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Schiano Moriello N, Pinchera B, Gentile I. Personalized care approaches to hepatitis C therapy: recent advances and future directions. Expert Rev Anti Infect Ther 2024; 22:139-151. [PMID: 38459735 DOI: 10.1080/14787210.2024.2328336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
INTRODUCTION The introduction of direct-acting antivirals (DAAs) has significantly transformed the therapeutic landscape for chronic C hepatitis virus (HCV) infection. However, there is still room for further improvement in optimizing therapy efficacy and minimizing adverse effects. AREAS COVERED This review is devoted to the rationale for adopting a personalized approach to HCV therapy. Specifically, we explore the role of host-related factors, such as sex or the presence of comorbidities. We thoroughly examine the implications of commonly encountered comorbidities, including HIV infection, chronic renal disease, liver cirrhosis, and other chronic viral hepatitis infections. Additionally, we discuss the prevalent drug-to-drug interactions between DAAs and other medications, while providing guidance on their management. Finally, we investigate viral-related issues that can influence treatment outcomes, such as viral genotype, quasi-species, and the presence of resistance-associated mutations. EXPERT OPINION Despite pivotal trials demonstrating efficacy rates exceeding 90% for currently available DAA regimens, there are still opportunities to optimize therapy outcomes and tailor treatment to each patient. This can be achieved through a meticulous evaluation of the patient's specific clinical conditions and comorbidities, a vigilant approach to manage potential drug interactions, and diligent patient follow-up.
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Affiliation(s)
| | - Biagio Pinchera
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Shah I, Ahmad W, Qadir A, Muhammad I, Islam M, Shah M, Jan N, Anjum S. Efficacy and Safety of Sofosbuvir and Velpatasvir Combination for the Treatment of Chronic Hepatitis C in Patients With or Without Cirrhosis. Cureus 2021; 13:e19768. [PMID: 34950547 PMCID: PMC8687797 DOI: 10.7759/cureus.19768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 11/05/2022] Open
Abstract
Background and aim For years, interferon-based treatment has been offered to patients with chronic hepatitis C virus (HCV) infection; however, the complexity of the treatment, efficacy, and adverse effects were the primary concerns. All these concerns were addressed with the introduction of directly acting antivirals (DAAs) to treat chronic HCV. Sofosbuvir and velpatasvir are second-generation DAAs used in combination for the treatment of chronic HCV infection. The aim of our study was to determine and compare the efficacy and safety profile of the sofosbuvir and velpatasvir combination in treating patients with chronic hepatitis C with or without cirrhosis. Materials and methods This descriptive study was conducted at the Department of Medicine, Khyber Teaching Hospital, Peshawar, from March 15th to September 15th, 2021 after approval from the Institution Research and Ethical Review Board (IREB). Diagnosis of HCV was based on the detection of hepatitis C ribonucleic acid (RNA) fragments by reverse transcription-polymerase chain reaction (RT-PCR). Liver status was assessed with liver function tests and imaging. Sofosbuvir (400 mg) and velpatasvir (100 mg) were administered once daily for 12 weeks, followed by polymerase chain reaction (PCR) for HCV RNA after 12 weeks of completion of treatment for determination of sustained virologic response at 12 weeks (SVR12). Patients with cirrhosis also received weight-based ribavirin. Adverse events experienced by the study participants during the course of treatment were recorded. Data were collected regarding patients' demographics, laboratory parameters, SVR12, and adverse events, and were then analyzed using SPSS, version 22 (IBM SPSS Statistics, Armonk, NY). Results A total of 58 patients with cirrhosis and 58 patients without cirrhosis with chronic HCV were enrolled. The rate of SVR12 in patients with cirrhosis was 89.7% (52 patients achieved SVR12), compared to 98.3% in patients without cirrhosis (57 patients achieved SVR12). Subgroup analysis of patients with cirrhosis revealed that patients who have failed to achieve SVR12 were mostly males, had prolonged disease duration, and low hemoglobin at baseline; however, the association of these factors with SVR12 was not significant. The incidence of adverse events among all study participants was 46.5%. Among the cirrhotic cohort, 37 (63.8%) patients experienced adverse events, while only 17 (29.3%) patients among the non-cirrhotic cohort had adverse events. A total of 24 patients with cirrhosis (41.37%) reported mild complaints. The most commonly reported adverse event was gastrointestinal (GI) upsets (46.2%), followed by fatigue (33.9%), while 19.9% developed miscellaneous adverse events such as headaches, rash, and insomnia. Conclusion The combination of sofosbuvir and velpatasvir is highly effective and safe in patients with HCV with or without cirrhosis. However, this combination's efficacy was slightly higher in non-cirrhotic patients (98.3%) than in cirrhotic patients (89.7%).
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Affiliation(s)
- Islam Shah
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK.,Internal Medicine, Khyber Medical College, Peshawar, PAK
| | - Wiqas Ahmad
- Gastroenterology and Hepatology, Hayatabad Medical Complex, Peshawar, PAK
| | - Abdul Qadir
- Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK
| | - Iltaf Muhammad
- Gastroenterology and Hepatology, Hayatabad Medical Complex, Peshawar, PAK
| | - Muhammad Islam
- Internal Medicine, Khyber Medical University, Peshawar, PAK
| | - Mustaqeem Shah
- Gastroenterology and Hepatology, Lady Reading Hospital, Peshawar, PAK
| | - Naeem Jan
- Gastroenterology and Hepatology, Hayatabad Medical Complex, Peshawar, PAK
| | - Sadia Anjum
- Radiology, Lady Reading Hospital, Peshawar, PAK
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Onorato L, Pisaturo M, Starace M, Minichini C, Di Fraia A, Astorri R, Coppola N. Virological Factors Associated with Failure to the Latest Generation of Direct Acting Agents (DAA) and Re-Treatment Strategy: A Narrative Review. Viruses 2021; 13:432. [PMID: 33800289 PMCID: PMC8000640 DOI: 10.3390/v13030432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 12/12/2022] Open
Abstract
The availability of all oral direct acting antiviral agents (DAAs) has revolutionized the management of HCV infections in recent years, allowing to achieve a sustained virological response (SVR) in more than 95% of cases, irrespective of hepatitis C Virus (HCV) genotype or staging of liver disease. Although rare, the failure to the latest-generation regimens (grazoprevir/elbasvir, sofosbuvir/velpatasvir, pibrentasvir/glecaprevir) represents a serious clinical problem, since the data available in the literature on the virological characteristics and management of these patients are few. The aim of the present narrative review was to provide an overview of the impact of baseline RASs in patients treated with the latest-generation DAAs and to analyze the efficacy of the available retreatment strategies in those who have failed these regimens.
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Affiliation(s)
| | | | | | | | | | | | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania L. Vanvitelli, 80138 Naples, Italy; (L.O.); (M.P.); (M.S.); (C.M.); (A.D.F.); (R.A.)
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Sarrazin C, Zimmermann T, Berg T, Hinrichsen H, Mauss S, Wedemeyer H, Zeuzem S. Prophylaxe, Diagnostik und Therapie der Hepatitis-C-Virus(HCV)-Infektion. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2020; 58:1110-1131. [PMID: 33197953 DOI: 10.1055/a-1226-0241] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- C Sarrazin
- Medizinische Klinik II Gastroenterologie, Hepatologie, Infektiologie, Diabetologie, St. Josefs-Hospital, Wiesbaden, Deutschland.,Medizinische Klinik I Gastroenterologie, Hepatologie, Pneumologie, Endokrinologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - T Zimmermann
- Medizinische Klinik II, Klinikum Worms, Worms, Deutschland.,Medizinische Klinik und Poliklinik, Gastroenterologie und Hepatologie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - T Berg
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | | | - S Mauss
- MVZ, Düsseldorf, Deutschland
| | - H Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - S Zeuzem
- Medizinische Klinik I Gastroenterologie, Hepatologie, Pneumologie, Endokrinologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
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Gorka S, Gulzar GM, Yattoo GN, Sodhi JS, Dar GA, Laway MA, Kaushik S, Dhar N, Mushfiq S, Aziz RA. Genotype 1 and 3 Response to Velpatasvir and Sofosbuvir in Chronic Hepatitis C in the Kashmiri Population: An Observational Study. J Clin Exp Hepatol 2020; 10:155-162. [PMID: 32189931 PMCID: PMC7068023 DOI: 10.1016/j.jceh.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/05/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Our data is one of the earliest study from the Indian subcontinent on Velpatasvir/Sofosbuvir (VEL/SOF) combination in chronic hepatitis C (CHC). The primary end point was to evaluate sustained virologic response (SVR) 12 in CHC-infected patients and to determine its effect in patients with hepatitis C virus-related cirrhosis. The secondary end point was to observe any adverse events related to treatment. METHODS All patients with CHC were randomized into two groups: noncirrhotic and cirrhotic. The combination of VEL/SOF was given as recommended. RESULTS One hundred patients with CHC infection treated with the VEL/SOF regimen were evaluated. A total of 79 (79%) of 100 patients were noncirrhotic, and 21 (21%) were cirrhotic. We achieved SVR12 in 99 (99%) of 100 patients. Among cirrhotics, the mean serum bilirubin (mg/dl), albumin (g/dl), and platelet count (×10³/μL) improved from baseline 1.82 ± 0.87, 3.22 ± 0.69, and 80.19 ± 46.03 to 1.74 ± 0.87, 3.48 ± 0.72, and 85.05 ± 42.50, respectively, at SVR12 (P-value > 0.05). Mean serum alanine aminotransferase (ALT) (U/L) improved from baseline 71.28 ± 59.17 to 35.38 ± 17.39 at SVR12 (P-value < 0.024). Baseline mean liver stiffness measurement (LSM) in cirrhotic patients was 28.24 ± 10.87 kPa, which decreased to 24.04 ± 9.33 kPa at SVR12 (P-value, 0.02). The baseline Model for End-Stage Liver Disease (MELD) score was 13.47 ± 3.66, which decreased to 12.33 ± 5.46 at SVR12 (P-value, 0.28). The Child-Turcotte-Pugh score improved by 1 point in 33.33% (7/21) patients and 2 points in 9.52% (2/21) patients, and in the majority, that is, 38.09% (8/21), the score remained as it is. CONCLUSION A single daily dose of the tablet SOF/VEL combination is safe and effective in all types of CHC. There was a significant improvement in the mean transaminase level and LSM at SVR12. And the MELD score improved by 1 point at SVR12 among cirrhotics.
