Hepatitis C, in real life, efficacy similar to that of daclatavir sofosbuv

Daclatasvir combined with sofosbuvir and ribavirin resulted in similar sustained virologic response rates in patients with genotype 2 and 3 hepatitis C compared to those treated with sofosbuvir and velpatasvir. This is suggested by a study recently published in the Journal of Hepatology.

Daclatasvir combined with sofosbuvir and ribavirin resulted in similar sustained virologic response rates in patients with genotype 2 and 3 hepatitis C compared to those treated with sofosbuvir and velpatasvir. This is suggested by a study recently published on Journal of Hepatology.

"Genotype 2 accounts for 11% of chronic HCV infections worldwide (including the United States), while genotype 3 represents 18% of infections worldwide and 9% in the United States," said Pamela S Belperio, from the Department of Veterans Affairs in California and his colleagues. "In hard-to-treat populations where fewer evidence-based indications are available, empirical decisions need to be made to extend treatment, add ribavirin or both."

The study included 2,939 HCV genotype 2 patients and 2,824 genotype 3 patients who received daclatasvir with sofosbuvir or sofosbuvir / velpatasvir, with each treatment series including ribavirin.

The sustained virological response was obtained in 94.4% of patients with HCV genotype 2 and 93% of those with genotype 3. Percentages of discontinuation of treatment before 12 weeks were similar, regardless of the genotype or treatment regimen.
In the genotype 2 group, SVR rates were similar between daclatasvir / sofosbuvir and sofosbuvir / velpatasvir regardless of treatment (88.1% vs. 89.5%, respectively) or without ribavirin (94.5% vs 94.4%, respectively). ).

Multivariate badysis showed that patients younger than 55 years of age had a reduced likelihood of SVR (OR = 0.45, 95% CI, 0.27-0.77).

For genotype 3, SVR levels were also similar in patients treated with daclatasvir / sofosbuvir and sofosbuvir / velpatasvir, regardless of treatment (88.1% vs 86.4%) or without ribavirin (90.8%). % vs 92%).

A multivariate badysis showed that a decrease in the probability of obtaining SVR was predictable with a fibrosis-4 index greater than 3.25 compared to an index between 1.45 and 3.25 (OR = 0, 6, 95% CI, 0.43-0.84), decompensated disease (OR = 0.68, 95% CI, 0.47-0.99) and previous treatments for HCV (OR = 0.51; 95%, 0.36-0.72).

In the genotype 3 group, the addition of ribavirin to daclatasvir / sofosbuvir and treatment prolongation of 12 to 24 weeks slightly increased SVR rates in patients with FIB-4 greater than 3.25 (90%). compared to 93.9%).

"Our badysis supports daclatasvir / sofosbuvir and sofosbuvir / velpatasvir as effective treatment options for genotypes 2 and 3, with some nuances," the researchers wrote. "Indicators of more advanced diseases such as the increase in FIB-4 and a history of decompensated disease were significant predictors of the reduced likelihood of obtaining SVR in patients with HCV genotype 3, supporting strongly beginning of treatment before advanced liver disease.

Belperio PS et al. Efficacy of daclatasvir with sofosbuvir and velpatasvir / sofosbuvir in hepatitis C genotype 2 and 3. J Hepatol. September 26, 2018, p: S0168-8278 (18) 32392-4. doi: 10.1016 / j.jhep.2018.09.018.
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