Only one-quarter of patients worldwide with the chronic hepatitis C virus (HCV) received antiviral treatment before the widespread use of direct-acting antiviral (DAA) drugs, a review that considered almost 500,000 people has found.
           
But the authors conclude that treatment rates should improve in the interferon-free era, although the costs of DAA therapy could limit participation.
           
“The number of patients eligible for treatment will increase significantly as DAA therapies are recommended now in patients with decompensated cirrhosis,” Philip Vutien, MD, one of the study’s authors from Stanford University Medical Center, Palo Alto, California, said. “In addition, as DAA therapies are much better tolerated, we would expect patients and their providers to be much more willing to initiate treatment.”
           
Vutien and a team from Stanford and Kaohsiung Medical University in Taiwan reviewed data from published reports, liver meetings and other primary sources. They included HCV treatment rates through March 2016 for any interferon-based or DAA-based therapies.
           
Thirty-nine studies, with a total of 476,443 chronic HCV patients, met the eligibility requirements.

Five of these studies included first-generation DAAs such as boceprevir (Victrelis) and telaprevir (Incivek) Newer DAAs such as sofosbuvir (Sovaldi) were not part of the analysis, Vutien told MD Magazine.
           
The review showed that just 25.5% of HCV patients received antiviral therapy. While 52% of patients were eligible for treatment, only 60% of them received it. For the 47% of individuals who weren’t eligible, the most common reason was their inability to provide pre-treatment workups including serologic testing and assessment for liver fibrosis and inflammation, according to the study.
            
“The use of the well tolerated newer all-oral DAA therapies will likely diminish the barriers related to treatment eligibility and provider/patient acceptance, especially those related to medical and/or psychiatric contraindications,” the authors wrote.
           
Treatment rates varied by geography. Studies from Europe showed the highest pooled rate at 34%. This compared to 28.3% for the Asia/Pacific region and 18.7% for North America. 
           
“Some of the regional differences in treatment rates may be due to barriers specific to HCV care in North America, including insurance reimbursement criteria and patient-physician preferences,” Vutien said.
           
The authors found no statistical difference in treatment rates between pegylated interferon plus ribavirin (PEG-IFN+RBV) combined with boceprevir or telaprevir, at 32%, and PEG-IFN + RBV alone, at 25%.
           
“We would expect treatment rates to significantly increase with the newer DAA therapies,” Vutien said.
           
However, the authors cautioned that the price of DAAs could keep patients away.
           
“With the current costs of all-oral DAAs well exceeding that of PEG-IFN-based therapies, the non-treatment rate due to insurance approval and cost may actually rise compared to that from the PEG-IFN era, even in high income countries,” the authors wrote.

The study, "Regional differences in treatment rates for patients with chronic hepatitis C infection: Systematic review and meta-analysis," was published online in PLOS this month.