Resistance-guided direct-acting antiviral retreatment resulted in nearly 90% sustained virologic response rates among patients with hepatitis C who developed resistance-associated substitutions after failing treatment with NS5A inhibitors.
In their study, Ana Belén Pérez, from the University Hospital Reina Sofía in Córdoba, Spain, and colleagues provided indications on how to use resistance information in settings where Vosevi (sofosbuvir/velpatasvir/voxilaprevir, Gilead Sciences) may not be available.
“We believe that our data may be of special relevance for those countries where new drug combinations are still not available, and may allow treating patients at a lower cost, avoiding drug-drug interaction and preserving the three-drug combination regimen,” they wrote. “We hypothesize that SVR rates may even be improved if resistance data are discussed between experienced virologists and treating clinicians.”
The study comprised 185 patients who did not respond to Harvoni (sofosbuvir/ledipasvir, Gilead Sciences), 79 who did not respond to combination Sovaldi (sofosbuvir, Gilead Sciences) and Daklinza (daclatasvir, Bristol-Myers Squibb), and 68 who did not respond to Viekira Pak (paritaprevir/ritonavir/ombitasvir/dasabuvir), all of whom also received ribavirin.
All patients received retreatment with sofosbuvir with an NS5A inhibitor and ribavirin for 12 or 24 weeks.
“When available, velpatasvir should be the NS5A component of the new retreatment regimen; if not available, the previously used NS5A inhibitor may be recycled adding ribavirin and extending the duration for 24 weeks,” the researchers wrote.”
Results from modified intention-to-treat analysis — excluding all patients unavailable for follow-up at 12 weeks — the SVR rates were 88.1% for those previously treated with sofosbuvir/ledispasvir, 83.3% for those treated with sofosbuvir and daclatasvir and 93.7% for those treated with ombitasvir-containing regimens.
“When possible, simeprevir-based regimens should be avoided, especially for patients with cirrhosis,” Pérez and colleagues explained. They continued to explain that most of the patients infected with genotype 3 were retreated and cured with a combination of sofosbuvir, an NS5A inhibitor and ribavirin after 24 weeks or a regimen of sofosbuvir with an additional two or three drugs and ribavirin, especially if Y93H is present. – by Talitha Bennett
Disclosures: Pérez reports that the study was supported in part by grants from Fondo de Investigación Sanitaria, Plan Nacional de I+D+I and Fondo Europeo de Desarrollo Regional-FEDER, Fundación Progreso y Salud, Junta de Andalucia, and GEHEP-SEIMC.