In the first head-to-head comparison of recommended hepatitis C treatments, researchers from Imperial College London have provided key evidence to support global efforts to eliminate the disease. Their findings have also helped uncover new ways to treat hepatitis C that could make it easier for more people to access and complete curative treatment.
The findings, published in The Lancet, confirm that current World Health Organisation (WHO)-recommended drug combinations for hepatitis C are highly effective, while also showing that alternative strategies, like shorter courses or taking treatment breaks, can still lead to successful outcomes.
Hepatitis C is a viral infection that affects the liver and can lead to serious complications (including liver cancer and cirrhosis) if untreated. It is spread through blood-to-blood contact and disproportionately affects marginalised communities around the world. In 2016, WHO set a goal to eliminate hepatitis C as a public health threat by 2030—but challenges remain.
The VIETNARMS trial—funded by the Wellcome Trust and led by investigators from Imperial College London in collaboration with, MRC Clinical Trials Unit and Oxford University Clinical Research Unit in Vietnam—enrolled over 600 adults with chronic hepatitis C. The trial was conducted at two major Vietnamese hospitals, the Hospital for Tropical Diseases in Ho Chi Minh City and the National Hospital for Tropical Diseases in Hanoi. It focused on two key questions:
- Which of the WHO-recommended treatments works best in people with mild-to-moderate disease?
- Can we make treatment easier to access and complete without reducing the chances of cure?
Comparing two trusted treatments
Participants were randomly assigned to take one of the two WHO-recommended drug combinations: Sofosbuvir–daclatasvir (SOF/DCV) and sofosbuvir–velpatasvir (SOF/VEL).
The trial showed that both treatments worked extremely well, even among people with genotype 6, a rarer strain of hepatitis C that’s common in Vietnam. Despite previous concerns, both drug combinations were equally effective across all hepatitis C types.
Although previously considered less effective, SOF/DCV slightly outperformed SOF/VEL, with 97.4% of patients cured compared to 95.1%, and a 93% chance that it was the more effective of the two. This new head-to-head evidence could help countries make better-informed decisions about which treatment to prioritise, particularly where drug prices vary significantly.
Flexible treatment options
To support patients who may struggle to complete the standard 12-week course, due to cost, treatment burden, or challenges such as substance dependency or mental health conditions, an innovative trial design also tested four alternative treatment strategies using both drug combinations:
- Standard-of-care: Daily DAA tablets for 12 weeks (the current global standard)
- Induction-maintenance: Daily tablets for two weeks, then just five days a week (weekends off) for 10 more weeks injectable pegylated interferon (PEG-IFN): Four weeks of tablets, plus weekly injections of a drug called PEG-IFN
- Response-guided: After one week of daily DAA tablets, participants’ viral response to treatment is measured. Based on this, participants either continued treatment for four, eight, or the full 12 weeks.
Compared to the standard-of-care, the alternative strategies used in the trial involved fewer tablets and were easier for people to stick to. All of these strategies were non-inferior to standard-of-care, meaning they were not worse than standard-of-care by more than a pre-specified amount (10%).
The most effective alternative was the “induction maintenance” approach—this cured 99.3% of people, slightly more than the standard 12-week treatment, which cured 98.7%
The other two strategies also worked well. The PEG-IFN option, which combined tablets with weekly injections, cured 94.1% of participants. The response-guided approach, which adjusted treatment length based on how people responded in the first week, cured 92.9%.
However, people in the response-guided group who stopped treatment after just four weeks didn’t do as well, even if they showed a strong early response. This confirms earlier findings that four weeks of tablets alone isn’t enough for most people. Interestingly, the PEG-IFN group, who also had only four weeks of tablets, still had high cure rates, showing the added injections helped make the treatment more effective.
Global impact
By showing that shorter or more flexible treatment plans can still cure hepatitis C, the VIETNARMS trial opens the door to new approaches that could better meet people’s needs, particularly those with limited access to care, or who face challenges like mental health issues or substance use.
The results also provide clear evidence for governments, doctors and global health organisations to consider a broader range of options in national treatment programmes—while also potentially lowering the cost of care.
Professor Graham Cooke, senior author, Deputy Dean of the Faculty of Medicine at Imperial and NIHR Imperial BRC Infection and AMR Theme Co-lead, said: “We expect this new evidence will help countries, clinicians and patients in the decisions they need to make if we are to achieve the ambitious WHO elimination targets for hepatitis C. By showing that a range of flexible and effective treatment options are possible, we hope our findings can support more inclusive, accessible and cost-effective care—especially in communities where treatment completion has been a challenge.”
Application Opens on 19 May 2025.
Funding to support Trust staff applying for NIHR fellowships. NIHR Imperial Biomedical Research Centre and the NIHR North West London Patient Safety Research Collaboration (PSRC) both have funding available to support staff to prepare and write applications for an NIHR fellowship.
BRC funding is specifically aimed at NMAHPPs (nurses, midwives, AHPs, Health Care Scientists, pharmacists and registered pharmacy technicians, psychologists and AHCS-accredited Clinical Research Practitioners), while the PSRC funding is available to all registered healthcare professionals proposing research related to patient safety. The funding, of up to £20,000, can be used to support up to 3 months’ salary for the applicant. This enables teams to backfill their post. Funding for the applicant may also include costs related to training courses, patient and public involvement, academic mentoring, and support with accessibility and reasonable adjustments as appropriate (please see the application forms for specific guidance).
The aim is to allow applicants protected time away from their usual role to write and submit an application.
To apply, download the Guidance and Application Form and submit the application by noon on 30 June 2025.
For more information, please contact Mekala Gunaratnam at m.gunaratnam@imperial.ac.uk
A major study of around 260,000 women, published in ERJ Open Research, shows an increase in asthma attacks in women with asthma who are taking the progesterone-only pill and are either aged under 35, or using fewer asthma treatments, or with a type of asthma called eosinophilic asthma.
There was no increase in asthma attacks for women taking the combined oestrogen and progesterone contraceptive pill. The researchers say their findings could be an important step towards understanding why women are more likely to have severe asthma than men.
The study was led by Dr Chloe Bloom, a Clinical Senior Lecturer in Respiratory Epidemiology at Imperial’s National Heart and Lung Institute (NHLI) and supported by Asthma + Lung UK and the NIHR Imperial BRC. She said, “Asthma is common in women, and unfortunately, women are twice as likely to die from asthma as men. To help prevent these deaths, we need a better understanding of why women are at greater risk.
“One theory is that sex hormones play a major role. But studying their effects can be tricky. For example, it’s often hard to know exactly when someone has reached puberty or menopause. Instead, we can study women who take sex hormone medications like the contraceptive pill, because we know exactly when they started and stopped using them.”
The researchers used the UK’s Clinical Practice Research Datalink to study a group of 261,827 women aged between 18 and 50 who had been diagnosed with asthma. They compared women who had never used the contraceptive pill with women who started taking either the combined or progesterone-only pill. They gathered data on whether the women experienced any asthma attacks – meaning they were either prescribed oral steroids for asthma, they visited the hospital emergency department for asthma or they died of asthma – between 2004 and 2020.
“We found that the combined pill did not affect whether women had asthma attacks. But some women who took the progesterone-only pill had more asthma attacks. These included women under 35 years old, those who used fewer asthma medications, like inhaled or oral steroids, and those with higher levels of inflammation linked to asthma in their blood,” Dr Bloom explained.
The risk of asthma attacks in women under 35 was around 39% higher in those taking the progesterone-only pill; in women taking fewer asthma treatments, the risk was around 20% higher; and in women with eosinophilic asthma (where sufferers have high levels of blood cells called eosinophils that cause inflammation) the risk was around 24% higher.
Dr Bloom said, “Our study is the first to look at a large group of women over time with such detailed data on both their contraceptive pill use and their medical history. We also used a special type of study design that mimics the methods of a clinical trial but applies to real-world health data. This approach helped us identify which groups of women might be more at risk of asthma attacks while using the pill.”
“Asthma is common in women of reproductive age, many of whom are taking the pill. This study helps women and healthcare professionals make more informed decisions about which contraceptive pill might be best for them. The findings also add another piece to the puzzle of why women may be more likely to have severe asthma than men.”
“This is an area that hasn’t been studied much. Most research has focused on oestrogen and testosterone, not progesterone. Our study is one of the first to show that progesterone may play an important role. We’re now calling for more research into how progesterone affects asthma, including how it might interact with asthma medications like steroids.”
The researchers are continuing to study the effects of sex hormones on asthma by looking at the possible effects of hormone replacement therapy and at the impact of pregnancy.
Professor Apostolos Bossios, Head of the European Respiratory Society’s group on airway diseases, asthma, COPD, and chronic cough, said, “We know that women are more likely to have asthma and to suffer more severe asthma. We need much more research to understand why asthma is worse for women than men, so we can begin to reduce the risk. This major study is an important step towards that aim.”
“Women with asthma who are taking the combined pill, or considering it, should speak to their doctor about their contraception options and their asthma symptoms. Whichever contraception they use, it’s vital that women with asthma use their preventer inhalers and any other prescribed treatments regularly.”
NHS staff from across north-west London have graduated from a programme that supports them to pursue research careers.
Clinical academics are healthcare professionals whose roles combine research and practice. They work in health and social care while conducting research to improve patient care. Traditionally, clinical academics tend to be doctors rather than other healthcare professionals such as nurses. However, recent reports have shown that the numbers of medically trained research staff in the UK have fallen by six per cent. National efforts are focused on increasing the number of clinical academics of all professions.
The Imperial College Academic Health Science Centre (AHSC) Starting out in Research Course is aimed at nurses, midwives, allied health professionals, healthcare scientists, pharmacists and psychologists (NMAHPPs) across Imperial College AHSC.
It aims to equip participants with the knowledge, skills and networks to pursue a research career.
Professor Mary Wells, NIHR Imperial BRC Deputy Director of Nursing Research at Imperial College Healthcare NHS Trust and a Professor of Practice in Cancer Nursing at Imperial College London, leads the course. She said:
“The Starting out in Research Course is a very important activity for Imperial College AHSC. It provides a comprehensive introduction to all aspects of undertaking research in a healthcare setting. We aim to nurture and expand the numbers of NMAHPPs doing research across the AHSC to invest in the clinical academics of the future. We know that research improves patient outcomes and experiences. Gaining skills and confidence in research through doing this course can help advance clinical practice and enrich the careers of those who take part.”
Research skills
The course was designed and delivered by NMAHPPs and clinical academics from Imperial and its NHS partners at Imperial’s White City campus from March – April 2025.
“Gaining skills and confidence in research through doing this course can help advance clinical practice and enrich the careers of those who take part.”Professor Mary WellsDeputy Director of Nursing Research at Imperial College Healthcare NHS Trust and a Professor of Practice in Cancer Nursing at Imperial College London,
Participants learned about topics such as identifying a research question, choosing a study design and how to involve patients and the public in research. They also heard from a range of clinical, research and academic staff on their experiences of undertaking research and developing their clinical academic careers.
Participants were put into groups and allocated coaches to explore how they can incorporate their learnings into their clinical work. The coaches are clinicians from across the AHSC partnership who are conducting research, including current PhD and post-doctoral fellows. Some of the coaches are graduates of the Starting Out in Research course.
Professor Mary Wells, added:
“Running this course is a real highlight of my role. I really enjoy encouraging and supporting others to develop their research careers and it’s been great to see the impact of this course on our staff over the years. We have had a very diverse group of healthcare professionals this year and I am excited to see where they go with the new knowledge and skills they have gained.
Participants’ experience
Maxine Myers caught up with some of the participants from the course.
Elizabeth Olanloye, Radiographer at The Royal Marsden NHS Foundation Trust, said:
“I’ve always been curious about research and how it can be used to improve patient care and clinical practice.
While I’m still at the early stages of my research journey, I’ve had some exposure through my academic studies and professional experiences, which sparked my interest further.
I joined the Starting Out in Research Course to deepen my understanding and build confidence in developing research ideas. It’s been really encouraging to see how research can make a real difference in healthcare, and I’m looking forward to gradually building my skills and contributing more in this area over time.
My long-term goal is to become a clinical academic, combining research with practice to help improve outcomes for patients and support evidence-based healthcare.
One of the biggest highlights of the course has been learning about the practical aspects of designing and conducting research, from identifying a strong research question to navigating regulatory requirements and securing funding.
The opportunity to hear from experienced researchers about their journeys has been inspiring and has reinforced my motivation to pursue research in my field.
The course has provided me with valuable tools and knowledge to advance my research career.”
Atsuko Campbell, Midwife at Chelsea and Westminster Hospital NHS Foundation Trust, said:
“Through day-to-day clinical practice as a midwife, I have seen how research evidence impacts and changes the care we provide, improving women’s and families’ experiences and choices. Because of this I’ve always had an interest in research but my experience has been limited and I was overwhelmed by where to start. The opportunity to participate in the Starting Out in Research Course came up and I thought I should try.
The programme made it clear that there’s so many resources and organisations that I can contact if I want to discover and learn more about research.
It also provided a great opportunity to connect with people working at the same trust as me and more widely in north-west London.
I enjoyed learning from the panel of speakers who have such a wide range of experience and expertise. I briefly worked with one of the speakers who has just completed her PhD. It was inspiring to see her career progression.
The course has enriched my knowledge of research and I am now thinking about doing a Master of Research degree.”
Ross McGrath, Dietician at Imperial College Healthcare NHS Trust, said:
“I joined the course because I wanted to find out how I could potentially get involved in research and how could I do this alongside my clinical work.
My interest in research has grown over time as I’ve seen how it directly shapes clinical guidelines and patient care. Through my own experiences as someone who has lived with Inflammatory Bowel Disease – a chronic autoimmune condition, which can cause debilitating symptoms such as severe stomach pain and impact quality of life – I’ve become increasingly aware of gaps in patient care. That realisation sparked my curiosity and drive to explore research to contribute to solutions.
The highlight of the course was getting to meet other clinicians at similar stages, all passionate about different areas of research and hearing about their ideas.
I cannot speak highly enough about all the speakers on the course that gave their time and energy to sharing their research experience to us. They were fantastic and their passion and energy for research was infectious. I genuinely left each day feeling inspired and motivated to begin a career in research, and this was all down to them.
The course has given me a solid foundation – both practically and mentally. I now feel more confident in approaching potential supervisors or collaborators, and I understand the next steps I need to develop a proposal or apply for funding.”
The course is coordinated by the Clinical Academic Training Office on behalf of Imperial College AHSC.
A key aim of Imperial College London and its NHS partners – Imperial College Healthcare NHS Trust, The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research and Chelsea and Westminster Hospital NHS Foundation Trust – is to develop a network of clinicians at all levels and professions across the AHSC partnership who are engaging in clinical research.
An Imperial-led study could help shape international colonoscopy guidelines, potentially easing pressure on healthcare systems and patients.
A new study from the Surgery and Cancer Theme has provided crucial insights into who needs ongoing monitoring for bowel cancer by colonoscopy after initial polyp removal (known as ‘post-polypectomy surveillance’) – findings that could refine global bowel cancer surveillance practices.
“These findings could reduce the number of unnecessary colonoscopies, lessening the burden on healthcare systems and sparing patients from invasive procedures they may not need.” Professor Amanda Cross Surgery & Cancer Theme Co-Lead
Published in GUT, the study titled “Colorectal cancer incidence after the first surveillance colonoscopy and the need for ongoing surveillance: a retrospective, cohort analysis” was led by Imperial’s Cancer Screening and Prevention Research Group. The research addresses a major evidence gap in bowel cancer prevention, namely, which patients need to continue having post-polypectomy surveillance beyond their first surveillance colonoscopy.
Bowel cancer develops from polyps – small growths in the bowel that can turn cancerous over time. While removing polyps via colonoscopy significantly reduces bowel cancer risk, current guidance varies internationally on how long patients should continue to undergo post-polypectomy surveillance.
“For people entering post-polypectomy surveillance, there is a lack of data to identify those needing a second surveillance colonoscopy,” said first author, Miss Emma Robbins. “This study provides much-needed evidence on this topic, which will be valuable in informing recommendations for ongoing post-polypectomy surveillance in future iterations of the UK, European, and US post-polypectomy surveillance guidelines.”
The research team analysed data from over 10,500 patients and found that:
- Patients with high-risk polyp findings at both their initial (baseline) and first surveillance colonoscopy had a significantly higher risk of developing bowel cancer than the general population. The researchers report that these patients should have a second surveillance colonoscopy.
- Patients with low-risk findings at their first surveillance colonoscopy – regardless of whether they had low-risk or high-risk findings at their baseline colonoscopy – were not at increased risk of bowel cancer compared to the general population. The researchers report that these patients can safely return to routine non-invasive bowel cancer screening, avoiding unnecessary further colonoscopies.
Impact on guidelines and patient care
The findings strongly support the 2020 UK post-polypectomy surveillance guidelines, which recommend stopping surveillance in patients with low-risk findings at the first surveillance colonoscopy. However, the study challenges more conservative approaches in the current European post-polypectomy surveillance guidelines, which recommend that patients continue surveillance until they have two consecutive surveillance colonoscopies at which low-risk findings are detected.
Speaking about the findings, Professor Amanda Cross, Professor of Cancer Epidemiology and last author, said: “These findings could reduce the number of unnecessary colonoscopies, lessening the burden on healthcare systems and sparing patients from invasive procedures they may not need.”
For patients, the study provides reassurance. Those with low-risk findings at their first surveillance colonoscopy, even if they had high-risk findings at their baseline colonoscopy, can be reassured that they are not at increased risk and can safely return to standard bowel cancer screening protocols.
Next steps
While the findings are promising, the authors note that the study’s ability to assess long-term surveillance needs in certain high-risk subgroups was limited by a small number of cancer cases. They suggest that future studies drawing on data from national screening programmes would help further refine recommendations.
The study not only supports current UK policy but offers a case for revisiting surveillance recommendations elsewhere in the world—potentially leading to a more evidence-based approach to bowel cancer prevention.
