There is excitement over CADTH’s new hepatitis C treatment recommendations report, CADTH Therapeutic Review, Drugs for Chronic Hepatitis C Infection: Recommendations Report, by the Canadian Drug Expert Committee (CDEC).
Action Hepatitis Canada has written about the new report and is very pleased that patient groups were asked for input, as are we, and that recommendations are in line with some of their feedback. For example, AHC highlighted the first recommendation which reads:
Recommendation 1: CDEC recommends that all patients with CHC infection should be considered for treatment, regardless of fibrosis score. Given the potential impact on health system sustainability of treating all patients with CHC infection on a first-come basis, priority for treatment should be given to patients with more severe disease.
Recommendation 4 stood out for us as the insufficient evidence seemed surprising. It reads:
Hep C Treatment Recommendations 2, 3, and 5 are as follows:
|Recommendation||Targeted Patients||Preferred Treatment|
|2||Those with genotype 1 (GT1) hepatitis C who have never tried treatment (treatment naive) regardless of liver cirrhosis stage||Harvoni or Holkira Pak +/- ribavirin for same duration as approved by Health Canada|
|Those with GT1 hep C who have tried treatment (treatment experienced) regardless of cirrhosis stage||Pegylated interferon + ribavirin (PR) for same duration as approved by Health Canada|
Sovaldi + ribavirin (12 weeks)
|Those with GT3 hep C without cirrhosis||Daklinza + Sovaldi (12 weeks)|
|Those with GT3 hep C with cirrhosis||Sovaldi + ribavirin (12 weeks)|
|Those with GT4 hep C who are treatment naive and don’t have liver cirrhosis||Sovaldi + PR (12 weeks)|
|Those with GT4 hep C who are treatment experienced or have liver cirrhosis regardless of treatment history||Insufficient evidence to make a recommendation|
|5||Those with GT1 hep C who have already tried
a protease inhibitor-PR regimen regardless of cirrhosis stage
|Treatment experienced with an all-oral DAA treatment||Insufficient evidence to make a recommendation|
Recommended condition for all patients being treated for hep C: Treatment should be started by hepatologists or physicians experienced with treating chronic hepatitis C. The report also includes recommendations for liver transplant recipients starting on page 22.