DAA triplet highly effective for refractory HCV

  • Llaneras J & al.
  • J Hepatol
  • 13 Jun 2019

  • International Clinical Digest
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Takeaway

  • 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.

Study design

  • 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.  

Key results

  • 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).

Limitations

  • Small sample size.

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