Sofosbuvir, velpatasvir and voxilaprevir combination for the treatment of hepatitis C
Rebecca Voaklander1, Ira M Jacobson1,2
1a Department of Medicine , Mount Sinai Beth Israel , New York , NY , USA.
Insights
Direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection is highly effective. A new regimen, sofosbuvir/velpatasvir/voxilaprevir, shows high cure rates in difficult-to-treat populations.
Area of Science:
- Hepatology
- Virology
- Pharmacology
Background:
- Direct-acting antiviral (DAA) therapies have significantly improved chronic hepatitis C virus (HCV) cure rates.
- Difficult-to-treat populations, including those with genotype 3 infection, cirrhosis, and prior DAA treatment failure, still require effective options.
- Limited salvage treatment options exist for patients who do not respond to initial DAA therapy.
Purpose of the Study:
- To review the preclinical and clinical development of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX).
- To evaluate SOF/VEL/VOX as a pangenotypic, interferon-free, oral, once-daily treatment for chronic HCV infection.
Main Methods:
- Literature review of preclinical and clinical studies from 2015 to June 2017.
- Analysis of data from the POLARIS clinical trials evaluating the SOF/VEL/VOX regimen.
Main Results:
- Sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) demonstrated safety and efficacy in treating chronic HCV infection.
- High cure rates (≥96%) were achieved in patients with prior DAA treatment failure, genotype 3, cirrhosis, and unfavorable resistance profiles.
- Voxilaprevir, a second-generation HCV protease inhibitor, contributes to the regimen's potency.
Conclusions:
- Sofosbuvir/velpatasvir/voxilaprevir is a potent and effective oral regimen for chronic HCV.
- This regimen shows particular promise as a salvage therapy for patients who have previously failed DAA treatment.
- The development of SOF/VEL/VOX offers a valuable new option for challenging HCV cases.
Introduction:
The advent of direct-acting antiviral (DAA) treatments for chronic hepatitis C virus (HCV) infection has dramatically increased rates of cure. However, there remain difficult-to-treat populations, including patients with genotype 3 infection and cirrhosis, and limited salvage treatment options for those that have failed first-line DAA therapy. Areas covered: This is a review of the preclinical and clinical development of sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX), an interferon-free, oral, once daily, pangenotypic treatment for chronic HCV infection. All relevant literature from 2015 through June of 2017 is included. Expert commentary: Voxilaprevir, a second-generation HCV protease inhibitor, in combination with the already approved combination of sofosbuvir and velpatasvir, was evaluated in the POLARIS trials and found to be a safe and effective regimen. Patients with prior DAA treatment failure, genotype 3, cirrhosis and/or unfavorable resistance profiles all achieved cure rates of 96% or greater. The most distinctive role for this potent regimen may prove to be as a salvage regimen for patients who have failed previous DAA therapy.
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