Published: 13 March 2017
13 March 2017
Monitoring finishes 31 December 2017.
Medsafe was recently alerted to a case of a type 2 diabetic who started hepatitis C treatment with Viekira Pak. Eight weeks after starting Viekira Pak, the patient’s blood glucose control had improved (HbA1c almost halved).
Hepatitis C can be treated with pegylated interferon-based therapy or direct-acting antivirals (DAAs). The World Health Organization (WHO) recommends using DAAs. There are case reports in the scientific literature which describe improvement of diabetes with hepatitis C treatment. Patients experienced reduced insulin resistance and improved blood glucose control[1-5].
However, the available information on the association between hepatitis C treatment and effects on blood glucose control in patients with type 2 diabetes is not definitive . There may be differences in effect depending on which hepatitis C virus genotype the patient is infected with, which treatment they undergo and interactions with other factors such as weight. In addition, there are some case reports of increases in blood glucose levels .
DAA regimens are used for the treatment of chronic hepatitis C infection. The WHO now recommends that DAA regimens are used for the treatment of hepatitis C rather than regimens with pegylated interferon and ribavirin .
There are a number of DAAs approved for use in New Zealand including Viekira Pak and Viekira Pak-RBV (Table 1).
Table 1: Direct-acting antivirals approved and available for use in New Zealand (as at 1 March 2017)
|Product name||Active ingredients||Sponsor|
|Viekira Pak||ombitasvir/paritaprevir/ritonavir copackaged with dasabuvir||AbbVie|
|Viekira Pak-RBV||ombitasvir/paritaprevir/ritonavir copackaged with dasabuvir and ribavirin||AbbVie|
|Zepatier||elbasvir/grazoprevir||Merck Sharp & Dohme|
Actions for healthcare professionals:
The overall benefit-risk balance of Viekira Pak, Viekira Pak-RBV and all other DAA regimens remains positive.
Advice on how to take DAAs and the known side effects can be found in the consumer medicine information (CMI) and data sheets.
Medsafe is placing this safety concern on the medicines monitoring () scheme to obtain further information on this issue. Please report any suspected adverse reactions with Viekira Pak, Viekira Pak-RBV and any other DAA regimen, particularly those relating to blood glucose control.
Consumers and healthcare professionals are encouraged to send reports of suspected adverse reactions to the Centre for Adverse Reactions Monitoring (CARM)
Medsafe cannot give advice about an individual's medical condition. If you have any concerns about a medicine you are taking Medsafe encourages you to talk to your healthcare professional.