Washington: The US Food and Drug Administration on Friday approved supplemental applications for Sovaldi (sofosbuvir) and Harvoni (ledipasvir and sofosbuvir) to treat hepatitis C virus (HCV) in children ages 12 to 17. Harvoni and Sovaldi were previously approved to treat HCV in adults.
These are the first direct-acting antiviral treatments approved for children and adolescents with HCV. Direct-acting antiviral drugs reduce the amount of HCV in the body by preventing the virus from multiplying, and in most cases, they cure HCV.
“These approvals will help change the landscape for HCV treatment by addressing an unmet need in children and adolescents,” said Dr Edward Cox, director of the Office of Antimicrobial Products in the FDA’s Centre for Drug Evaluation and Research.
The approvals provide paediatric treatment options for six major genotypes, or strains, of HCV. Harvoni is indicated for the treatment of paediatric patients 12 years of age and older or weighing at least 77 pounds (35 kilograms) with HCV genotype 1, 4, 5 or 6 infection without cirrhosis (liver disease) or with mild cirrhosis. Sovaldi in combination with ribavirin is indicated for the treatment of paediatric patients 12 years of age and older or weighing at least 77 pounds (35 kilograms) with genotype 2 or 3 HCV infection without cirrhosis or with mild cirrhosis.
HVC is a viral disease that causes inflammation of the liver that can lead to diminished liver function or liver failure. According to the Centres for Disease Control and Prevention, an estimated 2.7 to 3.9 million people in the United States have chronic HCV, and children born to HCV-positive mothers are at risk for HCV infection. It is estimated that there are 23,000 to 46,000 children in the United States with HCV infection.
The safety, pharmacokinetics (how the body absorbs, distributes and rids itself of a drug) and efficacy of Harvoni for the treatment of HCV genotype 1 infection were established in an open-label, multicentre clinical trial that included 100 paediatric patients 12 years of age and older. The results were comparable to those observed in adults and demonstrated that 98 percent of patients had no virus detected in the blood 12 weeks after finishing treatment, suggesting the patients’ infections were cured.
The safety and efficacy of Harvoni for treatment of HCV genotypes 4, 5 or 6 infection in paediatric patients 12 years of age and older is based on data showing similar exposures (amount of drug in the body) to Harvoni in adults and adolescents with HCV genotype 1 infection, as well as similar efficacy and exposures to Harvoni across HCV genotypes 1, 4, 5 and 6 in adults.
The most common adverse reactions observed with treatment with Harvoni were fatigue and headache.
Sovaldi in combination with ribavirin was evaluated in an open-label clinical trial that included 50 paediatric patients 12 years of age and older. The results were comparable to those observed in adults and 100 percent of patients with HCV genotype 2, and 97 percent of patients with HCV genotype 3 had no virus detected in the blood 12 weeks after finishing treatment.
The most common adverse events observed with Sovaldi in combination with ribavirin were fatigue and headache. All contraindications to ribavirin also apply to Sovaldi combination therapy.
Hepatitis B virus (HBV) reactivation has been reported in HCV/HBV coinfected adult patients who were undergoing or had completed treatment with HCV direct-acting antivirals, and who were not receiving HBV antiviral therapy. HBV reactivation in patients treated with direct-acting antiviral medicines resulted in serious liver problems or death. Healthcare professionals should screen all patients for evidence of current or prior HBV infection before starting treatment with Harvoni or Sovaldi, advises the FDA.
Harvoni and Sovaldi are marketed by Gilead Sciences, Inc.