Expansion of Treatment for Hepatitis C Virus Infection

Dev Katarey

doi:10.7326/L17-0696

Letters |20 March 2018

Expansion of Treatment for Hepatitis C Virus Infection

Dev Katarey, MBBS, MSc, PGCert(HBE)

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TO THE EDITOR:

I read Kattakuzhy and colleagues' (1) article on the efficacy of HCV treatment provided by NPs, PCPs, and specialist physicians with great interest. Although I agree in principle with the authors' conclusions, making an informed decision on the efficacy of using other treatment providers on the basis of these data is difficult.

The age of direct-acting antivirals has ensured that most patients receiving these drugs will attain a sustained virologic response (SVR). This may be especially true with the advent of glecaprevir and pibrentasvir, because phase 2 trials (such as MAGELLAN-1 [Glecaprevir and Pibrentasvir for 12 or 16 Weeks in Patients With Chronic HCV Genotype 1 or 4 and Prior Direct-Acting Antiviral Treatment Failure]) show SVR rates up to 100% (2). Rather than SVR rates, I believe that the rate of adverse events (AEs) stratified by treatment provider is the most useful indicator for determining the efficacy of alternative treatment providers. This information is unfortunately not available in the article. Moreover, even if it were available, AEs were self-reported by the treatment provider to the investigators, thus making these results subject to reporting bias.

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2018 American College of Physicians

Letters |20 March 2018

Expansion of Treatment for Hepatitis C Virus Infection

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Letters |20 March 2018

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