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Daclatasvir, sofosbuvir, and ribavirin for hepatitis C virus genotype 3 and advanced liver disease: A randomized
Vincent Leroy1, Peter Angus2, Jean-Pierre Bronowicki3
1Clinique Universitaire d'Hepato-Gastroentérologie, Pôle Digidune, CHU de Grenoble and Unité INSERM/Université Grenoble Alpes U823, IAPC Institut Albert Bonniot, Grenoble, France.
Insights
Hepatitis C genotype 3 patients with advanced liver disease achieved high sustained virological response (SVR12) using daclatasvir-sofosbuvir-ribavirin. Treatment duration of 12 or 16 weeks showed similar efficacy and good tolerability.
Area of Science:
- Hepatology
- Virology
- Pharmacology
Background:
- Hepatitis C virus (HCV) genotype 3 infection with advanced liver disease requires effective therapies.
- Previous studies showed high efficacy of daclatasvir (DCV) and sofosbuvir (SOF) in noncirrhotic patients.
Purpose of the Study:
- To evaluate the efficacy and tolerability of DCV-SOF plus ribavirin (RBV) in patients with HCV genotype 3 and advanced liver disease.
- To compare the outcomes of 12-week versus 16-week treatment durations.
Main Methods:
- Phase III ALLY-3+ study enrolled 50 treatment-naïve or experienced patients with advanced fibrosis or compensated cirrhosis.
- Patients received open-label DCV-SOF with weight-based RBV for 12 or 16 weeks.
- Primary endpoint was sustained virological response at post-treatment week 12 (SVR12).
Main Results:
- Overall SVR12 was 90% (45/50), with 88% for the 12-week group and 92% for the 16-week group.
- All patients with advanced fibrosis achieved SVR12.
- SVR12 in patients with cirrhosis was 86% overall, with high rates in both treatment durations and across treatment experience groups.
Conclusions:
- The combination of DCV-SOF-RBV demonstrated high efficacy and was well tolerated in genotype 3 HCV patients with advanced liver disease.
- Both 12 and 16 weeks of treatment resulted in similar high SVR12 rates.
- Treatment outcomes were consistent regardless of prior treatment experience.
Unlabelled:
Patients with hepatitis C virus (HCV) genotype 3 infection, especially those with advanced liver disease, are a challenging population in urgent need of optimally effective therapies. The combination of daclatasvir (DCV; pangenotypic nonstructural protein 5A inhibitor) and sofosbuvir (SOF; nucleotide nonstructural protein 5B inhibitor) for 12 weeks previously showed high efficacy (96%) in noncirrhotic genotype 3 infection. The phase III ALLY-3+ study (N = 50) evaluated DCV-SOF with ribavirin (RBV) in treatment-naïve (n = 13) or treatment-experienced (n = 37) genotype 3-infected patients with advanced fibrosis (n = 14) or compensated cirrhosis (n = 36). Patients were randomized 1:1 to receive open-label DCV-SOF (60 + 400 mg daily) with weight-based RBV for 12 or 16 weeks. The primary endpoint was sustained virological response at post-treatment week 12 (SVR12). SVR12 (intention-to-treat) was 90% overall (45 of 50): 88% (21 of 24) in the 12-week (91% observed) and 92% (24 of 26) in the 16-week group. All patients with advanced fibrosis achieved SVR12. SVR12 in patients with cirrhosis was 86% overall (31 of 36): 83% (15 of 18) in the 12-week (88% observed) and 89% (16 of 18) in the 16-week group; for treatment-experienced patients with cirrhosis, these values were 87% (26 of 30), 88% (14 of 16; 93% observed), and 86% (12 of 14), respectively. One patient (12-week group) did not enter post-treatment follow-up (death unrelated to treatment). There were 4 relapses (2 per group) and no virological breakthroughs. The most common adverse events (AEs) were insomnia, fatigue, and headache. There were no discontinuations for AEs and no treatment-related serious AEs.
Conclusion:
The all-oral regimen of DCV-SOF-RBV was well tolerated and resulted in high and similar SVR12 after 12 or 16 weeks of treatment among genotype 3-infected patients with advanced liver disease, irrespective of past HCV treatment experience.
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