rates across a range of DAA-experienced patients, with a simple 12-week single tablet regimen. Availability of Vosevi will have a significant impact for this group of patients, offering them the opportunity to be cured of this disease."

Gilead also today announced an extension of the marketing authorization for Harvoni® (ledipasvir 90mg/sofosbuvir 400mg). Previously authorized for the treatment of adults with chronic HCV genotype 1, 3, 4, 5 or 6 infection, the indication for Harvoni has been extended to include the treatment of chronic HCV genotype 1, 3, 4, 5 and 6 infection in adolescents aged 12 to < 18 years. Harvoni is the first direct-acting antiviral regimen to receive marketing authorization in the European Union extended for use in the adolescent population.

"The authorization of Vosevi and the extended indication for Harvoni demonstrate our ongoing commitment to bring therapies with high cure rates to all HCV-infected patients," said John Milligan, PhD, Gilead's President and Chief Executive Officer. "We look forward to working with healthcare providers and governments to ensure Vosevi is made available to patients who would benefit the most from it, while continuing to expand the benefits of our other approved medicines for patients with chronic HCV infection across Europe."

Sofosbuvir-based regimens are recommended by global guidelines across HCV genotypes and disease severities and have been used to treat more than 1.5 million patients worldwide. Vosevi is Gilead's fourth sofosbuvir-based treatment to be granted marketing authorization by the European Commission for the treatment of chronic HCV infection. The marketing authorization of Vosevi follows an accelerated review procedure by the European Medicines Agency, reserved for medicinal products expected to be of major public health interest. It allows for the marketing of Vosevi in all 28 countries of the European Union. Gilead will now work diligently with national pricing and reimbursement agencies across Europe to make Vosevi available to patients.

The approval of Vosevi is supported by data from four Phase 3 studies. Two studies (POLARIS-1 and POLARIS-4) evaluated 12 weeks of the single tablet regimen in patients with hepatitis C genotypes 1-6 previously treated unsuccessfully with DAA-containing regimens, including NS5A inhibitors. Two other studies (POLARIS-2 and POLARIS-3) evaluated 8 weeks of Vosevi in DAA-naïve patients with hepatitis C genotypes 1-6. Across POLARIS-1 and POLARIS-4, 97 percent of patients treated with Vosevi (n=431/445) achieved the primary efficacy endpoint of SVR12. In POLARIS-2, 95 percent of patients with hepatitis C genotypes 1-6 with and without cirrhosis treated with Vosevi (n=477/501) achieved the primary efficacy endpoint of SVR12. In POLARIS-3, 96 percent of patients with genotype 3 infection and compensated cirrhosis treated with Vosevi (n=106/110) achieved the primary efficacy endpoint of SVR12. The most common adverse drug reactions among patients who received Vosevi in the POLARIS studies were headache, diarrhea and nausea.

Sofosbuvir as a single agent was granted marketing authorization in the European Union on January 16, 2014, under the trade name Sovaldi®, for use in combination with other agents for the treatment of adults with chronic HCV infection. The single tablet regimen, Harvoni, received marketing authorization in the European Union on November 18, 2014. The single tablet regimen of sofosbuvir (400mg) and velpatasvir (100mg) received marketing authorization in the European Union on July 8, 2016, under the trade name Epclusa® for the treatment of adults with chronic HCV infection.
Vosevi was approved by the U.S. Food and Drug Administration on July 18, 2017 for the re-treatment of adults with genotype 1-6 chronic HCV infection.

Important Safety Information for Vosevi
Contraindications include hypersensitivity to the active substances or to any of the excipients. Co-administration with strong P-glycoprotein (P-gp) and/or strong cytochrome P450 (CYP) inducers (e.g. rifampicin, rifabutin, St. John's wort [Hypericum perforatum], carbamazepine, phenobarbital and phenytoin) are contraindicated. Co-administration with strong OATP1B inhibitors (e.g. ciclosporin), rosuvastatin, dabigatran etexilate and ethinylestradiol-containing medicinal products is also contraindicated.

Patients co-infected with hepatitis C and hepatitis B are at risk of hepatitis B virus reactivation and should therefore be monitored and managed according to current clinical guidelines.
Caution and frequent renal monitoring is recommended for co-administration with certain HIV antiretroviral treatments (e.g. tenofovir disoproxil fumarate- and efavirenz-containing regimens). Safety has not been established in patients with severe renal impairment (glomerular filtration rate <30ml/min).

Monitoring of digoxin and amiodarone is recommended when used with sofosbuvir/velpatasvir/voxilaprevir.

The "interaction with other medicinal products and other forms of interaction" section of the Vosevi EU Summary of Product Characteristics (SmPC) should be consulted before starting therapy with sofosbuvir/velpatasvir/voxilaprevir.

Sofosbuvir/velpatasvir/voxilaprevir should not be administered concomitantly with other medicinal products containing sofosbuvir.

In clinical studies, headache, diarrhoea and nausea were the most commonly reported adverse drug reactions.