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Affiliation(s)
- Suresh Gorka
- Address for correspondence: Suresh Gorka, DM Resident, Department of Gastroenterology, SKIMS, Room No 9, Block B, New Married Hostel, Soura, Srinagar, 190011, India.
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6
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Wuerth K, Magel T, Conway B. Sofosbuvir and velpatasvir in the treatment of chronic hepatitis C. Future Virol 2019. [DOI: 10.2217/fvl-2019-0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Advances in hepatitis C virus (HCV) treatment led to the development of highly effective all oral direct acting antiviral regimens. The combination of sofosbuvir and velpatasvir (SOF/VEL), two agents acting synergistically at different stages in the viral life cycle, has been evaluated in a broad range of clinical trials supporting its efficacy in complex and diverse patient populations. Following regulatory approval in 2016, SOF/VEL has been widely used as a safe, effective pangenotypic regimen in clinical practice. In this review, we will discuss the current preclinical, clinical and real-world data on SOF/VEL.
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Affiliation(s)
- Kelli Wuerth
- Vancouver Infectious Diseases Centre, Vancouver, BC V6Z2C7, Canada
| | - Tianna Magel
- Vancouver Infectious Diseases Centre, Vancouver, BC V6Z2C7, Canada
| | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, BC V6Z2C7, Canada
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Smolders EJ, Jansen AME, Ter Horst PGJ, Rockstroh J, Back DJ, Burger DM. Viral Hepatitis C Therapy: Pharmacokinetic and Pharmacodynamic Considerations: A 2019 Update. Clin Pharmacokinet 2019; 58:1237-1263. [PMID: 31114957 PMCID: PMC6768915 DOI: 10.1007/s40262-019-00774-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It has been estimated by the World Health Organization (WHO) that over 71 million people were infected with the hepatitis C virus (HCV) in 2015. Since then, a number of highly effective direct-acting antiviral (DAA) regimens have been licensed for the treatment of chronic HCV infection: sofosbuvir/daclatasvir, sofosbuvir/ledipasvir, elbasvir/grazoprevir, sofosbuvir/velpatasvir, glecaprevir/pibrentasvir, and sofosbuvir/velpatasvir/voxilaprevir. With these treatment regimens, almost all chronic HCV-infected patients, even including prior DAA failures, can be treated effectively and safely. It is therefore likely that further development of DAAs will be limited. In this descriptive review we provide an overview of the clinical pharmacokinetic characteristics of currently available DAAs by describing their absorption, distribution, metabolism, and excretion. Potential drug-drug interactions with the DAAs are briefly discussed. Furthermore, we summarize what is known about the pharmacodynamics of the DAAs in terms of efficacy and safety. We briefly discuss the relationship between the pharmacokinetics of the DAAs and efficacy or toxicity in special populations, such as hard to cure patients and patients with liver cirrhosis, liver transplantation, renal impairment, hepatitis B virus or HIV co-infection, bleeding disorders, and children. The aim of this overview is to educate/update prescribers and pharmacists so that they are able to safely and effectively treat HCV-infected patients even in the presence of underlying co-infections or co-morbidities.
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Affiliation(s)
- Elise J Smolders
- Department of Pharmacy, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
- Department of Pharmacy, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Anouk M E Jansen
- Department of Pharmacy, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Peter G J Ter Horst
- Department of Pharmacy, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Jürgen Rockstroh
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - David J Back
- Department of Clinical and Molecular Pharmacology, University of Liverpool, Liverpool, UK
| | - David M Burger
- Department of Pharmacy, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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8
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van Seyen M, Colbers A, Abbink EJ, Drenth JPH, Burger DM. Concomitant Intake of Coca-Cola to Manage the Drug-Drug Interaction Between Velpatasvir and Omeprazole Studied in Healthy Volunteers. Clin Pharmacol Ther 2019; 106:1093-1098. [PMID: 31313296 PMCID: PMC6851656 DOI: 10.1002/cpt.1569] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 04/17/2019] [Indexed: 12/13/2022]
Abstract
We aimed to evaluate the effect of the acid beverage Coca‐Cola on the pharmacokinetics of velpatasvir (VEL) when given with omeprazole. This was an open‐label, randomized, crossover trial in 11 healthy adults. A single dose of sofosbuvir/velpatasvir (SOF/VEL) 400/100 mg was administered alone (reference) or with omeprazole 40 mg once daily with water (intervention I); in the intervention II arm, omeprazole 40 mg was combined with 250 mL of Coca‐Cola. Geometric mean ratios (GMRs) were calculated for VEL area under the concentration‐time curve from zero to infinity (AUC0−inf) and maximum plasma concentration (Cmax). VEL exposure was reduced by 26.7% when SOF/VEL was coadministered with omeprazole vs. reference: GMRs (90% confidence interval (CI)) were 73.3% (55.6–96.8) and 69.1% (52.3–91.2) for AUC0‐inf and Cmax, respectively. Intake of SOF/VEL with Coca‐Cola compensated for the interaction with omeprazole and resulted in a higher VEL exposure. GMRs (90% CI) were 161.6% (122.4–213.3) for AUC0‐inf and 143.9% (109.0–190.0) for Cmax. Therefore, Coca‐Cola can be used to overcome the drug–drug interaction between VEL and omeprazole.
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Affiliation(s)
- Minou van Seyen
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Angela Colbers
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Evertine J Abbink
- Radboudumc Technology Center Clinical Studies, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost P H Drenth
- Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David M Burger
- Department of Pharmacy, Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
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Flamm S, Mutimer D, Asatryan A, Wang S, Rockstroh J, Horsmans Y, Kwo PY, Weiland O, Villa E, Heo J, Gane E, Ryder SD, Welzel TM, Ruane PJ, Agarwal K, Ng TI, Xue Z, Lovell SS, Krishnan P, Kopecky‐Bromberg S, Trinh R, Mensa FJ, Wyles DL. Glecaprevir/Pibrentasvir in patients with chronic HCV genotype 3 infection: An integrated phase 2/3 analysis. J Viral Hepat 2019; 26:337-349. [PMID: 30421537 PMCID: PMC7379735 DOI: 10.1111/jvh.13038] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023]
Abstract
Glecaprevir coformulated with pibrentasvir (G/P) is approved to treat hepatitis C virus (HCV) infection and was highly efficacious in phase 2 and 3 studies. Treating HCV genotype (GT) 3 infection remains a priority, as these patients are harder to cure and at a greater risk for liver steatosis, fibrosis progression and hepatocellular carcinoma. Data were pooled from five phase 2 or 3 trials that evaluated 8-, 12- and 16-week G/P in patients with chronic HCV GT3 infection. Patients without cirrhosis or with compensated cirrhosis were either treatment-naïve or experienced with interferon- or sofosbuvir-based regimens. Safety and sustained virologic response 12 weeks post-treatment (SVR12) were assessed. The analysis included 693 patients with GT3 infection. SVR12 was achieved by 95% of treatment-naïve patients without cirrhosis receiving 8-week (198/208) and 12-week (280/294) G/P. Treatment-naïve patients with cirrhosis had a 97% (67/69) SVR12 rate with 12-week G/P. Treatment-experienced, noncirrhotic patients had SVR12 rates of 90% (44/49) and 95% (21/22) with 12- and 16-week G/P, respectively; 94% (48/51) of treatment-experienced patients with cirrhosis treated for 16 weeks achieved SVR12. No serious adverse events (AEs) were attributed to G/P; AEs leading to study drug discontinuation were rare (<1%). G/P was well-tolerated and efficacious for patients with chronic HCV GT3 infection, regardless of cirrhosis status or prior treatment experience. Eight- and 12-week durations were efficacious for treatment-naïve patients without cirrhosis and with compensated cirrhosis, respectively; 16-week G/P was efficacious in patients with prior treatment experience irrespective of cirrhosis status.
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Affiliation(s)
- Steven Flamm
- Northwestern Feinberg School of MedicineChicagoIllinois
| | - David Mutimer
- Queen Elizabeth Hospital and NIHR Liver Biomedical Research UnitBirminghamUK
| | | | | | | | - Yves Horsmans
- Cliniques Universitaires Saint‐LucUCLBrusselsBelgium
| | - Paul Y. Kwo
- Division of Gastroenterology and HepatologyStanford UniversityPalo AltoCalifornia
| | - Ola Weiland
- Karolinska University Hospital Huddinge at Karolinska InstituteStockholmSweden
| | - Erica Villa
- University of Modena and Reggio EmiliaModenaItaly
| | - Jeong Heo
- Department of Internal MedicineCollege of MedicinePusan National University and Medical Research InstitutePusan National University HospitalBusanRepublic of Korea
| | - Edward Gane
- Liver UnitAuckland City HospitalAucklandNew Zealand
| | - Stephen D. Ryder
- NIHR Nottingham Biomedical Research Centre and Nottingham University Hospitals NHS TrustNottinghamUK
| | | | - Peter J. Ruane
- Ruane Medical & Liver Health InstituteLos AngelesCalifornia
| | - Kosh Agarwal
- Institute of Liver StudiesKings College HospitalLondonUK
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Bourlière M, Pietri O, Castellani P, Oules V, Adhoute X. Sofosbuvir, velpatasvir and voxilaprevir: a new triple combination for hepatitis C virus treatment. One pill fits all? Is it the end of the road? Therap Adv Gastroenterol 2018; 11:1756284818812358. [PMID: 30574189 PMCID: PMC6295690 DOI: 10.1177/1756284818812358] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/02/2018] [Indexed: 02/04/2023] Open
Abstract
The advent of oral direct-acting antiviral agents (DAAs) has dramatically improved the hepatitis C virus (HCV) treatment landscape in the last 4 years, providing cure rates over 95% with a shorter duration of treatment and a very good safety profile. This has enabled access to treatment in nearly all HCV infected patients. The launch of two pangenotypic fixed dose combinations (FDCs) in 2017 made a new step forward in HCV treatment by slightly increasing efficacy and more importantly allowing the treatment of patients without HCV genotyping, and in some cases without fibrosis assessment. However, retreatment of the few DAA failure patients was still an issue for some HCV genotypes. The launch of the triple regimen FDC, sofosbuvir/velpatasvir/voxilaprevir, solves this issue by providing a cure rate over 96% regardless of HCV genotype. In this review, we describe the current HCV treatment landscape and focus on the development of this triple FDC either in treatment-naïve or treatment-experienced patients with previous failure on a DAA regimen.
