Sofosbuvir and Velpatasvir for HCV Genotype 2 and 3 Infection.

Published

Journal Article

BACKGROUND: In phase 2 trials, treatment with the combination of the nucleotide polymerase inhibitor sofosbuvir and the NS5A inhibitor velpatasvir resulted in high rates of sustained virologic response in patients chronically infected with hepatitis C virus (HCV) genotype 2 or 3. METHODS: We conducted two randomized, phase 3, open-label studies involving patients who had received previous treatment for HCV genotype 2 or 3 and those who had not received such treatment, including patients with compensated cirrhosis. In one trial, patients with HCV genotype 2 were randomly assigned in a 1:1 ratio to receive sofosbuvir-velpatasvir, in a once-daily, fixed-dose combination tablet (134 patients), or sofosbuvir plus weight-based ribavirin (132 patients) for 12 weeks. In a second trial, patients with HCV genotype 3 were randomly assigned in a 1:1 ratio to receive sofosbuvir-velpatasvir for 12 weeks (277 patients) or sofosbuvir-ribavirin for 24 weeks (275 patients). The primary end point for the two trials was a sustained virologic response at 12 weeks after the end of therapy. RESULTS: Among patients with HCV genotype 2, the rate of sustained virologic response in the sofosbuvir-velpatasvir group was 99% (95% confidence interval [CI], 96 to 100), which was superior to the rate of 94% (95% CI, 88 to 97) in the sofosbuvir-ribavirin group (P=0.02). Among patients with HCV genotype 3, the rate of sustained virologic response in the sofosbuvir-velpatasvir group was 95% (95% CI, 92 to 98), which was superior to the rate of 80% (95% CI, 75 to 85) in the sofosbuvir-ribavirin group (P<0.001). The most common adverse events in the two studies were fatigue, headache, nausea, and insomnia. CONCLUSIONS: Among patients with HCV genotype 2 or 3 with or without previous treatment, including those with compensated cirrhosis, 12 weeks of treatment with sofosbuvir-velpatasvir resulted in rates of sustained virologic response that were superior to those with standard treatment with sofosbuvir-ribavirin. (Funded by Gilead Sciences; ASTRAL-2 ClinicalTrials.gov number, NCT02220998; and ASTRAL-3, NCT02201953.).

Full Text

Duke Authors

Cited Authors

  • Foster, GR; Afdhal, N; Roberts, SK; Bräu, N; Gane, EJ; Pianko, S; Lawitz, E; Thompson, A; Shiffman, ML; Cooper, C; Towner, WJ; Conway, B; Ruane, P; Bourlière, M; Asselah, T; Berg, T; Zeuzem, S; Rosenberg, W; Agarwal, K; Stedman, CAM; Mo, H; Dvory-Sobol, H; Han, L; Wang, J; McNally, J; Osinusi, A; Brainard, DM; McHutchison, JG; Mazzotta, F; Tran, TT; Gordon, SC; Patel, K; Reau, N; Mangia, A; Sulkowski, M; ASTRAL-2 Investigators, ; ASTRAL-3 Investigators,

Published Date

  • December 31, 2015

Published In

Volume / Issue

  • 373 / 27

Start / End Page

  • 2608 - 2617

PubMed ID

  • 26575258

Pubmed Central ID

  • 26575258

Electronic International Standard Serial Number (EISSN)

  • 1533-4406

Digital Object Identifier (DOI)

  • 10.1056/NEJMoa1512612

Language

  • eng

Conference Location

  • United States