In a proof-of-concept study, Lau et al. have shown that the treatment course of direct-acting antiviral agents (DAAs) can be reduced to 3 weeks and still be effective using a response-guided approach. Patients with chronic hepatitis C (genotype 1b) without cirrhosis were randomly allocated to receive one of three different triple DAA regimens: sofosbuvir, ledipasvir and asunaprevir (n = 12); sofosbuvir, daclatasvir and simeprevir (n = 6); or sofosbuvir, daclatasvir and asunaprevir (n = 8). Only those who demonstrated an ultra-rapid virologic response to DAAs by day 2 had their treatment course reduced from the standard 12 weeks to 3 weeks, achieving virologic 'cure' by week 3 with excellent tolerability. The authors hope that shortening the duration of therapy could substantially reduce treatment costs, but large-scale studies of this approach are needed.
Lau, G. et al. Efficacy and safety of 3-week response-guided tripe direct-acting antiviral therapy for chronic hepatitis C infection: a phase 2, open-label, proof-of-concept study. Lancet Gastroenterol. Hepatol. http://dx.doi.org/10.1016/S2468-1253(16)30015-2 (2016)
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Ray, K. Response-guided strategy to reduce DAA duration for hepatitis C. Nat Rev Gastroenterol Hepatol 13, 558 (2016). https://doi.org/10.1038/nrgastro.2016.150