Eight weeks of Sofosbuvir/Velpatasvir for genotype 3 hepatitis C in previously untreated patients with significant (F2/3) fibrosis

Alison Boyle*, Fiona Marra, Erica Peters, Shouren Datta, Trina Ritchie, Matthew Priest, Mathis Heydtmann, Stephen T. Barclay

*Corresponding author for this work

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Abstract

Twelve weeks sofosbuvir/velpatasvir (SOF/VEL) is a highly effective pangenotypic regimen for Hepatitis C. Phase 2 data suggests 8 weeks of treatment may be sufficient for previously untreated non-cirrhotic patients with genotype 3 (GT3) infection. To maximise the number of patients potentially cured within a fixed treatment budget, we elected to treat such patients locally eligible for treatment (F2/3), with 8 weeks of SOF/VEL. By local protocol, treatment-naive patients with F2 (LSM >6.9kPa <9.5kPa) or F3 fibrosis (≥9.5kPa <12.5kPa), were eligible for 8 weeks SOF/VEL treatment. Patients commencing treatment before 1-Oct-2017 were identified from the Scottish HCV database. Baseline and treatment outcome data obtained. Ninety patients were included for analysis (72 (80%) male, mean age 45 (IQR±8.4), 28 (31.1%) F3 fibrosis). Opioid agonist therapy (OAT) was prescribed in 82 (91.1%) patients. Of 49 patients attending Glasgow city Alcohol and Drug Services, 27 (55.1%) had evidence of recent drug use (< 3 months) including 8 (16.3%) with self-reported intravenous drug use. On an intention-to-treat basis, SVR rates were 86/90 (95.6%, 95% CI 89.0-98.8). Excluding those who prematurely discontinued treatment (n=4), died prior to SVR testing (n=1) or whom experienced reinfection (n=1), per protocol SVR rate was 84/84 (100%, 95% CI 95.7-100.0). In conclusion, Eight weeks SOF/VEL is highly effective in treatment-naive GT3 patients with significant fibrosis. This offers a non-protease inhibitor based 8-week regimen which may be useful for complex drug interactions or where time-limited opportunity for treatment. In limited resource settings, reduction in drug acquisition costs may help achieve progress towards the goal of HCV elimination.Introduction: Sofosbuvir/velpatasvir (SOF/VEL) is a highly effective pan-genotypic hepatitis C regimen, with high rates of sustained viral response (SVR) amongst those treated for genotype 3 (GT3) infection [1]. In phase 2 trials, 8 weeks of SOF/VEL was highly effective in treating non-cirrhotic patients with GT3 [2] but not genotype 1 infection [3].
Original languageEnglish
JournalJournal of Viral Hepatitis
Early online date13 Dec 2019
DOIs
Publication statusE-pub ahead of print - 13 Dec 2019

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Keywords

  • NS5A inhibitor
  • direct‐acting antiviral
  • genotype 3
  • hepatitis c
  • sofosbuvir
  • velpatasvir

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