Hepatitis drugs are effective and ever-cheaper. Yet the disease still kills.

July 10, 2019 | Disease

Melanie senior

There are plenty of good news stories around hepatitis. Effective, and ever-cheaper treatments are available for both hepatitis B (HBV) and C (HCV), two common strains of this viral condition. HCV can be cured almost completely, thanks to the therapy revolution brought about by Gilead’s Sovaldi (sofosbuvir) starting in 2014. The A and B strains of the disease can be prevented with vaccination.  

Sovaldi’s success – the drug sold $10 billion in its first full year on the market – was also a good news story for Gilead’s shareholders. The company pulled in more than $50 billion from its hepatitis franchise between 2014 and 2017. Sovaldi famously cost $1000 per pill, or $84,000 per typical treatment course in the US.

That particular party did not last long: competition forced down prices, while market demand started to reduce as patients were effectively treated. Competition provided much-needed good news for payers, however, clobbered with astronomical bills during 2014 and 2015 but in a strong position to negotiate thereafter. That, in turn, meant more good news for patients, not all of whom had been able to access the cure at its starting price. Competition also brought more convenient, shorter treatment regimens, covering a wider range of virus genotypes. Latecomer AbbVie scooped in a not-unreasonable $3.44 billion in 2018 from HCV drug Mavyret, whose list price is 60% lower than Sovaldi’s was. Those Mavyret sales were worth more than Gilead’s entire HCV franchise that year.

Large price cuts for HCV medicines in the Western world have come alongside lower HBV treatment costs, including through generic versions of the antivirals entecavir and tenofovir, according to the World Health Organization.

Yet, despite this, 300 million people across the world are still living with hepatitis, many of them in low and middle income countries, says the World Hepatitis Alliance. Hepatitis can trigger acute and chronic infections and, in some cases, liver cirrhosis and even a need for transplant. But symptoms do not always appear, especially in the early stages. About half of people suffering with HCV don’t know they have it.

The remaining challenges are awareness and diagnosis. Don’t rely too heavily on pharmaceutical companies for that – most are losing interest in what is, for most, a declining franchise. Gilead, struggling to fill the gap left by its once-booming HCV franchise, is moving into a very crowded, and challenging hematology space, and seeking to address other kinds of liver conditions such as non-alcoholic steatohepatitis (NASH – another crowding space). Johnson & Johnson and Merck are among those to have dis-continued HCV pipeline regimens. And Mavyret won’t plug the $20 billion hole that AbbVie will face when Humira goes generic in 2023, either – hence AbbVie’s $63 billion offer to buy Allergan.

Access to adequate testing facilities and affordable diagnostic tools is the main barrier to eliminating viral hepatitis by 2030 – a goal which all countries signed up to, but which only a dozen countries are currently on track to achieve, according to the World Hepatitis Alliance.  Sovaldi brought about a treatment revolution in HCV. Another revolution is required to ensure all those who need that treatment actually receive it.