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Affiliation(s)
- Marc Bourlière
- Hepato-Gastroenterology Department, Hospital Saint Joseph, 26 Bd de Louvain 13008 Marseilles, France
| | - Olivia Pietri
- Hepato-Gastroenterology Department, Hospital Saint Joseph, Marseilles, France
| | - Paul Castellani
- Hepato-Gastroenterology Department, Hospital Saint Joseph, Marseilles, France
| | - Valérie Oules
- Hepato-Gastroenterology Department, Hospital Saint Joseph, Marseilles, France
| | - Xavier Adhoute
- Hepato-Gastroenterology Department, Hospital Saint Joseph, Marseilles, France
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11
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Omar MA, Abdel-Lateef MA, Ali R, Derayea SM. Study on fluorescence properties of HCV antiviral (velpatasvir) and its fluorimetric determination in presence of sofosbuvir; application to stability study and human plasma. LUMINESCENCE 2018; 33:1249-1256. [PMID: 30144265 DOI: 10.1002/bio.3542] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 01/02/2023]
Abstract
Velpatasvir (VLP) is a new, oral, direct-acting antiviral with potent inhibitory activity against all hepatitis C virus (HCV) genotypes. A highly sensitive, simple, fast and specific one fluorometric method for determination of VLP in the presence of sofosbuvir was developed and validated. The fluorescence behavior of VLP in different organic solvents was examined and explained. Methanol was concluded to be the best sensitizing reagent. The native fluorescence intensity of VLP was accomplished at 383 nm with 339 nm for excitation wavelength. The impacts of experimental variables included pH, various organized media, and time of stability were examined and optimized. A linear relationship was achieved between the VLP concentration and the fluorescence intensity in a range of 5 to 5 × 103 ng mL-1 with 0.70 and 0.23 ng mL-1 , for quantitation and detection limits respectively. The proposed method was utilized for analyzing of VLP in human plasma and additionally expanded to examine the stability of VLP after its exposure to various stress conditions, like oxidative, alkaline, acidic, UV, daylight and sunlight conditions, according to ICH guidelines. Furthermore, the kinetics of acidic and oxidative degradations of VLP was examined. Moreover, the half-life times of the reaction (t1/2 ) and the first-order reaction rate constants were estimated. Finally, a suggestion for the degradation pathway was presented.
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Affiliation(s)
- Mahmoud A Omar
- Department of Analytical Chemistry, Faculty of Pharmacy, Minia University, Minia, Egypt
| | - Mohamed A Abdel-Lateef
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, Egypt
| | - Ramadan Ali
- Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, Egypt
| | - Sayed M Derayea
- Department of Analytical Chemistry, Faculty of Pharmacy, Minia University, Minia, Egypt
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12
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Rezk MR, Basalious EB, Badr KA. Novel determination of sofosbuvir and velpatasvir in human plasma by UPLC-MS/MS method: Application to a bioequivalence study. Biomed Chromatogr 2018; 32:e4347. [PMID: 30047564 DOI: 10.1002/bmc.4347] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/09/2018] [Accepted: 07/17/2018] [Indexed: 11/08/2022]
Abstract
A novel and sensitive LC-MS/MS method was developed, optimized and validated for quantification of sofosbuvir (SOF) and velpatasvir (VEL) in human plasma using ledipasvir as an internal standard (IS). Sample preparation was done using acetonitrile for precipitation of plasma proteins. Chromatographic analysis was done on an Acquity UPLC BEH C18 column using 0.1% formic acid and acetonitrile as a mobile phase. The Xevo TQD LC-MS/MS system was run with electrospray ionization mode. The developed method was optimized and then validated according to the US Food and Drug Administration guidelines. Linearity was found to be in the range of 0.25-3500 ng/mL for SOF and 1-1000 ng/mL for VEL. A short run time of 1.5 min allows swift analysis of many plasma samples per day. The developed method was successfully utilized for estimating both SOF and VEL in the plasma of healthy human volunteers participated in a bioequivalence study.
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Affiliation(s)
- Mamdouh R Rezk
- Analytical Chemistry Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Emad B Basalious
- Pharmaceutics and Industrial Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Kamal A Badr
- Pharmaceutics Department, Faculty of Pharmacy, Deraya University, Egypt.,Advanced Research Center, Nasr City, Cairo, Egypt
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Sagnelli E, Starace M, Minichini C, Pisaturo M, Macera M, Sagnelli C, Coppola N. Resistance detection and re-treatment options in hepatitis C virus-related chronic liver diseases after DAA-treatment failure. Infection 2018; 46:761-783. [DOI: 10.1007/s15010-018-1188-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 07/30/2018] [Indexed: 12/12/2022]
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Antiviral Activity, Safety, and Tolerability of Multiple Ascending Doses of Elbasvir or Grazoprevir in Participants Infected With Hepatitis C Virus Genotype-1 or -3. Clin Ther 2018; 40:704-718.e6. [PMID: 29703432 DOI: 10.1016/j.clinthera.2018.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE Elbasvir (MK-8742) and grazoprevir (MK-5172; Merck & Co, Inc, Kenilworth, New Jersey) are hepatitis C virus (HCV)-specific inhibitors of the nonstructural protein 5A phosphoprotein and the nonstructural protein 3/4A protease, respectively. The aims of these studies were to evaluate the antiviral activity and safety of different doses of elbasvir or grazoprevir each administered as monotherapy to participants infected with either HCV genotype (GT) 1 or GT3. METHODS These 2 double-blind, randomized, placebo-controlled, sequential-panel, multiple ascending dose studies were conducted to assess the safety and pharmacodynamics of 5 days of once-daily elbasvir or 7 days of once-daily grazoprevir in adult male participants chronically infected with either HCV GT1 or GT3. FINDINGS Oral administration of elbasvir or grazoprevir once daily exhibited potent antiviral activity in participants with chronic GT1 or GT3 HCV infections. HCV RNA levels declined rapidly (within 1 day for elbasvir and 2 days for grazoprevir). At 50 mg of elbasvir once daily, the mean maximum reductions in HCV RNA from baseline were 5.21, 4.17, and 3.12 log10 IU/mL for GT1b-, GT1a-, and GT3-infected participants, respectively. At 100 mg of grazoprevir once daily, the mean maximum reductions in HCV RNA from baseline were 4.74 and 2.64 log10 IU/mL for GT1- and GT3-infected participants. IMPLICATIONS The results in the elbasvir monotherapy study showed that 10 to 50 mg of elbasvir was associated with a rapid decline in HCV viral load; the results in the grazoprevir monotherapy study suggest that doses of 50 mg of grazoprevir and higher are on the maximum response plateau of the dose-response curve for GT1-infected participants. The results of these proof-of-concept studies provided preliminary data for the selection of the dosages of elbasvir and grazoprevir to test in Phase II and III clinical studies. ClinicalTrials.gov identifiers: NCT00998985 (Protocol 5172-004) and NCT01532973 (Protocol 8742-002).
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Cory TJ, Mu Y, Gong Y, Kodidela S, Kumar S. Sofosbuvir + velpatasvir + voxilaprevir for the treatment of hepatitis C infection. Expert Opin Pharmacother 2018; 19:749-757. [PMID: 29634360 DOI: 10.1080/14656566.2018.1459567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Hepatitis C is a disease with a significant global impact. Over the last several years, the treatment of the disease has been revolutionized. Therapy has transformed over the last several years with the approval of second generation direct acting antivirals, and currently utilized medications for the treatment of hepatitis C are significantly more efficacious with better safety profiles than previously approved treatments. Treatment for individuals who have failed therapy on direct acting antivirals has, until recently, been complex and difficult to treat, but the approval of sofosbuvir/velpatasvir/voxilaprevir represents a new therapeutic option for these individuals. Areas covered: Sofosbuvir/velpatasvir/voxilaprevir is a recently approved therapeutic combination for the treatment of hepatitis C. This article reviews the studies leading to the approval of the combination, and its efficacy and safety profile. Expert opinion: Sofosbuvir/velpatasvir/voxilaprevir fills one of the previously unfilled niches for the treatment of hepatitis C, that of the treatment of individuals who have failed therapy with resistant virus. With the filling of this niche, there appears to be a general slowing of the development of new therapeutics. Although understandable, in the long term, there are considerable risks associated with the decreased development of new drugs to treat hepatitis C.
