Greg Jefferys Hepatitis C blog deals with all the issues associated with hepatitis C
Since I first travelled to India in May 2015 to buy generic Sovaldi and Ribavirin to cure my Hepatitis C my work has focused on providing information about the best Hepatitis C treatment options.
Seven years have passed since that trip to India and in 2022 a number of new Hep C treatments have become available and prices of both the brand and generic treatments have fallen.
Also, importantly, a lot more research has been done into the treatment outcomes of the different Hep C drugs. The published results of this research has shown some very interesting results, most interesting of these results is that the cheapest drug combination, Sofosbuvir 400 mg + Daclatasvir 60 mg, is probably the best treatment option for most people with HCV. Below is a graph from tests by the pharma giant AbbVie, the manufacturer of Mavyret. These results show that Sofosbuvir + Daclatasvir is superior to Mavyret for treating all genotypes except, possibly, Genotype 3.
The combination of Sofosbuvir 400 mg (Sovaldi) and Daclatasvir 60 mg (Daklinza) was the world’s first pan-genotype Hepatitis C treatment. However because Sovaldi is owned by Gilead and Daklinza is owned by Bristol Myer Squib this drug combination was never promoted or advertised. Gilead promoted Sovaldi and Harvoni and BMS did not do much at all to promote Daklinza. Both companies put high price tags on their drugs so that the price for the combined treatment of Sofosbuvir + Daclatasvir was around US$140,000. The high price meant that health insurance companies and national health services were not interested in Sof + Dac as a Hep C treatment option.
Many of the drugs used to treat Hepatitis C are very expensive to manufacture however Daclatasvir is actually a very cheap drug to manufacture. This is because the Daclatasvir molecule is a very simple molecule, whereas the Velpatasvir molecule used in Epclusa or the Ledipasvir molecule used in Harvoni are very complex molecules requiring expensive equipment and processes. Because Daclatasvir is so easy to make it means it is cheap to make. Sofosbuvir is also a relatively easy and cheap molecule to manufacturer so combining licensed generic Daclatasvir with Sofosbuvir creates a very effective and very affordable treatment option.
So don’t think there is some catch to this, the only reason that the drug combination of Sofosbuvir + Daclatasvir is not the most widely used Hepatitis C treatment is simply because the two massive, global pharmaceutical companies who owned the separate patents, Gilead and BMS, were so greedy and so selfish they would not work together to offer humanity the best and cheapest Hep C treatment. Rather they both took a strategy that was only about making the maximum profits for themselves.
A 12 week treatment of Sofosbuvir + Daclatasvir costs less than US$600, including delivery.
Because treating all genotypes of Hepatitis C with Sofosbuvir + Daclatasvir is more effective than either Mavyret or Harvoni and equal to Epclusa except for the possible exception of treating genotype 3, where Epclusa seems very slightly more effective.
As mentioned above US based Big Pharma company AbbVie conducted a trial called ENDURANCE-3 which demonstrated that Mavyret (Mavyret is the combination of the two DAAs Glecaprevir + Pibrentasvir – G/P) is “non-inferior” to the combination of Sofosbuvir + Daclatasvir (SOF/DCV). What does Abbvie mean by “non-inferior”? Its a nice way of saying that Sofosbuvir + Daclatasvir is superior to Mavyret because the facts are that Sofosbuvir + Daclatasvir achieved 97% cure rate whereas Mavyret only achieved 95% cure rate in the difficult to treat GT3 population. Saying that Maviret is “non-inferior” to Sof + Dac is just another way of saying that Sofosbuvir + Daclatsvir is “slightly superior”. This is a BIG admission by the manufacturer of Mavyret.
The REDEMPTION trials were a series of trials run by Dr James Freeman, founder of FixHepC. The Redemption Trials put the cure results for Sofosbuvir + Daclatasvir in the range 93% for Genotype 3. For Genotypes 2, 5 and genotype 6 the cure rates were 100% and for Hep C Genotype 1 a cure rate of 97% came from 12 weeks treatment of Sof + Dac. For Genotype 4 the cure rate was 95%.
The Redemption Trials were based on research results of over 1000 patients and presented at the 2016 International Liver Conference in Barcelona. These trials were initiated by Dr James Freeman and are important because they were not sponsored by any of the pharmaceutical companies and were totally independent.
So what do these results tell us about treating Hepatitis C with Sofosbuvir plus Daclatasvir?
It is simple: Twelve weeks of Sofosbuvir + Daclatasvir is the cheapest and most effective pan-genotype Hepatitis C for a person who does not have cirrhosis. Sof + Dac will treat all genotypes better as well as, or better than, any other drug combination with the exception of genotype 3 where a longer treatment time with Sofosbuvir + Daclatasvir would give better results.
Here are some guidelines for people treating their Hepatitis C with Sofosbuvir 400 mg + Daclatasvir 60 mg.
Sofosbuvir and Daclatasvir are both water soluble and are absorbed into the bloodstream through the stomach.
If you have a Sofosbuvir pill and a separate Daclatasvir pill these pills should be taken together at the same time each day.
The pills should be taken with a small amount of food and not too much water or other beverages. The reason for this is taking the pills with a small amount of food will hold the medicines in the stomach for the maximum time, ensuring absorption of the active ingredients.
Because Sofosbuvir can cause insomnia in some people it may be wise to that the pills in the morning with breakfast.
Coffee and tea should only be taken in moderation while using Sofosbuvir and Daclatasvir. The reason for this is that the enzymes, called CYP enzymes, used by the body to remove caffeine from the blood are from the same family of enzymes that the body uses to remove Sofosbuvir and Daclatasvir from the blood. High levels of caffeine may create an “under-dose” situation.
Having said that one or two cups of coffee or tea is no problem at all.
Energy Drinks such as Red Bull and other brands contain high levels of caffeine and another stimulant called Taurine. Taurine will also stimulate production of CYP enzymes and so Energy drinks should be avoided.
High levels of these CYP enzymes can also be caused by some drugs and herbal supplements, particularly St John’s Wort. It is wise to avoid any herbal supplements while doing Hepatitis C treatment with Sofosbuvir + Daclatasvir.
Food and Hepatitis C Treatment
There are no common foods that cause any problematic interactions with Sofosbuvir and Daclatasvir.
There is something of a myth going around that food like grapefruit, papaya and so on should be avoided.
This is not entirely correct.
The reason behind this myth is that certain fruits will slightly suppress production of the CYP enzymes (the enzymes that break down Sofosbuvir and Daclatasvir). What this means is that by eating these foods while doing Hep C treatment the Sofosbuvir and Daclatasvir will remain active in the blood a little longer, which is probably not a bad thing.
To put this simply and in perspective the half-life of Sofosbuvir in your blood is about 20 minutes. That means that if your body absorbs 400 mg of Sofosbuvir 20 minutes later there will be only 200 mg of Sofosbuvir. After 40 minutes there will be about 100 mg and after an hour about 50 mg.
If you were to eat several grapefruit or a couple of papaya the effect might be that at the end of an hour you might have 60 or 70 mg left instead of 50 mg… its not a problem. You would need to eat about serval grapefruit to make any real significant difference.
Taking other medication while doing Hepatitis C Treatment.
If you are on other medication you should check with your doctor to make sure there are no clashes between the Hep C medication and your other medicines. If you want to check for yourself there is a very good website which has an interactive chart that lists all Hep C medicines and other medications and you can check you medicine on this. Here is the link: