- Sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX; Vosevi) is highly effective for clearing HCV in patients who fail to achieve a sustained virologic response (SVR) to initial combination of direct-acting antivirals (DAAs).
- Clearance rates are lower in genotype (GT) 3, particularly with underlying cirrhosis.
Why this matters
- This study adds real-world evidence supporting the DAA trio in refractory HCV.
- Prospective, nationwide Spanish study of 137 patients (75% men; median age, 56 years) receiving 12 weeks of SOF/VEL/VOX for DAA-refractory HCV; 34% had compensated cirrhosis.
- SVR was measured at 12 weeks posttherapy (SVR12).
- Funding: None disclosed.
- Most had GT1 (1b, 39%; 1a, 22%) or GT3 (22%) infection; GT4 (10%) and GT2 (5%) were also represented.
- Main prior DAAs were SOF-based regimens (64%) or ritonavir-boosted paritaprevir/ombitasvir ± dasabuvir (Viekira, 20%).
- 136 patients (99%) achieved undetectable viral load at end of treatment; 135 were followed through 12 weeks.
- Overall SVR12 rate was 95%.
- SVR12 was lower with GT3 (80% vs 99%; P<.001 and underlying cirrhosis vs lowest with both>
- Non-SVR12: 6 of 7 treatment failures occurred in GT3; 1 patient was reinfected.
- SVR12 was not affected by prior DAA type (P=.62), Child-Turcotte-Pugh score (P=.19), hepatocellular carcinoma (P=.07), HIV (P=.72), or resistance-associated substitutions (P=.54).
- Small sample size.