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Affiliation(s)
- Theodore J Cory
- a Department of Clinical Pharmacy and Translational Science , University of Tennessee Health Science Center College of Pharmacy , Memphis , TN , USA
| | - Ying Mu
- a Department of Clinical Pharmacy and Translational Science , University of Tennessee Health Science Center College of Pharmacy , Memphis , TN , USA
| | - Yuqing Gong
- b Department of Pharmaceutical Sciences , University of Tennessee Health Science Center College of Pharmacy , Memphis , TN , USA
| | - Sunitha Kodidela
- b Department of Pharmaceutical Sciences , University of Tennessee Health Science Center College of Pharmacy , Memphis , TN , USA
| | - Santosh Kumar
- b Department of Pharmaceutical Sciences , University of Tennessee Health Science Center College of Pharmacy , Memphis , TN , USA
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Ahmed H, Abushouk AI, Attia A, Gadelkarim M, Gabr M, Negida A, Abdel-Daim MM. Safety and efficacy of sofosbuvir plus velpatasvir with or without ribavirin for chronic hepatitis C virus infection: A systematic review and meta-analysis. J Infect Public Health 2018; 11:156-164. [DOI: 10.1016/j.jiph.2017.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 08/08/2017] [Accepted: 09/09/2017] [Indexed: 01/26/2023] Open
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Sorbo MC, Cento V, Di Maio VC, Howe AYM, Garcia F, Perno CF, Ceccherini-Silberstein F. Hepatitis C virus drug resistance associated substitutions and their clinical relevance: Update 2018. Drug Resist Updat 2018. [PMID: 29525636 DOI: 10.1016/j.drup.2018.01.004] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Nowadays, due to the development of potent Direct-Acting Antiviral Agents (DAAs) that specifically target NS3, NS5A and NS5B viral proteins, several new and highly efficacious options to treat chronic Hepatitis C virus (HCV) infection are available. The natural presence of resistance associated substitutions (RASs), as well as their rapid emergence during incomplete drug-pressure, are intrinsic characteristics of HCV that greatly affect treatment outcome and the chances to achieve a virolgical cure. To date, a high number of RASs in NS3, NS5A, and NS5B have been associated in vivo and/or in vitro with reduced susceptibility to DAAs, but no comprehensive RASs list is available. This review thus provides an updated, systematic overview of the role of RASs to currently approved DAAs or in phase II/III of clinical development against HCV-infection, discriminating their impact in different HCV-genotypes and DAAs, providing assistance for a fruitful use of HCV resistance testing in clinical practice.
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Affiliation(s)
- Maria C Sorbo
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Valeria Cento
- Residency program in Microbiology and Virology, Università degli Studi di Milano. Milan, Italy.
| | - Velia C Di Maio
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Anita Y M Howe
- Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, BC, Canada
| | - Federico Garcia
- Clinical Microbiology Service, Hospital Universitario San Cecilio, Granada, Spain
| | - Carlo F Perno
- Department of Oncology and Oncohematology, Università degli Studi di Milano. Milan, Italy.
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Jakobsen JC, Nielsen EE, Feinberg J, Katakam KK, Fobian K, Hauser G, Poropat G, Djurisic S, Weiss KH, Bjelakovic M, Bjelakovic G, Klingenberg SL, Liu JP, Nikolova D, Koretz RL, Gluud C. Direct-acting antivirals for chronic hepatitis C. Cochrane Database Syst Rev 2017; 9:CD012143. [PMID: 28922704 PMCID: PMC6484376 DOI: 10.1002/14651858.cd012143.pub3] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Millions of people worldwide suffer from hepatitis C, which can lead to severe liver disease, liver cancer, and death. Direct-acting antivirals (DAAs), e.g. sofosbuvir, are relatively new and expensive interventions for chronic hepatitis C, and preliminary results suggest that DAAs may eradicate hepatitis C virus (HCV) from the blood (sustained virological response). Sustained virological response (SVR) is used by investigators and regulatory agencies as a surrogate outcome for morbidity and mortality, based solely on observational evidence. However, there have been no randomised trials that have validated that usage. OBJECTIVES To assess the benefits and harms of DAAs in people with chronic HCV. SEARCH METHODS We searched for all published and unpublished trials in The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, LILACS, and BIOSIS; the Chinese Biomedical Literature Database (CBM), China Network Knowledge Information (CNKI), the Chinese Science Journal Database (VIP), Google Scholar, The Turning Research into Practice (TRIP) Database, ClinicalTrials.gov, European Medicines Agency (EMA) (www.ema.europa.eu/ema/), WHO International Clinical Trials Registry Platform (www.who.int/ictrp), the Food and Drug Administration (FDA) (www.fda.gov), and pharmaceutical company sources for ongoing or unpublished trials. Searches were last run in October 2016. SELECTION CRITERIA Randomised clinical trials comparing DAAs versus no intervention or placebo, alone or with co-interventions, in adults with chronic HCV. We included trials irrespective of publication type, publication status, and language. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were hepatitis C-related morbidity, serious adverse events, and health-related quality of life. Our secondary outcomes were all-cause mortality, ascites, variceal bleeding, hepato-renal syndrome, hepatic encephalopathy, hepatocellular carcinoma, non-serious adverse events (each reported separately), and SVR. We systematically assessed risks of bias, performed Trial Sequential Analysis, and followed an eight-step procedure to assess thresholds for statistical and clinical significance. We evaluated the overall quality of the evidence, using GRADE. MAIN RESULTS We included a total of 138 trials randomising a total of 25,232 participants. The trials were generally short-term trials and designed primarily to assess the effect of treatment on SVR. The trials evaluated 51 different DAAs. Of these, 128 trials employed matching placebo in the control group. All included trials were at high risk of bias. Eighty-four trials involved DAAs on the market or under development (13,466 participants). Fifty-seven trials administered DAAs that were discontinued or withdrawn from the market. Study populations were treatment-naive in 95 trials, had been exposed to treatment in 17 trials, and comprised both treatment-naive and treatment-experienced individuals in 24 trials. The HCV genotypes were genotype 1 (119 trials), genotype 2 (eight trials), genotype 3 (six trials), genotype 4 (nine trials), and genotype 6 (one trial). We identified two ongoing trials.We could not reliably determine the effect of DAAs on the market or under development on our primary outcome of hepatitis C-related morbidity or all-cause mortality. There were no data on hepatitis C-related morbidity and only limited data on mortality from 11 trials (DAA 15/2377 (0.63%) versus control 1/617 (0.16%); OR 3.72, 95% CI 0.53 to 26.18, very low-quality evidence). We did not perform Trial Sequential Analysis on this outcome.There is very low quality evidence that DAAs on the market or under development do not influence serious adverse events (DAA 5.2% versus control 5.6%; OR 0.93, 95% CI 0.75 to 1.15 , 15,817 participants, 43 trials). The Trial Sequential Analysis showed that there was sufficient information to rule out that DAAs reduce the relative risk of a serious adverse event by 20% when compared with placebo. The only DAA that showed a lower risk of serious adverse events when meta-analysed separately was simeprevir (OR 0.62, 95% CI 0.45 to 0.86). However, Trial Sequential Analysis showed that there was not enough information to confirm or reject a relative risk reduction of 20%, and when one trial with an extreme result was excluded, the meta-analysis result showed no evidence of a difference.DAAs on the market or under development may reduce the risk of no SVR from 54.1% in untreated people to 23.8% in people treated with DAA (RR 0.44, 95% CI 0.37 to 0.52, 6886 participants, 32 trials, low quality evidence). Trial Sequential Analysis confirmed this meta-analysis result.Only 1/84 trials on the market or under development assessed the effects of DAAs on health-related quality of life (SF-36 mental score and SF-36 physical score).There was insufficient evidence from trials on withdrawn or discontinued DAAs to determine their effect on hepatitis C-related morbidity and all-cause mortality (OR 0.64, 95% CI 0.23 to 1.79; 5 trials, very low-quality evidence). However, these DAAs seemed to increase the risk of serious adverse events (OR 1.45, 95% CI 1.22 to 1.73; 29 trials, very low-quality evidence). Trial Sequential Analysis confirmed this meta-analysis result.None of the 138 trials provided useful data to assess the effects of DAAs on the remaining secondary outcomes (ascites, variceal bleeding, hepato-renal syndrome, hepatic encephalopathy, and hepatocellular carcinoma). AUTHORS' CONCLUSIONS The evidence for our main outcomes of interest come from short-term trials, and we are unable to determine the effect of long-term treatment with DAAs. The rates of hepatitis C morbidity and mortality observed in the trials are relatively low and we are uncertain as to how DAAs affect this outcome. Overall, there is very low quality evidence that DAAs on the market or under development do not influence serious adverse events. There is insufficient evidence to judge if DAAs have beneficial or harmful effects on other clinical outcomes for chronic HCV. Simeprevir may have beneficial effects on risk of serious adverse event. In all remaining analyses, we could neither confirm nor reject that DAAs had any clinical effects. DAAs may reduce the number of people with detectable virus in their blood, but we do not have sufficient evidence from randomised trials that enables us to understand how SVR affects long-term clinical outcomes. SVR is still an outcome that needs proper validation in randomised clinical trials.
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Affiliation(s)
- Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenSjællandDenmarkDK‐2100
- Holbaek HospitalDepartment of CardiologyHolbaekDenmark4300
| | - Emil Eik Nielsen
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Joshua Feinberg
- Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812Blegdamsvej 9CopenhagenDenmark2100
| | - Kiran Kumar Katakam
- Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812Blegdamsvej 9CopenhagenDenmark2100
| | - Kristina Fobian
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Goran Hauser
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Goran Poropat
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Snezana Djurisic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Karl Heinz Weiss
- Heidelberg University HospitalInternal Medicine IV: Gastroenterology, Infectious Diseases, ToxicologyIm Neuenheimer Feld 410HeidelbergGermanyD‐69120
| | - Milica Bjelakovic
- University of NisMedical FacultyBoulevard Dr Zorana Djindjica 81NisSerbia18000
| | - Goran Bjelakovic
- Medical Faculty, University of NisDepartment of Internal MedicineZorana Djindjica 81NisSerbia18000
| | - Sarah Louise Klingenberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenSjællandDenmarkDK‐2100
| | - Jian Ping Liu
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese Medicine11 Bei San Huan Dong Lu, Chaoyang DistrictBeijingChina100029
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenSjællandDenmarkDK‐2100
| | | | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenSjællandDenmarkDK‐2100
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Gao M, O'Boyle DR, Roberts S. HCV NS5A replication complex inhibitors. Curr Opin Pharmacol 2017; 30:151-157. [PMID: 27643675 DOI: 10.1016/j.coph.2016.07.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 01/29/2023]
Abstract
The development of anti-HCV drugs is one of the most successful stories of antiviral therapy. In fact, for the first time in human history we have the potential to eradicate a chronic viral infection using only orally administered direct antiviral agents (DAAs). HCV NS5A replication complex inhibitors, exemplified by Daclatasvir (DCV, BMS-790052, Daklinza®), are a new class of DAA. The astonishing in vitro potency of DCV (pM to low nM range) translated to remarkable efficacy in clinical trials, and 2nd generation NS5A inhibitors have become essential components of HCV combination therapies. The current cure rate of effective combination therapies exceeds 90% in most clinical trials. The extraordinary potency of NS5A inhibitors promoted significant efforts to understand their mechanism(s) of inhibition.
