A LANDMARK study has delivered much-needed evidence to support global hepatitis C virus (HCV) elimination goals, confirming that two affordable, WHO-recommended first-line treatments are highly effective. Conducted in Viet Nam, the first randomised controlled trial comparing sofosbuvir–daclatasvir and sofosbuvir–velpatasvir found both regimens achieved impressive cure rates, each nearing 99%, with sofosbuvir–daclatasvir showing a 93% probability of superior efficacy.
These findings are particularly important for low- and middle-income countries, where the majority of HCV cases are concentrated and where access to generic antivirals is crucial. Sofosbuvir–daclatasvir, which can cost as little as 60USD per treatment course, is already the most widely available option globally.
Beyond the head-to-head comparison, the study also explored innovative strategies to simplify or shorten treatment. An “induction–maintenance” regimen using fewer doses performed just as well as standard 12-week therapy, potentially reducing drug costs without compromising cure rates. Meanwhile, a short 4-week course paired with PEGylated interferon showed promise, although its use may be limited by side effects and suitability for only select patients.
While cure rates were generally high, the study noted lower-than-expected results in patients with genotype 2, warranting further research. Importantly, the trial did not include individuals with advanced liver disease, and its results may not fully apply to populations outside of Viet Nam due to genetic and demographic differences.
Still, the findings offer timely evidence for tailoring treatment in diverse care settings. As WHO pushes toward the 2030 target for viral hepatitis elimination, strategies like reduced-pill regimens and patient-specific treatment plans could help overcome remaining barriers.
By confirming the non-inferiority and cost-effectiveness of sofosbuvir–daclatasvir and introducing flexible approaches for harder-to-treat cases, this study strengthens the case for scalable, affordable HCV treatment worldwide.
Reference
Cooke GS et al. Treatment options to support the elimination of hepatitis C: an open-label, factorial, randomised controlled non-inferiority trial. Lancet. 2025;405(10491):1769-80.
