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Everson GT, Towner WJ, Davis MN, Wyles DL, Nahass RG, Thuluvath PJ, Etzkorn K, Hinestrosa F, Tong M, Rabinovitz M, McNally J, Brainard DM, Han L, Doehle B, McHutchison JG, Morgan T, Chung RT, Tran TT. Sofosbuvir With Velpatasvir in Treatment-Naive Noncirrhotic Patients With Genotype 1 to 6 Hepatitis C Virus Infection: A Randomized Trial. Ann Intern Med 2015; 163:818-26. [PMID: 26551051 DOI: 10.7326/m15-1000] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Effective, pangenotypic treatments for hepatitis C virus (HCV) infection are needed. OBJECTIVE To assess the safety and efficacy of sofosbuvir with velpatasvir in patients infected with HCV genotypes 1 to 6. DESIGN Randomized, phase 2, open-label study. (ClinicalTrials.gov: NCT01858766). SETTING 48 U.S. sites. PATIENTS 377 treatment-naive noncirrhotic patients. In part A, patients infected with HCV genotypes 1 to 6 were randomly assigned to sofosbuvir, 400 mg, with velpatasvir, 25 or 100 mg, for 12 weeks. In part B, patients with genotype 1 or 2 HCV infection were randomly assigned to sofosbuvir, 400 mg, and velpatasvir, 25 or 100 mg, with or without ribavirin for 8 weeks. MEASUREMENTS Sustained virologic response at 12 weeks (SVR12). RESULTS In part A, SVR12 rates were 96% (26 of 27) with velpatasvir, 25 mg, and 100% (28 of 28) with velpatasvir, 100 mg, for genotype 1; 93% (25 of 27) in both groups for genotype 3; and 96% (22 of 23) with velpatasvir, 25 mg, and 95% (21 of 22) with velpatasvir, 100 mg, for genotypes 2, 4, 5, and 6. In part B, for genotype 1, SVR12 rates were 87% (26 of 30) with velpatasvir, 25 mg; 83% (25 of 30) with velpatasvir, 25 mg, plus ribavirin; 90% (26 of 29) with velpatasvir, 100 mg; and 81% (25 of 31) with velpatasvir, 100 mg, plus ribavirin. For genotype 2, SVR12 rates were 77% (20 of 26) with velpatasvir, 25 mg; 88% (22 of 25) with velpatasvir, 25 mg, plus ribavirin; 88% (23 of 26) with velpatasvir, 100 mg; and 88% (23 of 26) with velpatasvir, 100 mg, plus ribavirin. Adverse events included fatigue (21%), headache (20%), and nausea (12%). One patient committed suicide. LIMITATION The study was open-label, no inferential statistics were planned, and sample sizes were small. CONCLUSION Twelve weeks of sofosbuvir, 400 mg, and velpatasvir, 100 mg, was well-tolerated and resulted in high SVR in patients infected with HCV genotypes 1 to 6. PRIMARY FUNDING SOURCE Gilead Sciences.
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Affiliation(s)
- Gregory T. Everson
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - William J. Towner
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Mitchell N. Davis
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - David L. Wyles
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Ronald G. Nahass
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Paul J. Thuluvath
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Kyle Etzkorn
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Federico Hinestrosa
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Myron Tong
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Mordechai Rabinovitz
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - John McNally
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Diana M. Brainard
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Lingling Han
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Brian Doehle
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - John G. McHutchison
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Timothy Morgan
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Raymond T. Chung
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
| | - Tram T. Tran
- From University of Colorado Denver, Aurora, Colorado; Kaiser Permanente and Cedars-Sinai Medical Center, Los Angeles, California; Digestive CARE, South Florida Center of Gastroenterology, Wellington, Florida; University of California, San Diego, La Jolla, California; ID CARE, Hillsborough, New Jersey; Mercy Medical Center, Baltimore, Maryland; Borland-Groover Clinic, Jacksonville, Florida; Orlando Immunology Center, Orlando, Florida; Huntington Medical Research Institutes, Pasadena, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Gilead Sciences, Foster City, California; VA Long Beach Healthcare System, Long Beach, California; and Massachusetts General Hospital, Boston, Massachusetts
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