Maybe 'retreaters' like me have gone the way of the Dodo? If so, well and good.
Hi Jeff,
Nothing has really changed in terms of success rates although going a little longer in GT3 definitely helps.
The peak of originator DAA use was around 2015Q2 - 2016Q1 when there were around 160,000 patients being treated each quarter. In 2017Q4 that number was 80,000 so over the last 2 years, the number of people treating with originator medication has fallen to 1/2 what it was. The situation for generics appears similar and we only help about 1/2 as many people as would have been the case a year ago.
So the major reason is there are less people treating so fewer people relapsing.
Another reason you don't see much here is that most of the hard cases (cirrhotic past treatment failure) have either been successfully treated or died. This leaves a relatively easier population to treat where the SVR rates are over 95%.
The other significant change is that 3 years ago I was one of the only doctors prescribing generics. Over time other doctors have seen the results themselves and started prescribing and of course, have had relapses. The conversations have tended to be in the background involving me the patient, their doctor and sometimes others. Mostly we've settled on adding Sofosbuvir to Viekira or Zepatier or adding Asunaprevir or Simeprevir to Harvoni or Sovaldi/Daklinza to produce the Vosevii you have when Vosevii does not exist. Anyone who has worked with HIV understands that 3 drugs (targets) are much better than 2, however, the guidelines (both AASLD and EASL) and the various government/insurance funding requirements, and to a degree ethical and medicolegal considerations, dictate this is better done on the QT with informed consent from those that need to know.
Almost all the patients who relapsed the first time have been successfully retreated the second time. There are a couple of exceptions - one who failed 12 weeks Sof/Dac and then 24 weeks Harvoni who cleared on 24 weeks Viekira/Sof/Riba. Another GT3 who is still on maintenance Sof/Dac while we wait for something better (they were bucket list unwell prior to treatment and travelling well on HIV style maintenance).
