Sofosbuvir and Velpatasvir for HCV in Patients with Decompensated Cirrhosis

TLDR

Background: "As the population that is infected with the hepatitis C virus (HCV) ages, the number of patients with decompensated cirrhosis is expected to increase. Possible: "The aging hepatitis C population is projected to increase decompensated cirrhosis cases, prompting a phase‑3 open‑label study of 267 patients with Child‑Pugh‑B cirrhosis across HCV genotypes 1–6." Mechanism: "Patients were randomly assigned in a 1:1:1 ratio to receive the nucleotide polymerase inhibitor sofosbuvir and the NS5A inhibitor velpatasvir once daily for 12 weeks, sofosbuvir‑velpatasvir plus ribavirin for 12 weeks, or sofosbuvir‑velpatasvir for 24 weeks." Also the earlier sentence about primary endpoint: "The primary end point was a sustained virologic response at 12 weeks after the end of therapy." That is part of mechanism? It's more about outcome. But we can include in mechanism: "The study compared three regimens: 12‑week sofosbuvir‑velpatasvir, 12‑week sofosbuvir‑velpatasvir plus ribavirin, and 24‑week sofosbuvir‑velpatasvir, with the primary endpoint of sustained virologic response 12 weeks post‑therapy." Findings: combine all findings: overall SVR rates: 83%, 94%, 86%; no significant differences; serious adverse events 16-19%; common AEs: fatigue, nausea, headache, anemia with ribavirin; high rates of SVR.

Abstract

As the population that is infected with the hepatitis C virus (HCV) ages, the number of patients with decompensated cirrhosis is expected to increase.We conducted a phase 3, open-label study involving both previously treated and previously untreated patients infected with HCV genotypes 1 through 6 who had decompensated cirrhosis (classified as Child-Pugh-Turcotte class B). Patients were randomly assigned in a 1:1:1 ratio to receive the nucleotide polymerase inhibitor sofosbuvir and the NS5A inhibitor velpatasvir once daily for 12 weeks, sofosbuvir-velpatasvir plus ribavirin for 12 weeks, or sofosbuvir-velpatasvir for 24 weeks. The primary end point was a sustained virologic response at 12 weeks after the end of therapy.Of the 267 patients who received treatment, 78% had HCV genotype 1, 4% genotype 2, 15% genotype 3, 3% genotype 4, and less than 1% genotype 6; no patients had genotype 5. Overall rates of sustained virologic response were 83% (95% confidence interval [CI], 74 to 90) among patients who received 12 weeks of sofosbuvir-velpatasvir, 94% (95% CI, 87 to 98) among those who received 12 weeks of sofosbuvir-velpatasvir plus ribavirin, and 86% (95% CI, 77 to 92) among those who received 24 weeks of sofosbuvir-velpatasvir. Post hoc analysis did not detect any significant differences in rates of sustained virologic response among the three study groups. Serious adverse events occurred in 19% of patients who received 12 weeks of sofosbuvir-velpatasvir, 16% of those who received 12 weeks of sofosbuvir-velpatasvir plus ribavirin, and 18% of those who received 24 weeks of sofosbuvir-velpatasvir. The most common adverse events were fatigue (29%), nausea (23%), and headache (22%) in all patients and anemia (31%) in the patients receiving ribavirin.Treatment with sofosbuvir-velpatasvir with or without ribavirin for 12 weeks and with sofosbuvir-velpatasvir for 24 weeks resulted in high rates of sustained virologic response in patients with HCV infection and decompensated cirrhosis. (Funded by Gilead Sciences; ASTRAL-4 ClinicalTrials.gov number, NCT02201901.).