Important Safety Information for Harvoni
Contraindications include hypersensitivity to the active substances or to any of the excipients. Co-administration with rosuvastatin or St. John's wort (Hypericum perforatum) is contraindicated. Co-administration with certain P-glycoprotein (P-gp) inducers (e.g. rifampicin, carbamazepine and phenytoin) is not recommended. For patients on statins dose reduction should be considered and careful monitoring for statin adverse events (myopathy and rhabdomyolysis) should be undertaken.
Patients co-infected with hepatitis C and hepatitis B are at risk of hepatitis B virus reactivation and should therefore be monitored and managed according to current clinical guidelines.
Caution and frequent renal monitoring is recommended for co-administration with certain HIV antiretroviral regimens. Safety has not been established in patients with severe renal impairment.
Monitoring of digoxin and dabigatran is recommended when used with ledipasvir/sofosbuvir.
Ledipasvir/sofosbuvir should not be administered concomitantly with other medicinal products containing sofosbuvir.
In clinical studies headache, fatigue and nausea were more common in patients treated with ledipasvir/sofosbuvir compared to placebo.

About Gilead Sciences
Gilead Sciences is a biopharmaceutical company that discovers, develops and commercializes innovative therapeutics in areas of unmet medical need. The company's mission is to advance the care of patients suffering from life-threatening diseases worldwide. Gilead has operations in more than 30 countries worldwide, with headquarters in Foster City, California.

Forward­Looking Statement
This press release includes forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995 that are subject to risks, uncertainties and other factors, including the risk that physicians may not see the benefits of prescribing Vosevi for the treatment of adults with chronic HCV infection or Harvoni for the treatment of adolescents with chronic HCV infection. These risks, uncertainties and other factors could cause actual results to differ materially from those referred to in the forward-looking statements. The reader is cautioned not to rely on these forward-looking statements. These and other risks are described in detail in Gilead's Quarterly Report on Form 10-Q for the quarter ended March 31, 2017, as filed with the U.S. Securities and Exchange Commission. All forward-looking statements are based on information currently available to Gilead, and Gilead assumes no obligation to update any such forward-looking statements.

Full European Summary of Product Characteristics for Vosevi, Sovaldi, Harvoni and Epclusa are available from the EMA website at www.ema.europa.eu.

Vosevi, Sovaldi, Harvoni and Epclusa are trademarks or registered trademarks of Gilead Sciences, Inc. or its related companies.

For more information on Gilead Sciences, please visit the company's website at www.gilead.com, follow Gilead on Twitter (@GileadSciences) or call Gilead Public Affairs at 1-800-GILEAD-5 or 1-650-574-3000.

Thursday, July 27, 2017

Australia - 'We have been waiting for so long': hep C patients get access to new cure

'We have been waiting for this moment for so long': hepatitis C patients have access to cure with Epclusa PBS listing
Kate Aubusson
More than 200,000 Australians with hepatitis C will soon be able to afford a new, highly effective treatment for the chronic, highly stigmatised infection.
From August 1, the Turnbull government will subsidise the drug Epclusa, a bumper medication combining the two antivirals sofosbuvir and velpatasvir, Health Minister Greg Hunt is set to announce on Friday.
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Prioritize Injection Drug Users for Hepatitis C Treatment

Coverage from the
International AIDS Society (IAS) 2017 Conference 

Prioritize Injection Drug Users for Hepatitis C Treatment
Ingrid Hein
July 27, 2017 
"Average drug users with HCV are likely to infect two to six people before they move away from drug use," he reported. "A focus on treating people who are HCV-positive and injecting is the only way to slow and prevent spread of the virus."
Targeting treatment to patients with advanced liver fibrosis "as a result of the virus has been shown to be a less-effective model for eliminating HCV," Dr Dillon told Medscape Medical News. By selecting patients most likely to spread the disease, the impact will be greater, he added.
In Scotland, more than 85% of the people with a diagnosis of hepatitis C inject drugs, Dr Dillon reported. To date, they have been considered by most treatment services to be "too chaotic to treat" because they are associated with poor adherence to therapy and rapid reinfection, he explained.
Continuer reading....

Hepatitis drugs more affordable but disease still deadly: WHO

Hepatitis drugs more affordable but disease still deadly: WHO
GENEVA (Reuters) - Prices of drugs to cure hepatitis C and to treat hepatitis B are dropping dramatically, offering affordability and hope to 325 million people living with the viral liver disease that can be fatal, the World Health Organisation (WHO) said on Thursday. A generic antiviral drug for hepatitis C, which can be cured in three months, was placed this week on WHO's list of pre-qualified medicines.
Continue reading....

Related On This Blog
The controversy over expensive new drugs for hepatitis C
Link to research and news articles addressing the high cost of hepatitis C drugs; insurance restrictions - private insurers/Medicaid - and availability of generic versions/India, Egypt and other lower-income countries or through online "buyers clubs"

State Medicaid Programs Should Not Deny Hepatitis C Drugs

Morning Consult
State Medicaid Programs Should Not Deny Hepatitis C Drugs
Michael Ruppal   |  
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