Which drug is better for treating Hepatitis C Epclusa or Mavyret?

Epclusa Versus Mavyret

The Short Story

In the past 12 months there has been a fundamental game shift in the treatment of Hepatitis C with the arrival of AbbVie’s new pan-genotype drug Mavyret. (Pan-genotype means that the drug treats all genotypes of Hepatitis C.)

Mavyret is set up in direct completion with Gilead’s pan-genotype Hep C drug Epclusa.

Whilst Mavyret and Epclusa are quite similar in their effectiveness for treating Hepatitis C AbbVie decided to launch Mavyret at the significantly lower price of around US,000 for a treatment. Much, much less than the US,000 price tag that Gilead had on Epclusa and Harvoni.

This lower price and huge savings immediately meant that USA based health insurance companies, and national health services around the world, had their doctors prescribing Mavyret for treating all genotypes of Hep C where they had previously prescribed Epclusa or Harvoni.

Aside from the issue of price, controversy has revolved around the question of which drug is actually better for treating Hepatitis C, Mavyret or Epclusa? And where do Harvoni and Sofosbuvir + Daclatasvir fit into the equation of treatment options?

Well the answer is actually very simple, both Epclusa and Mavyret are about the same if the person who is being treated has not failed a previous treatment and does not have a high liver fibrosis level.

However if a person has high liver fibrosis or cirrhosis or has failed a previous Hep C treatment then Epclusa is marginally a better treatment than Mavyret.

And it just might be that the drug combination of Sofosbuvir + Daclatasvir is better than both.

So if you have health insurance and the doctor prescribes either Epclusa or Mavyret, or you are getting the medication supplied by your national health service, there is no significant difference in treatment outcomes between Mavyret and Epclusa.

However, if you must purchase your Hepatitis C treatment with your own money the fact is that there is no generic version of Mavyret but there is a licensed generic Epclusa, generic Harvoni and the very cheap option of Sofosbuvir + Daclatasvir.

So, whilst the cost difference between brand Mavyret and brand Epclusa favours Mavyret if you decide to buy generic Epclusa you are looking at a price of US,000 per treatment against a price of US,000 per treatment for Mavyret. Given that there is no significant advantage in Mavyret over Epclusa then generic Epclusa is obviously the best treatment choice. As you will see below, if you have genotype 1 generic Harvoni and Sofosbuvir + Daclatasvir are both excellent and low priced treatment options.

Summary

Both Mavyret and Epclusa give cure rates above 97% for all genotypes of Hepatitis C except for G3 where both give a cure rate of around 95%. It appears that people with cirrhosis or who have failed previous treatments would get greater benefit  from Epclusa than fro Mavyret. Sofosbuvir + Daclatasvir appears to be as effective as either Mavyret or Epclusa.

The Long Story

Clinical Testing

One of the difficulties with making informed decisions about whether Mavyret or Epclusa is the better Hep C treatment option is that Gilead (Epclusa Astral Trials) and Abbvie (Mavyret Endurance Trials) used slightly different criteria for selecting patients for the trials. Gilead in the Astral Epclusa trials used patients in the trials regardless of if they had cirrhosis or not and if they had failed previous treatments or not.  Abbvie excluded patients with prior treatment failures and with cirrhosis from their results. Obviously excluding these two categories of people would improve the results significantly and also make it difficult to make direct comparisons between Mavyret and Epclusa. So I have included (below) various graphs from various trials that give some indications on how Mavyret compares with Epclusa and also with Harvoni and Sof + Dac.

Epclusa Background

Epclusa is a combination of two drugs, Sofosbuvir 400 mg + Velpatasvir 100 mg. Epclusa is manufactured by US based Big Pharma company Gilead Sciences and can be used to treat all genotypes of Hepatitis C and in most circumstances can be used regardless of cirrhosis or previous treatment history with other medicines.

Mavyret Background

Mavyret (also spelt Maviret in some countries) is a combination of two drugs Glecaprevir  100 mg  and Pibrentasvi 40 mg. Mavyret is manufactured by US based Big Pharma company AbbVie.

Both Mavyret and Epclusa are one pill that contains the two drugs. Both drugs are direct-acting antivirals (DAAs) which means they directly interfere with Hepatitis C virus’s ability to replicate (reproduce).

Clinic Trial Results

During clinical trials both Epclusa and Mavyret were shown to be effective at clearing all six genotypes of HCV from the blood. Both are effective against Hepatitis C genotype 1. Over the course of eight studies involving greater than 2,300 patients with Hepatitis C, Mavyret cured 99% of  patients who did NOT have cirrhosis or who had failed previous treatment. The cure rates were significantly lower for patients with cirrhosis though longer treatment times improved the cure rate.

In the Endurance 3 Trials run by AbbVie Sofosbuvir 400 mg + Daclatasvir 60 mg gave a two percent higher cure rate than Mavyret against Hepatitis C genotype 3.

The results of Epclusa and Mavyret were reportedly similar for the treatment of genotypes 1, 2 and 4, 5 and 6 whereas  only 95% of patients infected with Hep C genotype 3  were cured after treatment with either medication.

Interestingly in the Endurance trials on Mavyret that were run by AbbVie the combination of Sofosbuvir 400 mg + Daclatasvir 60 mg out-performed Mavyret by 2% giving a cure rate of around 97%.

This has very interesting implications because the a 12 weeks treatment with Sofosbuvir + Daclatasvir has a retail price of around US0 compared the the cost of Mavyret at around US,000.

In other trial results Mavyret and Epclusa gave similar results for treating Hepatitis C genotype 3. That is both Mavyret and Epclusa gave a cure rate of around 95% for people infected with HCV genotype 3.

For treating Hep C genotype 1 Mavyret appears to be about 2% better than Epclusa however Gilead’s Harvoni (Sofosbuvir + Ledipasvir) appears to be equal to Mavyret for treating genotype 1.

With both Mavyret and Epclusa higher cure rates were obtained by longer treatment times.

Below are some graphs that show cure rates for the various population DAA Hepatitis C treatments.

These results show that adding Ribavirin to Epclusa improves cure rates as does increasing the treatment time.

Trial results comparing Harvoni (Sofosbuvir + Ledipasvir) with Sofosbuvir + Daclatasvir treating Hepatitis C genotype 1. The results show that Sofosbuvir + Daclatasvir is slightly better than Harvoni for treating Hep C genotype 1.

Results of the Astral 1 trial for treatment with Epclusa on patients without cirrhosis who were treatment naive (had not failed previous treatments). Cure rates are lower for people with high fibrosis levels or who have failed previous treatment.

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