Journal Information
Vol. 84. Issue 2.
Pages 267-268 (April - June 2019)
Vol. 84. Issue 2.
Pages 267-268 (April - June 2019)
Letter to the Editor
DOI: 10.1016/j.rgmxen.2018.07.005
Open Access
Optimizing the treatment strategy to achieve hepatitis C virus elimination in Mexico
Optimización de la estrategia terapéutica para lograr la eliminación del virus de la hepatitis C en México
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I. Ruiza,b,c,
Corresponding author
isaac.ruiz@me.com

Corresponding author. French National Reference Center for Viral Hepatitis B, C and delta, Department of Hepatology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France; INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France; Hopital Henri Mondor Universite Paris Est. 51 avenue du Marechal de Lattre de Tassigny 94010 Creteil, France. Tel.: +(+33) 1.49.81.35.36
a Department of Hepatology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
b INSERM U955, Institut Mondor de Recherche Biomédicale, Créteil, France
c National Reference Center for Viral Hepatitis B, C and D, Department of Virology, Hôpital Henri Mondor, Université Paris-Est, Créteil, France
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Some points in the Mexican Consensus on the Treatment of Hepatitis C,1 should be carefully considered. For example, for genotype 2, the treatments recommended in the Consensus were sofosbuvir + daclatasvir ± ribavirin for 12 weeks or sofosbuvir + velpatasvir for 12 weeks. In their study, Zhou et al.2 reported the worldwide prevalence of the L31M polymorphism at 52, 41, and 86% in the United States, Europe, and Asia, respectively. The importance of that polymorphism lies in the fact that it confers up to 100-fold resistance to daclatasvir. There are no data in Mexico, but prevalence can be expected to be similar to that in the United States, in other words, 50%, which would be the cause of (and explanation for) the therapeutic failure of the combination with daclatasvir in some of those patients. Those results were confirmed in a prospective, real-life study on a French cohort that evaluated sofosbuvir + daclatasvir ± ribavirin, in which the sustained virologic response 12 weeks after treatment (SVR12) was 88% (n = 244/278).3 In contrast, in clinical trials and real-world studies, the sofosbuvir/velpatasvir and glecaprevir/pibrentasvir combinations showed that the polymorphism had no impact on the SVR12.4

The World Health Organization proposed the goal of hepatitis C virus (HCV) elimination by 2030, but very few countries have been able to implement an adequate strategy for achieving that objective. Resources must be optimized in Mexico, given that it is a country that faces many difficulties, such as not having access to all treatments (the pan-genotype glecaprevir/pibrentasvir combination), the impossibility of treating all patients (especially after a therapeutic failure), and the lack of resistance tests, whose importance has been demonstrated in the treatments in which the resistance-associated substitutions (RASs), such as first-generation antivirals, have had an impact. Currently, there are 2 new pan-genotype treatments that have shown their efficacy in clinical trials and in real-world studies. The SVR12 was reported at over 95%, there were no severe side effects, tolerance was good in all the patient groups, and retreatment was efficacious in patients with first treatment failure, as well as in patients that were considered difficult-to-treat. Both the treatment and the tests needed before, during, and after treatment are simplified with those combinations.

Based on the data described above, a simplified treatment with 2 pan-genotype combinations appears to be more appropriate as a national strategy. France and England are leaders in eradication strategy, and they have adopted that treatment route, and those combinations have been recommended in the recently published European guidelines, as well.5 In addition, treatment simplification will make it possible to concentrate efforts on early detection in patients, a crucial stage for achieving elimination. An expert consensus can be used to recommend public health strategies to the government and to work with the pharmaceutical industries to facilitate said public health policies. The elimination of HCV is in everyone's best interest.

Financial disclosure

Isaac Ruiz received predoctoral fellowship grants from the National Agency for Research on AIDS and Viral Hepatitis (ANRS) and the Consejo Nacional de Ciencia y Tecnología de México (CONACYT).

Conflict of interest

Isaac Ruiz has served as an advisor for Abbvie.

References
[1]
I. Aiza-Haddad, A. Ballesteros-Amozurrutia, O.D. Borjas-Almaguer, et al.
Consenso Mexicano para el Tratamiento de la Hepatitis C.
Rev Gastroenterol Méx, 83 (2018), pp. 275-324
[2]
N. Zhou, Z. Han, S. Hartman-Neumann, et al.
Characterization of NS5A polymorphisms and their impact on response rates in patients with HCV genotype 2 treated with daclatasvir-based regimens.
J Antimicrob Chemother, 71 (2016), pp. 3495-3505
[3]
C. Hezode, V. de Ledinghen, G. Haour, et al.
Sofosbuvir plus ribavirin and sofosbuvir plus daclatasvir-based regimens are suboptimal in genotype 2 patients: Real-life experience from the Hepather ANRSCO22 cohort.
J Hepatol, 68 (2018), pp. S105-S364
[4]
C. Hezode, N. Reau, E.S. Svarovskaia, et al.
Resistance analysis in patients with genotype 1-6 HCV infection treated with sofosbuvir/velpatasvir in the phase III studies.
J Hepatol, 68 (2018), pp. 895-903
[5]
European Association for the Study of the Liver. EASL Recommendations on treatment of hepatitis C 2018. J Hepatol. 2018;69:461-511, https://doi.org/10.1016/j. jhep.2018.03.026

Please cite this article as: Ruiz I. Optimización de la estrategia terapéutica para lograr la eliminación del virus de la hepatitis C en México. Revista de Gastroenterología de México. 2019;84:267–268.

Copyright © 2019. Asociación Mexicana de Gastroenterología
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