Greg Jefferys Hepatitis C blog deals with all the issues associated with hepatitis C
One of the strangest things about Hepatitis C treatment is that the cheapest and most effective drug combination for the treatment of Hepatitis C, the combination of Sofosbuvir + Daclatasvir, is widely ignored in the “First World” (Europe, North American etc).
For the treatment of all genotypes of Hepatitis C the combination of Sofosbuvir + Daclatasvir is equal to Epclusa (Sofosbuvir + Velpatasvir) and superior to Mavyret.
Sofosbuvir + Daclatasvir is significantly cheaper than either Epclusa or Mavyret because Daclatasvir is a very easy molecule to manufacture. The simplicity of manufacture makes it cheap.
So why is the cheapest and most effective treatment for Hepatitis C largely ignored in “Western” countries?
Once upon a time, there was a company called Pharmasett that was owned by a group of ex-university researchers. Pharmasett was working on a new kind of Hepatitis C drug, a Direct Acting Antiviral called PSI-7977, an NS5B inhibitor, which stopped the Hepatitis C virus form replicating in the human liver.
This is the drug we know today as Sovaldi (Sofosbuvir).
Back when Sofosbuvir was PSI-7977 Pharmasett were working with the pharmaceutical giant BMS (Bristol Myer Squib) and combining Sofosbuvir with BMS’s NS5A inhibitor called Daclatasvir, a combination that created an affordable, highly effective, pan-genotypic treatment for everyone with Hepatitis C.
However when Gilead Sciences found out about Sofosbuvir and realized the huge potential profits that they could make from a drug that cured Hepatitis C, they purchased Pharmasett from the ex-university researchers for about 12 billion dollars.
And those ex-university researchers became very, very rich.
Because GILEAD is a greedy beast it did not want to share its potential profits with anyone else so GILEAD severed that relationship with BMS and Daclatasvir and went on to develop another drug to replace Daclatasvir, this was Ledipasvir.
It took a little longer to create Ledipasvir but GILEAD could not wait to start its profits rolling in so it began selling Sovaldi alone, which was not as effective as Sofosbuvir + Daclatasvir but it enabled GILEAD to recoup its 12 billion dollars in less than 12 months.
Sovaldi was not as effective as Sovaldi + Daclatasvir but GILEAD did not have to share its profits so GILEAD was happy, even though lots of people failed their treatment with Sovaldi alone.
So instead of the world getting a cheap pan-genotypic drug that cured all genotypes of Hep C the world got Sovaldi and then Harvoni.
Harvoni was only effective for the treatment of Hep C Genotype 1 but G1 represented about 70% of all Hep C infections in the USA and GILEAD knew that the USA was where it could make big bucks fastest. So GILEAD focused on Harvoni using Sofosbuvir and Ledipasvir which Gilead owned.
Because Gilead owned Sofosbuvir and because Daclatasvir by itself was not a viable treatment this was a commercial decision that helped no-one except Gilead and it allowed Gilead to take all the profits and delayed the release of a single dose pan-genotypic treatment for more than 3 years.
The pricing of Sovaldi was first at $84,00 and Harvoni at $94,000 in effect valued the NS5A (Ledipasvir) part at $10,000.
But BMS was charging about $50,000 for 84 Daclatasvir pills, which meant that relatively few people (outside the world of generics) got access to the powerful drug combination of Sofosbuvir + Daclatasvir.
This strategy worked very well for Gilead’s profits but, for people who were infected with Genotype 2 or Genotype 3 this did not work not well at all
Eventually Gilead developed Velpatasvir which combined with Sofosbuvir created Epclusa, a genuine pan-genotype Hep C treatment. But Velpatasvir is expensive to make and, because of this Epclusa is actually still the most expensive of the Hep C treatments, even in generic form.
In the mean time another pharmaceutical giant, AbbVie, realized the potential profits to be made from a drug combination that treated all genotypes of Hep C and came up with the drug Mavyret.
Over the last four years there have been many research studies comparing Epclusa, Mavyret and the combination of Sofosbuvir + Daclatasvir as pan-genotype treatment for Hep C.
In all cases Epclusa and Sofosbuvir + Daclatasvir perform as equals and both are slightly superior to Mavyret.
So the combination of Sofosbuvir + Daclatasvir is the cheapest and most effective pan-genotype Hepatitis C treatment.
The major advantage of a pan-genotype medication for Hep C is that it removes the need for an expensive genotype test.
In most countries a Hepatitis C genotype test will cost between US$100 and US$200.
This puts genotype testing out of the reach of many people who live in financially difficult circumstances.
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