Significant efficacy of 3 recommended regimens for the treatment of hepatitis C virus genotype 3 (HCV-GT3) — sofosbuvir+daclatasvir (SOF+DAC), sofosbuvir/velpatasvir (SOF/VEL), and glecaprevir/pibrentasvir (GLE/PIB) — was demonstrated in a high proportion of patients with cirrhosis, according to the largest European real-world study, published in Liver International.
In patients with cirrhosis or those who have not responded to previous treatment, HCV-GT3 is associated with more rapid disease progression and lower rates of response to treatment than other genotypes. Because real-life comparisons between the 3 recommended regimens, SOF+DAC, SOF/VEL, and GLE/PIB, are scarce, researchers conducted a large longitudinal cohort multicenter study to compare their antiviral efficacy. Data were collected between December 2014 and October 2018, using the NAVIGATORE Lombardia Network web-based platform, which included 1544 patients treated with SOF+DAC (n=1023, 66.2%), SOF/VEL (n=369, 23.9%), and GLE/PIB (n=152, 9.8%) from Lombardy, Northern Italy.
They found that sustained virologic response 12 weeks after treatment completion (SVR12) was similar across the groups, at 94.8% in SOF+DAC, 97.6% in SOF/VEL, and 96.7% in GLE/PIB (P =.065).
When the analysis was stratified for cirrhosis, SVR12 in patients with cirrhosis was 94.9% in SOF+DAC, 93.6% in SOF/VEL, and 100% in GLE/PIB. The relative risk for SVR12 for GLE/PIB vs SOF+DAC was 1.05 (95% CI, 1.03-1.07). A significant difference of SVR12 was observed in SOF/VEL recipients between patients with and without cirrhosis (93.6% [73/78] vs 98.6% [277/281], respectively; P =.026).
In the multivariate analysis, treatment with SOF/VEL was associated with a higher likelihood of SVR12 than SOF+DAC, but only in the absence of ribavirin.
Other factors independently associated withSVR12 were a higher baseline HCV-RNA load and male sex.
“In conclusion, in a large real-world cohort of HCV-GT3-infected patients with a high proportion of cirrhosis, the success rate was remarkable, with no significant difference between SOF+DAC, SOF/VEL, and GLE/PIB,” stated the study authors. They added that, “The current prescription shift towards novel regimens (i.e. SOF/VEL and GLE/PIB) in easier-to-treat patients in this era allows RBV-free and shorter schedules, without mining a high SVR12 rate in this ‘difficult-to-treat’ genotype.”
Disclosure: This clinical trial was supported by AbbVie, Gilead Sciences, and Merck Sharp and Dohme. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Soria A, Fava M, Bernasconi DP, et al. Comparison of three therapeutic regimens for genotype‐3 hepatitis C virus infection in a large real-life multicentre cohort [published online January 22, 2020]. Liver Int. doi:10.1111/liv.14386