Liver transplants for HCV infection to become obsolete in 10-20 years
In 10 to 20 years, liver transplantation will no longer be performed for patients with hepatitis C as the infection is now curable with direct-acting antiviral (DAA) therapies, says an expert at the International Digestive Disease Forum (IDDF) 2015 held recently in Hong Kong.
“Hepatitis C virus [HCV] has been the hottest topic in gastroenterology. With the new DAAs, cure rates of up to 100 percent can be achieved, in some cases without interferons,” said Professor Michael Manns of the Hannover Medical School in Hannover, Germany.
A number of DAA regimens are currently available for the treatment of different HCV genotypes. As pharmaceutical companies continue to fight for an edge in the HCV market, the grazoprevir/elbasvir combination, asunaprevir/daclatasvir/beclabuvir combination, and sofosbuvir/GS5816 combination are expected to become available in 2016, while samatasvir, sovaprevir and other promising agents are in development.
“Chronic hepatitis C has become a curable disease. Although the cure rate remains low in many parts of the world, we will be able to eliminate HCV in the next 25 years,” suggested Manns. “I’m sure in 10 to 20 years, there will be no more liver transplantations due to HCV infection.”
“Companies and researchers are on the way to leave hepatitis C and go into hepatitis B,” he continued. “At present, we can stop the progression of hepatitis B virus [HBV] infection, but a cure is not available. We need to work on strategies that interact with the covalently closed circular DNA [cccDNA] to achieve a finite duration of treatment and cure the disease.”
HBV therapies in early phases of development include viral core inhibitors, cccDNA inhibitors, entry inhibitors and immune therapies, he added.
A common challenge in eliminating HCV and HBV is the cost of new therapies, which may be unaffordable for some patients.
As liver transplantation remains in demand for various conditions, researchers are looking into alternatives to address challenges such as organ shortage and increasing donor age. One such alternative is hepatocyte transplantation.
“The liver has a high regenerative potential. Hepatocyte transplantation can therefore be developed for conditions such as acute liver failure, inborn errors of metabolism, and genetic liver diseases where we only need to replace one gene,” explained Manns.
“In Europe, for example, hepatocyte transplantation has received orphan drug status for inborn errors of urea cycle defects. The study is almost completed, and the treatment will soon be approved for this genetic liver defect,” he said.