Chia-Yen Dai
Kaohsiung Medical University, Taiwan
Title: Recent Advance of treatment of chronic Hepatitis C in Taiwan
Biography
Biography: Chia-Yen Dai
Abstract
The all oral direct antiviral agents (DAAs) achieving as high as >90% of sustained virological response (SVR) rate have become the new standard of care over the world. The cost of DAAs has been reimbursement by the National Health Insurance (NHI) in Taiwan for patients with chronic hepatitis C since 2017. The all oral DAAs regimens were reimbursed by the NHI including dual therapy (Daklinza+Sunvepra), 3 DAAs (Viekirax+Exviera) since Jan 24. 2017 and single tablet regimen (Zepatier) since Aug 1. 2017 for genotype 1 (GT 1) patients with fibrosis stage=3 or 4 which was diagnosed by the liver biopsy or the non-invasive measurement of fibrosis. In 2018, Harvoni wi/wo ribavirin for genotype 1, 4, 5, 6 and Sovaldi+ ribavirin for genotype 2 were reimbursed by the NHI with the same criteria of liver fibriosis. National Hepatitis C Program Office, Ministry of Health and Welfare has analyzed the data from the registry system established by the NHI Administration with all patients registered by the website. Total 9,538 patients (Male 42.2%, mean age: 65.4±10.3 years) received the therapy in 2017. According to the record of the registration system, until the end of May 2018, 9276 (97.3%) patients reached end of follow up (12 weeks after cessation of DAA therapy). With 902 (9.7%) patients lack of HCV RNA results at week 12 after cessation of therapy, the SVR12 was 97.1 % (8128//9276) by per-protocol analysis. There were 548 (5.7%) patients discontinuing the therapy prematurely. In the real-world first year Taiwanese NHI reimbursed DAA regimens for Taiwanese CHC patients with GT-1 infection and advanced fibrosis or cirrhosis (Child A classification), the SVR rate is high with a low rate of discontinuation. Further efforts will be make to reach the goal of elimination of HCV in 2030 set by World Health Organization.