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Affiliation(s)
- Min Gao
- Bristol-Myers Squibb Company, Wallingford, CT 06492, USA.
| | | | - Susan Roberts
- Bristol-Myers Squibb Company, Wallingford, CT 06492, USA
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20
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Jacobson IM, Lawitz E, Gane EJ, Willems BE, Ruane PJ, Nahass RG, Borgia SM, Shafran SD, Workowski KA, Pearlman B, Hyland RH, Stamm LM, Svarovskaia E, Dvory-Sobol H, Zhu Y, Subramanian GM, Brainard DM, McHutchison JG, Bräu N, Berg T, Agarwal K, Bhandari BR, Davis M, Feld JJ, Dore GJ, Stedman CAM, Thompson AJ, Asselah T, Roberts SK, Foster GR. Efficacy of 8 Weeks of Sofosbuvir, Velpatasvir, and Voxilaprevir in Patients With Chronic HCV Infection: 2 Phase 3 Randomized Trials. Gastroenterology 2017; 153:113-122. [PMID: 28390869 DOI: 10.1053/j.gastro.2017.03.047] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Patients with chronic hepatitis C virus (HCV) infection have high rates of sustained virologic response (SVR) after 12 weeks of treatment with the nucleotide polymerase inhibitor sofosbuvir combined with the NS5A inhibitor velpatasvir. We assessed the efficacy of 8 weeks of treatment with sofosbuvir and velpatasvir plus the pangenotypic NS3/4A protease inhibitor voxilaprevir (sofosbuvir-velpatasvir-voxilaprevir). METHODS In 2 phase 3, open-label trials, patients with HCV infection who had not been treated previously with a direct-acting antiviral agent were assigned randomly to groups given sofosbuvir-velpatasvir-voxilaprevir for 8 weeks or sofosbuvir-velpatasvir for 12 weeks. POLARIS-2, which enrolled patients infected with all HCV genotypes with or without cirrhosis, except patients with genotype 3 and cirrhosis, was designed to test the noninferiority of 8 weeks of sofosbuvir-velpatasvir-voxilaprevir to 12 weeks of sofosbuvir-velpatasvir using a noninferiority margin of 5%. POLARIS-3, which enrolled patients infected with HCV genotype 3 who had cirrhosis, compared rates of SVR in both groups with a performance goal of 83%. RESULTS In POLARIS-2, 95% (95% confidence interval [CI], 93%-97%) of patients had an SVR to 8 weeks of sofosbuvir-velpatasvir-voxilaprevir; this did not meet the criterion to establish noninferiority to 12 weeks of sofosbuvir-velpatasvir, which produced an SVR in 98% of patients (95% CI, 96%-99%; difference in the stratum-adjusted Mantel-Haenszel proportions of -3.2%; 95% CI, -6.0% to -0.4%). The difference in the efficacy was owing primarily to a lower rate of SVR (92%) among patients with HCV genotype 1a infection receiving 8 weeks of sofosbuvir-velpatasvir-voxilaprevir. In POLARIS-3, 96% of patients (95% CI, 91%-99%) achieved an SVR in both treatment groups, which was significantly superior to the performance goal. Overall, the most common adverse events were headache, fatigue, diarrhea, and nausea; diarrhea and nausea were reported more frequently by patients receiving voxilaprevir. In both trials, the proportion of patients who discontinued treatment because of adverse events was low (range, 0%-1%). CONCLUSIONS In phase 3 trials of patients with HCV infection, we did not establish that sofosbuvir-velpatasvir-voxilaprevir for 8 weeks was noninferior to sofosbuvir-velpatasvir for 12 weeks, but the 2 regimens had similar rates of SVR in patients with HCV genotype 3 and cirrhosis. Mild gastrointestinal adverse events were associated with treatment regimens that included voxilaprevir. ClinicalTrials.gov numbers: POLARIS-2, NCT02607800; and POLARIS-3, NCT02639338.
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Affiliation(s)
- Ira M Jacobson
- Mount Sinai Beth Israel, New York, New York; Icahn School of Medicine at Mount Sinai, New York, New York.
| | - Eric Lawitz
- Texas Liver Institute, University of Texas Health Science Center, San Antonio, Texas
| | - Edward J Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - Bernard E Willems
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Peter J Ruane
- Ruane Medical and Liver Health Institute, Los Angeles, California
| | | | - Sergio M Borgia
- William Osler Health System, Brampton Civic Hospital, Brampton, Ontario, Canada
| | | | | | | | | | | | | | | | - Yanni Zhu
- Gilead Sciences, Inc, Foster City, California
| | | | | | | | - Norbert Bräu
- James J. Peters Veterans Affairs Medical Center, Bronx, New York; Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas Berg
- Medical Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Kosh Agarwal
- Institute of Liver Studies, Kings College Hospital, London, United Kingdom
| | - Bal Raj Bhandari
- Gastroenterology and Nutritional Medical Services, Bastrop, Louisiana
| | - Mitchell Davis
- Digestive Care, South Florida Center of Gastroenterology, Wellington, Florida
| | - Jordan J Feld
- Toronto Western Hospital Liver Centre, Toronto, Ontario, Canada
| | - Gregory J Dore
- St Vincent's Hospital Sydney, University of New South Wales Sydney, Sydney, New South Wales, Australia; Kirby Institute, University of New South Wales Sydney, Sydney, New South Wales, Australia
| | | | | | - Tarik Asselah
- Hôpital Beaujon, Université Paris Diderot, INSERM UMR 1149, Centre de Recherche sur l'Inflammation, Clichy, France
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Jakobsen JC, Nielsen EE, Feinberg J, Katakam KK, Fobian K, Hauser G, Poropat G, Djurisic S, Weiss KH, Bjelakovic M, Bjelakovic G, Klingenberg SL, Liu JP, Nikolova D, Koretz RL, Gluud C. Direct-acting antivirals for chronic hepatitis C. Cochrane Database Syst Rev 2017; 6:CD012143. [PMID: 28585310 PMCID: PMC6484383 DOI: 10.1002/14651858.cd012143.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Millions of people worldwide suffer from hepatitis C, which can lead to severe liver disease, liver cancer, and death. Direct-acting antivirals (DAAs) are relatively new and expensive interventions for chronic hepatitis C, and preliminary results suggest that DAAs may eradicate hepatitis C virus (HCV) from the blood (sustained virological response). However, it is still questionable if eradication of hepatitis C virus in the blood eliminates hepatitis C in the body, and improves survival and leads to fewer complications. OBJECTIVES To assess the benefits and harms of DAAs in people with chronic HCV. SEARCH METHODS We searched for all published and unpublished trials in The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, MEDLINE, Embase, Science Citation Index Expanded, LILACS, and BIOSIS; the Chinese Biomedical Literature Database (CBM), China Network Knowledge Information (CNKI), the Chinese Science Journal Database (VIP), Google Scholar, The Turning Research into Practice (TRIP) Database, ClinicalTrials.gov, European Medicines Agency (EMA) (www.ema.europa.eu/ema/), WHO International Clinical Trials Registry Platform (www.who.int/ictrp), the Food and Drug Administration (FDA) (www.fda.gov), and pharmaceutical company sources for ongoing or unpublished trials. Searches were last run in October 2016. SELECTION CRITERIA Randomised clinical trials comparing DAAs versus no intervention or placebo, alone or with co-interventions, in adults with chronic HCV. We included trials irrespective of publication type, publication status, and language. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were hepatitis C-related morbidity, serious adverse events, and quality of life. Our secondary outcomes were all-cause mortality, ascites, variceal bleeding, hepato-renal syndrome, hepatic encephalopathy, hepatocellular carcinoma, non-serious adverse events (each reported separately), and sustained virological response. We systematically assessed risks of bias, performed Trial Sequential Analysis, and followed an eight-step procedure to assess thresholds for statistical and clinical significance. The overall quality of the evidence was evaluated using GRADE. MAIN RESULTS We included a total of 138 trials randomising a total of 25,232 participants. The 138 trials assessed the effects of 51 different DAAs. Of these, 128 trials employed matching placebo in the control group. All included trials were at high risk of bias. Eighty-four trials involved DAAs on the market or under development (13,466 participants). Fifty-seven trials administered withdrawn or discontinued DAAs. Trial participants were treatment-naive (95 trials), treatment-experienced (17 trials), or both treatment-naive and treatment-experienced (24 trials). The HCV genotypes were genotype 1 (119 trials), genotype 2 (eight trials), genotype 3 (six trials), genotype 4 (nine trials), and genotype 6 (one trial). We identified two ongoing trials.Meta-analysis of the effects of all DAAs on the market or under development showed no evidence of a difference when assessing hepatitis C-related morbidity or all-cause mortality (OR 3.72, 95% CI 0.53 to 26.18, P = 0.19, I² = 0%, 2,996 participants, 11 trials, very low-quality evidence). As there were no data on hepatitis C-related morbidity and very few data on mortality (DAA 15/2377 (0.63%) versus control 1/617 (0.16%)), it was not possible to perform Trial Sequential Analysis on hepatitis C-related morbidity or all-cause mortality.Meta-analysis of all DAAs on the market or under development showed no evidence of a difference when assessing serious adverse events (OR 0.93, 95% CI 0.75 to 1.15, P = 0.52, I² = 0%, 15,817 participants, 43 trials, very low-quality evidence). The Trial Sequential Analysis showed that the cumulative Z-score crossed the trial sequential boundary for futility, showing that there was sufficient information to rule out that DAAs compared with placebo reduced the relative risk of a serious adverse event by 20%. The only DAA that showed a significant difference on risk of serious adverse events when meta-analysed separately was simeprevir (OR 0.62, 95% CI 0.45 to 0.86). However, Trial Sequential Analysis showed that there was not enough information to confirm or reject a relative risk reduction of 20%, and when one trial with an extreme result was excluded, then the meta-analysis result showed no evidence of a difference.DAAs on the market or under development seemed to reduce the risk of no sustained virological response (RR 0.44, 95% CI 0.37 to 0.52, P < 0.00001, I² = 77%, 6886 participants, 32 trials, very low-quality evidence) and Trial Sequential Analysis confirmed this meta-analysis result.Only 1/84 trials on the market or under development assessed the effects of DAAs on health-related quality of life (SF-36 mental score and SF-36 physical score).Withdrawn or discontinued DAAs had no evidence of a difference when assessing hepatitis C-related morbidity and all-cause mortality (OR 0.64, 95% CI 0.23 to 1.79, P = 0.40, I² = 0%; 5 trials, very low-quality evidence). However, withdrawn DAAs seemed to increase the risk of serious adverse events (OR 1.45, 95% CI 1.22 to 1.73, P = 0.001, I² = 0%, 29 trials, very low-quality evidence), and Trial Sequential Analysis confirmed this meta-analysis result.Most of all outcome results were short-term results; therefore, we could neither confirm nor reject any long-term effects of DAAs. None of the 138 trials provided useful data to assess the effects of DAAs on the remaining secondary outcomes (ascites, variceal bleeding, hepato-renal syndrome, hepatic encephalopathy, and hepatocellular carcinoma). AUTHORS' CONCLUSIONS Overall, DAAs on the market or under development do not seem to have any effects on risk of serious adverse events. Simeprevir may have beneficial effects on risk of serious adverse event. In all remaining analyses, we could neither confirm nor reject that DAAs had any clinical effects. DAAs seemed to reduce the risk of no sustained virological response. The clinical relevance of the effects of DAAs on no sustained virological response is questionable, as it is a non-validated surrogate outcome. All trials and outcome results were at high risk of bias, so our results presumably overestimate benefit and underestimate harm. The quality of the evidence was very low.
