Direct-acting antivirals indicated for treatment of chronic hepatitis C infection. Studies have shown that some diabetic patients experienced symptomatic hypoglycaemia who initiated direct-acting antiviral therapy for hepatitis C. The studies indicate that rapid reduction in hepatitis C viral load during direct-acting antiviral therapy for hepatitis C may lead to improvements in glucose metabolism in patients with diabetes, potentially resulting in symptomatic hypoglycaemia if diabetic treatment is continued at the same dose. Many studies recorded these changes in glycaemic control in the first 3 months of treatment. Some studies reported the need to modify patient’s diabetic medication or doses following changes in glucose metabolism, with up to 30% of patients requiring adjustments to their treatment.
An EU review confirmed the risk of hypoglycaemia in patients with diabetes who had been initiated on direct-acting antivirals for chronic hepatitis C. Information on the risk is being added to the Summary of Product Characteristics and Patient Information Leaflet for these medicines.
Physicians initiating direct-acting antiviral therapy in patients with diabetes should inform the healthcare professional in charge of the diabetic care of the patient.
Healthcare professionals are advised to report suspected adverse reactions of direct-acting antivirals via the Yellow Card Scheme.
Direct-acting antivirals for chronic hepatitis C infection include: daclatasvir (Daklinza▼); sofosbuvir/velpatasvir (Epclusa▼); ledipasvir/sofosbuvir (Harvoni▼); sofosbuvir (Sovaldi▼); sofosbuvir/velpatasvir/voxilaprevir (Vosevi▼); dasabuvir (Exviera▼); ombitasvir/paritaprevir/ritonavir (Viekirax▼); glecaprevir/pibrentasvir (Maviret▼); and elbasvir/grazoprevir (Zepatier▼).