An Indian trial supports eight weeks of sofosbuvir-velpatasvir for non-cirrhotic hepatitis C

The edition in brief

RESOLVE, run in five Indian public hospitals and funded by ICMR, randomised 880 treatment-naive adults with hepatitis C and no cirrhosis to 8 or 12 weeks of sofosbuvir-velpatasvir. Sustained virological response was 98.8% versus 99.0% per protocol, with a difference of 0.2 percentage points, and no drug-related serious adverse events. Shortening treatment by a third could ease cost and completion in programme settings, though guidelines have not changed and the trial excluded cirrhosis and prior treatment. An ASGE clinical practice update reviews remimazolam, an ultra-short-acting benzodiazepine metabolised independently of liver and kidney function, as an alternative to midazolam and propofol for endoscopic sedation, particularly in higher-risk patients. An international study of 345 children across 44 centres found six-week mortality after a first variceal bleed was 4.1%, lower than in adults, with worse outcomes in cirrhosis, biliary atresia with poor bile flow, decompensated disease and after sclerotherapy, and differences between centres. A meta-analysis of patient-reported outcomes in refractory ascites showed marked impairment in social, mental and physical function compared with stable cirrhosis, and a lack of validated tools. The pearl covers confirming the indication for a short hepatitis C course.