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Affiliation(s)
| | - Emil Eik Nielsen
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Joshua Feinberg
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Kiran Kumar Katakam
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalBlegdamsvej 9CopenhagenDenmark2100
| | - Kristina Fobian
- Department 7812, Rigshospitalet, Copenhagen University HospitalCopenhagen Trial Unit, Centre for Clinical Intervention ResearchBlegdamsvej 9CopenhagenDenmark2100
| | - Goran Hauser
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Goran Poropat
- Clinical Hospital Centre RijekaDepartment of GastroenterologyKresimirova 42RijekaCroatia51 000
| | - Snezana Djurisic
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalBlegdamsvej 9CopenhagenDenmark2100
| | - Karl Heinz Weiss
- Heidelberg University HospitalInternal Medicine IV: Gastroenterology, Infectious Diseases, ToxicologyIm Neuenheimer Feld 410HeidelbergGermanyD‐69120
| | - Milica Bjelakovic
- University of NisMedical FacultyBoulevard Dr Zorana Djindjica 81NisSerbia18000
| | - Goran Bjelakovic
- Medical Faculty, University of NisDepartment of Internal MedicineZorana Djindjica 81NisSerbia18000
| | - Sarah Louise Klingenberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | - Jian Ping Liu
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese Medicine11 Bei San Huan Dong Lu, Chaoyang DistrictBeijingChina100029
| | - Dimitrinka Nikolova
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
| | | | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Department 7812, Rigshospitalet, Copenhagen University HospitalThe Cochrane Hepato‐Biliary GroupBlegdamsvej 9CopenhagenDenmarkDK‐2100
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Bourlière M, Gordon SC, Flamm SL, Cooper CL, Ramji A, Tong M, Ravendhran N, Vierling JM, Tran TT, Pianko S, Bansal MB, de Lédinghen V, Hyland RH, Stamm LM, Dvory-Sobol H, Svarovskaia E, Zhang J, Huang KC, Subramanian GM, Brainard DM, McHutchison JG, Verna EC, Buggisch P, Landis CS, Younes ZH, Curry MP, Strasser SI, Schiff ER, Reddy KR, Manns MP, Kowdley KV, Zeuzem S. Sofosbuvir, Velpatasvir, and Voxilaprevir for Previously Treated HCV Infection. N Engl J Med 2017; 376:2134-2146. [PMID: 28564569 DOI: 10.1056/nejmoa1613512] [Citation(s) in RCA: 394] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients who are chronically infected with hepatitis C virus (HCV) and who do not have a sustained virologic response after treatment with regimens containing direct-acting antiviral agents (DAAs) have limited retreatment options. METHODS We conducted two phase 3 trials involving patients who had been previously treated with a DAA-containing regimen. In POLARIS-1, patients with HCV genotype 1 infection who had previously received a regimen containing an NS5A inhibitor were randomly assigned in a 1:1 ratio to receive either the nucleotide polymerase inhibitor sofosbuvir, the NS5A inhibitor velpatasvir, and the protease inhibitor voxilaprevir (150 patients) or matching placebo (150 patients) once daily for 12 weeks. Patients who were infected with HCV of other genotypes (114 patients) were enrolled in the sofosbuvir-velpatasvir-voxilaprevir group. In POLARIS-4, patients with HCV genotype 1, 2, or 3 infection who had previously received a DAA regimen but not an NS5A inhibitor were randomly assigned in a 1:1 ratio to receive sofosbuvir-velpatasvir-voxilaprevir (163 patients) or sofosbuvir-velpatasvir (151 patients) for 12 weeks. An additional 19 patients with HCV genotype 4 infection were enrolled in the sofosbuvir-velpatasvir-voxilaprevir group. RESULTS In the three active-treatment groups, 46% of the patients had compensated cirrhosis. In POLARIS-1, the rate of sustained virologic response was 96% with sofosbuvir-velpatasvir-voxilaprevir, as compared with 0% with placebo. In POLARIS-4, the rate of response was 98% with sofosbuvir-velpatasvir-voxilaprevir and 90% with sofosbuvir-velpatasvir. The most common adverse events were headache, fatigue, diarrhea, and nausea. In the active-treatment groups in both trials, the percentage of patients who discontinued treatment owing to adverse events was 1% or lower. CONCLUSIONS Sofosbuvir-velpatasvir-voxilaprevir taken for 12 weeks provided high rates of sustained virologic response among patients across HCV genotypes in whom treatment with a DAA regimen had previously failed. (Funded by Gilead Sciences; POLARIS-1 and POLARIS-4 ClinicalTrials.gov numbers, NCT02607735 and NCT02639247 .).
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Affiliation(s)
- Marc Bourlière
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Stuart C Gordon
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Steven L Flamm
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Curtis L Cooper
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Alnoor Ramji
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Myron Tong
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Natarajan Ravendhran
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - John M Vierling
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Tram T Tran
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Stephen Pianko
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Meena B Bansal
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Victor de Lédinghen
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Robert H Hyland
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Luisa M Stamm
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Hadas Dvory-Sobol
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Evguenia Svarovskaia
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Jie Zhang
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - K C Huang
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - G Mani Subramanian
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Diana M Brainard
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - John G McHutchison
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Elizabeth C Verna
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Peter Buggisch
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Charles S Landis
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Ziad H Younes
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Michael P Curry
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Simone I Strasser
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Eugene R Schiff
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - K Rajender Reddy
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Michael P Manns
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Kris V Kowdley
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
| | - Stefan Zeuzem
- From Hospital Saint Joseph, Marseille (M.B.), and University Hospital of Bordeaux, Pessac (V.L.) - both in France; Henry Ford Health System, Detroit (S.C.G.); Northwestern University, Chicago (S.L.F.); Ottawa Hospital Research Institute, Ottawa (C.L.C.), and St. Paul's Hospital, Vancouver, BC (A.R.) - both in Canada; Huntington Medical Research Institutes, Pasadena (M.T.), Cedars-Sinai Medical Center, Los Angeles (T.T.T.), and Gilead Sciences, Foster City (R.H.H., L.M.S., H.D.-S., E.S., J.Z., K.C.H., G.M.S., D.M.B., J.G.M.) - all in California; Digestive Disease Associates, Catonsville, MD (N.R.); Baylor College of Medicine, Houston (J.M.V.); Monash Health and Monash University, Clayton, VIC (S.P.), and Royal Prince Alfred Hospital, Sydney (S.I.S.) - both in Australia; Icahn School of Medicine at Mount Sinai (M.B.B.) and Columbia University Medical Center (E.C.V.) - both in New York; ifi-Institute for Interdisciplinary Medicine, Hamburg (P.B.), Hannover Medical School, Hannover (M.P.M.), and Johann Wolfgang Goethe University Medical Center, Frankfurt (S.Z.) - all in Germany; University of Washington (C.S.L.) and Swedish Medical Center (K.V.K.) - both in Seattle; Gastro One, Germantown, TN (Z.H.Y.); Beth Israel Deaconess Medical Center, Boston (M.P.C.); University of Miami, Miami (E.R.S.); and University of Pennsylvania, Philadelphia (K.R.R.)
