icon-folder.gif   Conference Reports for NATAP  
  EASL 46th Annual Meeting
March 30th - April 3rd 2011
Berlin, Germany
Back grey_arrow_rt.gif
Hepatitis C Treatment In France: three-to four-fold increase between now and 2012 is anticipated in the number of patients treated in hospital for HCV genotype 1 infection (the most common in France)
  From Jules: You can expect the same in the USA and other developed western countries
anRS French National Agency for Research on AIDS & Viral Hepatitis Press release
Hepatitis C : new treatments herald
a considerable increase in the number
of patients treated in 2012
While new drugs (protease inhibitors) for the treatment of hepatitis C are expected to receive marketing authorization in Europe at the end of this year, a study reported at the conference of the European Association for the Study of the Liver (EASL) in Berlin (march 30 - avril 3th) predicts how many patients are likely to be given such treatment in France in the years ahead. A three-to four-fold increase between now and 2012 is anticipated in the number of patients treated in hospital for HCV genotype 1 infection (the most common in France). These findings should be taken into account in healthcare planning.

Treatment of hepatitis C will enter a new era with the advent of triple-drug regimens. Data released in late 2010 gave patients real hope: new drugs-protease inhibitors (boceprevir and telaprevir, developed respectively by Merck/Schering-Plough and Vertex Pharmaceuticals Inc/Janssen Pharmaceutica/Tibotec)-each combined with standard treatment comprising pegylated interferon and ribavirin, yielded very good results in patients infected with HCV genotype 1, the most widespread in France : 70 to 75% response to first-intention treatment and 30 to 85% response after failure of standard treatment. Protease inhibitors, European marketing authorization for which is expected at the end of 2011, represent a major advance in the treatment of hepatitis C.
What impact will these new drugs have on hospital departments and on treatment organization? In 2010 an estimated 5100 patients infected with HCV genotype 1 were receiving standard treatment in France (pegylated interferon + ribavirin) : how many are likely to receive the new therapeutic combinations in 2012 ?
Sylvie Deuffic-Burban, of Professor Yazdan Yazdanpanah's team (Inserm U 995, Universite Lille Nord de France), has modeled several scenarios in patients infected by HCV genotype 1, taking into account anticipated changes between 2010 and 2012 inparameters such as the number of people newly found to be HCV-positive, and the administration of new drugs as a function of the different stages of fibrosis. Depending on the scenario, by 2012 an estimated 15 000 to 19 400 patients will be receiving treatment, that is three to four times as many as in 2010. This work was supported by the French National Agency for Research on AIDS and Viral Hepatitis (ANRS).
Modeling studies have their limitations, but are nonetheless the only way scientifically to anticipate future trends and to look ahead to potential difficulties in healthcare organization. ANRS Director Professor Jean-François Delfraissy considers that "triple-drug therapies of hepatitis C will enable the eradication of HCV, unlike HIV, in a large proportion of patients eligible for treatment. It is important to start new studies on, for instance, the impact of these treatments on public health and health economics".
The ANRS is committed to a major research program on the use of protease inhibitors. It is sponsoring a patient cohort (ANRS CO 20 CUPIC) in collaboration with AFEF (the French Association for the Study of the Liver) and AFSSAPS (French Health Products Safety Agency). AFSSAPS allows pre-registered molecules prescription in health centers in France before the granting of a marketing authorization. The individuals eligible as cohort members-treatment failure patients infected solely by HCV genotype 1 who have developed cirrhosis-will be followed in the cohort during treatment with protease inhibitors. It will provide essential information on the efficacy and safety of these drugs, and on the occurrence of treatment resistance. Several hundred patients are expected to participate. Lastly, two clinical trials in patients co-infected with HIV and HCV who are already being treated for hepatitis C will start in early April. These trials may lead to a broadening of recommendations for the prescription of protease inhibitors.
The Anrs is the French National Agency for Research on AIDS and Viral Hepatitis. Its mission is to seek new ways to improve the prevention and treatment of these infections, both in the developed world and in countries with limited resources. The Anrs brings together researchers and physicians from French hospitals and research organizations (Inserm, Cnrs, Institut Pasteur, Ird, universities) to work on prioritized scientific projects. At its overseas research sites, the Anrs mobilizes French and local scientists in work on healthcare issues of paramount importance to the developing world. The French ministries of research, foreign affairs, and health allocate to the Anrs an annual budget of approximately 44 million Euros (62 million dollars).

S. Deuffic-Burban1,2, P. Mathurin3,4, S. Pol5, C. Larsen6, F. Roudot-Thoraval7, J.-C. Desenclos6, D. Dhumeaux8, Y. Yazdanpanah1,2,9 1ATIP-AVENIR, Inserm U995, Universite Lille Nord de France, Loos, 2EA2694, Universite Lille Nord de France, 3Service des Maladies de l'Appareil Digestif et de la Nutrition, Hôpital Huriez, CHRU Lille, 4Inserm U995, Universite Lille Nord de France, Lille, 5Groupe Hospitalier Cochin Hôtel Dieu, Unite d'Hepatologie, Universite Paris Descartes et Inserm U-1016, Paris, 6Departement des maladies infectieuses, Institut de Veille Sanitaire, Saint Maurice, 7Service Sante Publique, Hôpital Henri Mondor, 8Inserm U955, Physiopathologie et therapeutique des hepatites virales chroniques, Hôpital Henri-Mondor, Creteil, 9Service Universitaire des Maladies Infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Tourcoing, France.
Background: In 2012, genotype 1 (G1) HCV-infected patients will be treated with the association of pegylated interferon (PEG-IFN), ribavirin (RBV) and a DAA namely a protease inhibitor (PI) with a substantially higher efficacy. Evaluating the impact of this new association availability on HCV-treatment prescriptions is crucial for resource allocation, planning and treatment optimization. Aim: To estimate the number of G1 patients to be treated with the new association of PEG-IFN/RBV/PI in France in 2012.
Methods: We used a published model of HCV progression to predict the number of patients to treat in 2012 according to their fibrosis score and treatment history status. Data on PEG-IFN sales (2002-2009) were used to calibrate the model; we assumed that the proportion of G1 patients treated with PEG-IFN in 2010/2011 was similar to 2009. We estimated the number of patients to treat in 2012 under 3 scenarios based on HCV screening rate and the proportion of screened patients treated: 1) HCV screening rate unchanged vs. 2010; proportion of treated F0-F1 patients unchanged, proportion of treated F2-F4 patients increased to the current proportion of treated F2-F4 genotype 2/3 (G2/3) patients; 2) Scenario 1 but the proportion of treated F0-F1 patients increased to the current proportion of treated F0-F1 G2/3 patients; 3) Scenario 2 but 5%-increase in HCV screening rate.
Results: Assuming a HCV screening rate of 62% at the end of 2011, the number of G1 patients who knew their HCV status was estimated at 47,400 (56% treatment-naive). Table presented the estimated number of G1 patients treated in 2010 and to be treated in 2012.


Conclusions: Our model-based estimates indicate that new and more efficacious anti-HCV treatments may result in 9,900-14,300 additional patients to treat in France in 2012, representing a 2- to 3-fold increase in the number of G1 patients who will be treated.