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Hepatitis C Series: Miracle Drug… Effective or not?

////Hepatitis C Series: Miracle Drug… Effective or not?

In the previous article, we briefly mentioned that despite the fact that researchers may have found the miracle cure for hepatitis C, it is unobtainable due to its costly markup. WHO has even stated that “no country in the world could afford to treat all those who needed the drugs.” [1] As if to comfort those desperate to get their hands on this magic drug, the Cochrane Collaboration published a paper which divulges the drug may not be that effective after all.

Wait… what? So is it effective or not? People’s lives are at risk here!

Before we jump into any conclusion, let’s analyse the evidence before us:

Claim “This Hep C drug works.” – drug manufacturer “The effectiveness of the Hep C drug may be overestimated.” – Cochrane Collaboration (a global independent network of researchers and professionals)
Supporting evidence Through measuring the amount of virus left in the bloodstream 12 weeks after drug treatment
  • The absence of evidence that it can “prevent harm from disease or save lives” [1]
  • The amount of virus left in the bloodstream does not mean that the virus won’t recur by lingering in other parts of the body. In fact, evidence shows the returning of the virus in very sick patients, eventually causing end-stage liver disease

Cochrane Collaboration further mentions that “all the included trials were with high risk of bias,”[2] as they are funded by the drug manufacturer themselves. Essentially, there is a certain probability that the published outcome could be deviating from the true result, be that done intentionally or subconsciously, through systematic errors performed in any phases of research (e.g. in study design, data collection, data analysis, publication). [3]

Even if you are completely unenthusiastic about whether this hep C drug is effective or not, just remember one take-home message: If you are analysing evidence-based research and wondering what is the best treatment for your patient is, remember the difference between disease-oriented evidence (DOE) and patient-oriented evidence (POE). DOE often looks at the marker of disease, in this case, how much virus left in the bloodstream, whilst POE focuses on outcomes that patients care about, for instance mortality and morbidity. Unfortunately, many research focuses on the former, but as a good doctor, what we really need is the latter. As one of the reviewer from the Cochrane review, Jakobsen, correctly pointed out, “From a patient perspective, it does not matter if virus cannot be detected in the blood if DAAs do not improve survival or lead to fewer hepatitis C complications.” [1]

Reference:  

[1]https://www.theguardian.com/society/2017/jun/08/miracle-hepatitis-c-drugs-costing-30k-per-patient-may-have-no-clinical-effect

[2]http://www.cochrane.org/CD011132/LIVER_aminoadamantanes-versus-other-antiviral-drugs-for-chronic-hepatitis-c

[3]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917255/

[4]https://wilkes.libguides.com/c.php?g=191942&p=1266516

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2019-08-15T16:14:34+00:00Medicine In The News|Comments Off on Hepatitis C Series: Miracle Drug… Effective or not?

About the Author:

I'm a medical student at Cambridge University, and one of the co-founders of 6med. I created the BMAT Crash Course and Interview Crash Course, and helped code BMAT Ninja and UKCAT Ninja. If you need a hand with anything, feel free to give me a shout!