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Preclinical Pharmacokinetics and First-in-Human Pharmacokinetics, Safety, and Tolerability of Velpatasvir, a Pangenotypic Hepatitis C Virus NS5A Inhibitor, in Healthy Subjects. Antimicrob Agents Chemother 2017; 61:AAC.02084-16. [PMID: 28193657 DOI: 10.1128/aac.02084-16] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/04/2017] [Indexed: 12/13/2022] Open
Abstract
Preclinical characterization of velpatasvir (VEL; GS-5816), an inhibitor of the hepatitis C virus (HCV) NS5A protein, demonstrated that it has favorable in vitro and in vivo properties, including potent antiviral activity against hepatitis C virus genotype 1 to 6 replicons, good metabolic stability, low systemic clearance, and adequate bioavailability and physicochemical properties, to warrant clinical evaluation. The phase 1 (first-in-human) study evaluated the safety, tolerability, and pharmacokinetics of VEL in healthy human subjects following administration of single and multiple (n = 7) once-daily ascending doses and of VEL in the presence and absence of food. Following administration of single and multiple doses, VEL was safe and well tolerated when administered at up to 450 mg and when administered with food. The pharmacokinetic behavior of VEL observed in humans was generally in agreement with that seen during preclinical characterization. Following administration of multiple doses, VEL trough concentrations were significantly greater than the protein-adjusted half-maximal (50%) effective concentration of VEL against HCV genotype 1 to 6 replicons at all evaluated doses greater than 5 mg. The pharmacokinetics of VEL were not significantly affected by administration with food. Collectively, the results of this study support the further clinical investigation of VEL administered once daily as part of a regimen with other pangenotypic direct-acting antivirals for the treatment of HCV infection.
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In Vitro Antiviral Activity and Resistance Profile of the Next-Generation Hepatitis C Virus NS5A Inhibitor Pibrentasvir. Antimicrob Agents Chemother 2017; 61:AAC.02558-16. [PMID: 28193664 PMCID: PMC5404558 DOI: 10.1128/aac.02558-16] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 02/09/2017] [Indexed: 02/06/2023] Open
Abstract
Pibrentasvir (ABT-530) is a novel and pan-genotypic hepatitis C virus (HCV) NS5A inhibitor with 50% effective concentration (EC50) values ranging from 1.4 to 5.0 pM against HCV replicons containing NS5A from genotypes 1 to 6. Pibrentasvir demonstrated similar activity against a panel of chimeric replicons containing HCV NS5A of genotypes 1 to 6 from clinical samples. Resistance selection studies were conducted using HCV replicon cells with NS5A from genotype 1a, 1b, 2a, 2b, 3a, 4a, 5a, or 6a at a concentration of pibrentasvir that was 10- or 100-fold over its EC50 for the respective replicon. With pibrentasvir at 10-fold over the respective EC50, only a small number of colonies (0.00015 to 0.0065% of input cells) with resistance-associated amino acid substitutions were selected in replicons containing genotype 1a, 2a, or 3a NS5A, and no viable colonies were selected in replicons containing NS5A from other genotypes. With pibrentasvir at 100-fold over the respective EC50, very few colonies (0.0002% of input cells) were selected by pibrentasvir in genotype 1a replicon cells while no colonies were selected in other replicons. Pibrentasvir is active against common resistance-conferring substitutions in HCV genotypes 1 to 6 that were identified for other NS5A inhibitors, including those at key amino acid positions 28, 30, 31, or 93. The combination of pibrentasvir with HCV inhibitors of other classes produced synergistic inhibition of HCV replication. In summary, pibrentasvir is a next-generation HCV NS5A inhibitor with potent and pan-genotypic activity, and it maintains activity against common amino acid substitutions of HCV genotypes 1 to 6 that are known to confer resistance to currently approved NS5A inhibitors.
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25
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Weisberg IS, Jacobson IM. A pangenotypic, single tablet regimen of sofosbuvir/velpatasvir for the treatment of chronic hepatitis C infection. Expert Opin Pharmacother 2017; 18:535-543. [DOI: 10.1080/14656566.2017.1282459] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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26
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Brieva T, Rivero A, Rivero-Juarez A. Pharmacokinetic drug evaluation of velpatasvir plus sofosbuvir for the treatment of hepatitis C virus infection. Expert Opin Drug Metab Toxicol 2017; 13:483-490. [PMID: 28165830 DOI: 10.1080/17425255.2017.1292253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The fixed-dose combination therapy of sofosbuvir (SOF) plus velpatasvir (VEL) is the first pangenotypic, direct-acting antiviral (DAA), single-treatment regimen (STR) for the treatment of hepatitis C virus (HCV) infection to be commercialized. It is approved for the treatment of HCV genotypes 1, 2, 3, 4, 5, and 6. Following approval in 2016, new pharmacokinetic and pharmacodynamic data were reported, which led to important clinical applications. Areas covered: This review provides a summary of the pharmacokinetics, pharmacodynamics, efficacy and safety of SOF/VEL therapy for treatment of HCV infection. The topics covered include data regarding the drug's absorption, distribution, metabolism, excretion and antiviral activity strategies, such as clinical dose selection and treatment duration. Expert opinion: This novel combination therapy containing 400 mg of SOF plus 100 mg of VEL, taken orally, once daily, with or without food, has an excellent pharmacokinetic and pharmacodynamic profile. SOF/VEL achieved very high rates of sustained virological response in treatment-naive and treatment-experienced patients with chronic HCV genotype 1-6 infection, including those with compensated cirrhosis or HIV-1 co-infection.
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Affiliation(s)
- Teresa Brieva
- a Unidad de Enfermedades Infecciosas , Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba , Cordoba , Spain
| | - Antonio Rivero
- a Unidad de Enfermedades Infecciosas , Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba , Cordoba , Spain
| | - Antonio Rivero-Juarez
- a Unidad de Enfermedades Infecciosas , Hospital Universitario Reina Sofía de Córdoba, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba , Cordoba , Spain
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27
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Burstow NJ, Mohamed Z, Gomaa AI, Sonderup MW, Cook NA, Waked I, Spearman CW, Taylor-Robinson SD. Hepatitis C treatment: where are we now? Int J Gen Med 2017; 10:39-52. [PMID: 28255252 PMCID: PMC5322849 DOI: 10.2147/ijgm.s127689] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Chronic hepatitis C infection affects millions of people worldwide and confers significant morbidity and mortality. Effective treatment is needed to prevent disease progression and associated complications. Previous treatment options were limited to interferon and ribavirin (RBV) regimens, which gave low cure rates and were associated with unpleasant side effects. The era of direct-acting antiviral (DAA) therapies began with the development of first-generation NS3/4A protease inhibitors in 2011. They vastly improved outcomes for patients, particularly those with genotype 1 infection, the most prevalent genotype globally. Since then, a multitude of DAAs have been licensed for use, and outcomes for patients have improved further, with fewer side effects and cure rates approaching 100%. Recent regimens are interferon-free, and in many cases, RBV-free, and involve a combination of DAA agents. This review summarizes the treatment options currently available and discusses potential barriers that may delay the global eradication of hepatitis C.
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Affiliation(s)
- Nicholas J Burstow
- Liver Unit, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Zameer Mohamed
- Liver Unit, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Asmaa I Gomaa
- National Liver Institute, Menoufiya University, Shbeen El Kom, Egypt
| | - Mark W Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa
| | - Nicola A Cook
- Liver Unit, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Imam Waked
- National Liver Institute, Menoufiya University, Shbeen El Kom, Egypt
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, Republic of South Africa
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Wilson EM, Rosenthal ES, Kattakuzhy S, Tang L, Kottilil S. Clinical Laboratory Testing in the Era of Directly Acting Antiviral Therapies for Hepatitis C. Clin Microbiol Rev 2017; 30:23-42. [PMID: 27795306 PMCID: PMC5217793 DOI: 10.1128/cmr.00037-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Directly acting antiviral (DAA) combination therapies for chronic hepatitis C virus (HCV) infection are highly effective, but treatment decisions remain complex. Laboratory testing is important to evaluate a range of viral, host, and pharmacological factors when considering HCV treatment, and patients must be monitored during and after therapy for safety and to assess the viral response. In this review, we discuss the laboratory tests relevant for the treatment of HCV infection in the era of DAA therapy, grouped according to viral and host factors.
