Real-world effectiveness of daclatasvir plus sofosbuvir and velpatasvir/sofosbuvir in hepatitis C genotype 2 and 3.
J Hepatol
; 70(1): 15-23, 2019 01.
Article
em En
| MEDLINE
| ID: mdl-30266283
ABSTRACT
BACKGROUND & AIM:
Understanding the real-world effectiveness of all-oral hepatitis C virus (HCV) regimens informs treatment decisions. We evaluated the effectiveness of daclatasvirâ¯+â¯sofosbuvir⯱â¯ribavirin (DCVâ¯+â¯SOF⯱â¯RBV) and velpatasvir/sofosbuvir (VEL/SOF)⯱â¯RBV in patients with genotype 2 and genotype 3 infection treated in routine practice.METHODS:
This observational analysis was carried out in an intent-to-treat cohort of patients with HCV genotype 2 and genotype 3. Sustained virologic response (SVR) analysis was performed in 5,400 patients initiated on DCVâ¯+â¯SOF⯱â¯RBV or VEL/SOF⯱â¯RBV at any Department of Veterans Affairs facility.RESULTS:
For genotype 2, SVR rates did not differ between DCVâ¯+â¯SOF (94.5%) and VEL/SOF (94.4%) or between DCVâ¯+â¯SOFâ¯+â¯RBV (88.1%) and VEL/SOFâ¯+â¯RBV (89.5%). For genotype 3, SVR rates did not differ between DCVâ¯+â¯SOF (90.8%) and VEL/SOF (92.0%) or between DCVâ¯+â¯SOFâ¯+â¯RBV (88.1%) and VEL/SOFâ¯+â¯RBV (86.4%). In multivariate models of patients with genotype 2 and 3 infection, the treatment regimen was not a significant predictor of the odds of SVR. For genotype 3, significant predictors of reduced odds of SVR were prior HCV treatment-experience (odds ratio [OR] 0.51, 95% CI 0.36-0.72; p <0.001), FIB-4 >3.25 (OR 0.60; 95%CI 0.43-0.84; pâ¯=â¯0.002) and a history of decompensated liver disease (OR 0.68; 95%CI 0.47-0.98; pâ¯=â¯0.04). For patients with genotype 2 and 3, treated with VEL/SOF⯱â¯RBV, 89% and 85% received 12-weeks of treatment, respectively. For DCVâ¯+â¯SOF⯱â¯RBV, 56% and 20% of patients with HCV genotype 2 received 12-weeks and 24-weeks of treatment, respectively; while 53% and 23% of patients with HCV genotype 3 received 12-weeks and 24-weeks, with most direct-acting antiviral experienced patients receiving 24-weeks.CONCLUSIONS:
In patients infected with HCV genotype 2 and 3, DCVâ¯+â¯SOF⯱â¯RBV and VEL/SOF⯱â¯RBV produced similar SVR rates within each genotype, and the regimen did not have a significant impact on the odds of SVR. For patients with genotype 3, prior treatment-experience and advanced liver disease were significant predictors of reduced odds of SVR regardless of regimen. LAYSUMMARY:
In clinical practice, cure rates for hepatitis C virus (HCV) genotype 2 were 94% and cure rates for HCV genotype 3 were 90%. The chance of achieving cure was the same whether a person received daclatasvir plus sofosbuvir or velpatasvir/sofosbuvir. Ribavirin did not affect cure rates. The chance of a cure was lowest in people who had received HCV medication in the past.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
DNA Viral
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Carbamatos
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Sistema de Registros
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Hepacivirus
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Hepatite C Crônica
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Sofosbuvir
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Compostos Heterocíclicos de 4 ou mais Anéis
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Imidazóis
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article