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Affiliation(s)
- Eleanor M Wilson
- Institute of Human Virology, University of Maryland School of Medicine, University of Maryland, Baltimore, Maryland, USA
- Critical Care Medicine Department of the NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Elana S Rosenthal
- Critical Care Medicine Department of the NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Sarah Kattakuzhy
- Institute of Human Virology, University of Maryland School of Medicine, University of Maryland, Baltimore, Maryland, USA
- Critical Care Medicine Department of the NIH Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Lydia Tang
- Institute of Human Virology, University of Maryland School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Shyam Kottilil
- Institute of Human Virology, University of Maryland School of Medicine, University of Maryland, Baltimore, Maryland, USA
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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Hashem MB, Elbaz T, El-kassas M, Esmat G. Management of Hepatitis C Virus—Genotypes 4, 5, and 6 Using Direct Antiviral Agents: Review of Current Status. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Gane EJ, Kowdley KV, Pound D, Stedman CAM, Davis M, Etzkorn K, Gordon SC, Bernstein D, Everson G, Rodriguez-Torres M, Tsai N, Khalid O, Yang JC, Lu S, Dvory-Sobol H, Stamm LM, Brainard DM, McHutchison JG, Tong M, Chung RT, Beavers K, Poulos JE, Kwo PY, Nguyen MH. Efficacy of Sofosbuvir, Velpatasvir, and GS-9857 in Patients With Hepatitis C Virus Genotype 2, 3, 4, or 6 Infections in an Open-Label, Phase 2 Trial. Gastroenterology 2016; 151:902-909. [PMID: 27486033 DOI: 10.1053/j.gastro.2016.07.038] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Studies are needed to determine the optimal regimen for patients with chronic hepatitis C virus (HCV) genotype 2, 3, 4, or 6 infections whose prior course of antiviral therapy has failed, and the feasibility of shortening treatment duration. We performed a phase 2 study to determine the efficacy and safety of the combination of the nucleotide polymerase inhibitor sofosbuvir, the NS5A inhibitor velpatasvir, and the NS3/4A protease inhibitor GS-9857 in these patients. METHODS We performed a multicenter, open-label trial at 32 sites in the United States and 2 sites in New Zealand from March 3, 2015 to April 27, 2015. Our study included 128 treatment-naïve and treatment-experienced patients (1 with HCV genotype 1b; 33 with HCV genotype 2; 74 with HCV genotype 3; 17 with genotype HCV 4; and 3 with HCV genotype 6), with or without compensated cirrhosis. All patients received sofosbuvir-velpatasvir (400 mg/100 mg fixed-dose combination tablet) and GS-9857 (100 mg) once daily for 6-12 weeks. The primary end point was sustained virologic response 12 weeks after treatment (SVR12). RESULTS After 6 weeks of treatment, SVR12s were achieved by 88% of treatment-naïve patients without cirrhosis (29 of 33; 95% confidence interval, 72%-97%). After 8 weeks of treatment, SVR12s were achieved by 93% of treatment-naïve patients with cirrhosis (28 of 30; 95% CI, 78%-99%). After 12 weeks of treatment, SVR12s were achieved by all treatment-experienced patients without cirrhosis (36 of 36; 95% CI, 90%-100%) and 97% of treatment-experienced patients with cirrhosis (28 of 29; 95% CI, 82%-100%). The most common adverse events were headache, diarrhea, fatigue, and nausea. Three patients (1%) discontinued treatment due to adverse events. CONCLUSIONS In a phase 2 open-label trial, we found sofosbuvir-velpatasvir plus GS-9857 (8 weeks in treatment-naïve patients or 12 weeks in treatment-experienced patients) to be safe and effective for patients with HCV genotype 2, 3, 4, or 6 infections, with or without compensated cirrhosis. ClinicalTrials.gov ID: NCT02378961.
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Affiliation(s)
| | | | - David Pound
- Indianapolis Gastroenterology Research Foundation, Indianapolis, Indiana
| | | | - Mitchell Davis
- Digestive CARE-South Florida Center of Gastroenterology, Wellington, Florida
| | - Kyle Etzkorn
- Borland-Groover Clinic, Jacksonville, Mississippi
| | | | | | | | | | | | - Omer Khalid
- Digestive Health Specialists, Winston-Salem, North Carolina
| | | | - Sophia Lu
- Gilead Sciences, Foster City, California
| | | | | | | | | | - Myron Tong
- Huntington Medical Research Institutes Liver Center, Pasadena, California
| | | | - Kimberly Beavers
- Medical University of South Carolina, Charleston, South Carolina
| | - John E Poulos
- Cumberland Research Associates, LLC, Fayetteville, Georgia
| | - Paul Y Kwo
- Indiana University School of Medicine, Indiana
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Lawitz E, Reau N, Hinestrosa F, Rabinovitz M, Schiff E, Sheikh A, Younes Z, Herring R, Reddy KR, Tran T, Bennett M, Nahass R, Yang JC, Lu S, Dvory-Sobol H, Stamm LM, Brainard DM, McHutchison JG, Pearlman B, Shiffman M, Hawkins T, Curry M, Jacobson I. Efficacy of Sofosbuvir, Velpatasvir, and GS-9857 in Patients With Genotype 1 Hepatitis C Virus Infection in an Open-Label, Phase 2 Trial. Gastroenterology 2016; 151:893-901.e1. [PMID: 27486034 DOI: 10.1053/j.gastro.2016.07.039] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/25/2016] [Accepted: 07/26/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The best regimen to re-treat patients who do not respond to direct-acting antivirals (DAAs) and the feasibility of further shortening regimens is unclear. We assessed the efficacy and safety of the combination of the nucleotide polymerase inhibitor sofosbuvir, the NS5A inhibitor velpatasvir, and the NS3/4A protease inhibitor GS-9857 in patients with hepatitis C virus genotype 1 infection. METHODS We performed an open-label trial at 32 sites in the United States and at 2 sites in New Zealand of 197 patients with genotype 1 hepatitis C virus infection, with or without compensated cirrhosis, who were treatment-naive or were treated previously with a DAA. Between March 2, 2015, and September 1, 2015, patients received sofosbuvir-velpatasvir (400 mg/100 mg in a fixed-dose combination) plus GS-9857 (100 mg) once daily for 6-12 weeks, plus ribavirin for 1 treatment group consisting of treatment-naive patients with cirrhosis. The primary end point was sustained virologic response 12 weeks after treatment (SVR12). RESULTS Among treatment-naive patients without cirrhosis, 71% (24 of 34; 95% confidence interval [CI], 53-85) achieved SVR12 after 6 weeks of treatment and 100% (36 of 36; 95% CI, 90%-100%) achieved SVR12 after 8 weeks of treatment. Among treatment-naive patients with cirrhosis, 94% (31 of 33; 95% CI, 80-99) achieved SVR12 after 8 weeks of treatment and 81% (25 of 31; 95% CI, 63-93) achieved SVR12 after 8 weeks of treatment with ribavirin. Among DAA-experienced patients treated for 12 weeks, 100% without cirrhosis (31 of 31; 95% CI, 89-100) and 100% with cirrhosis (32 of 32; 95% CI, 89-100) achieved SVR12. The most common adverse events were headache, diarrhea, fatigue, and nausea. One patient (<1%) discontinued treatment because of adverse events. CONCLUSIONS In a phase 2 open-label trial, we found 8 weeks of treatment with sofosbuvir-velpatasvir plus GS-9857 to be safe and effective in treatment-naive patients; 12 weeks was safe and effective in patients previously treated with DAAs. The combination was safe and effective in patients with or without compensated cirrhosis. Clinicaltrials.gov no: NCT02378935.
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Affiliation(s)
- Eric Lawitz
- Texas Liver Institute, University of Texas Health Sciences Center, San Antonio, Texas.
| | - Nancy Reau
- Rush University Medical Center, Chicago, Illinois
| | | | | | - Eugene Schiff
- Schiff Center for Liver Diseases, University of Miami Miller School of Medicine, Miami, Florida
| | - Aasim Sheikh
- Gastrointestinal Specialists of Georgia, Marietta, Georgia
| | | | | | - K Rajender Reddy
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Tram Tran
- Sinai Medical Center, Los Angeles, California
| | - Michael Bennett
- Medical Associates Research Group, Inc, San Diego, California
| | | | | | - Sophia Lu
- Gilead Sciences, Foster City, California
| | | | | | | | | | | | | | | | - Michael Curry
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Chahine EB, Sucher AJ, Hemstreet BA. Sofosbuvir/Velpatasvir: The First Pangenotypic Direct-Acting Antiviral Combination for Hepatitis C. Ann Pharmacother 2016; 51:44-53. [PMID: 27609942 DOI: 10.1177/1060028016668897] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To review the pharmacology, efficacy, and safety of sofosbuvir/velpatasvir in the treatment of patients with hepatitis C virus (HCV) infection. DATA SOURCES A literature search through PubMed was conducted (June 2008 to August 2016) using the terms GS-5816, velpatasvir, and sofosbuvir. References from retrieved articles and the prescribing information were reviewed for any additional material. STUDY SELECTION/DATA EXTRACTION The literature search was limited to human studies published in English. Phase I, II, and III studies of sofosbuvir/velpatasvir for HCV were identified. DATA SYNTHESIS Sofosbuvir/velpatasvir is indicated for adult patients with chronic HCV genotype 1 through 6. It is given without ribavirin in patients with or without compensated cirrhosis and with ribavirin in patients who have decompensated cirrhosis. The ASTRAL-1 study demonstrated that sofosbuvir 400 mg plus velpatasvir 100 mg for 12 weeks was effective at achieving high sustained virological response (SVR12) rates in patients with HCV genotype 1, 2, 4, 5, or 6. The ASTRAL-2 and ASTRAL-3 studies demonstrated that the same regimen was effective at achieving high SVR12 rates in patients with HCV genotype 2 or 3. The ASTRAL-4 study demonstrated that the same regimen plus ribavirin was effective at achieving high SVR12 rate in patients with decompensated cirrhosis. The most common adverse reactions (≥10% of patients) associated with sofosbuvir/velpatasvir were headache and fatigue. CONCLUSIONS Sofosbuvir/velpatasvir is safe and effective to treat HCV genotypes 1, 2, 3, 4, 5, and 6 in patients with or without compensated cirrhosis. The addition of ribavirin is recommended in patients with decompensated cirrhosis.
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Discovery of ravidasvir (PPI-668) as a potent pan-genotypic HCV NS5A inhibitor. Bioorg Med Chem Lett 2016; 26:4508-4512. [DOI: 10.1016/j.bmcl.2016.07.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 12/17/2022]
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Gane EJ, Schwabe C, Hyland RH, Yang Y, Svarovskaia E, Stamm LM, Brainard DM, McHutchison JG, Stedman CA. Efficacy of the Combination of Sofosbuvir, Velpatasvir, and the NS3/4A Protease Inhibitor GS-9857 in Treatment-Naïve or Previously Treated Patients With Hepatitis C Virus Genotype 1 or 3 Infections. Gastroenterology 2016; 151:448-456.e1. [PMID: 27240903 DOI: 10.1053/j.gastro.2016.05.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/12/2016] [Accepted: 05/19/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS We performed a phase 2 trial of the efficacy and safety of 4, 6, and 8 weeks of sofosbuvir, given in combination with the NS5A inhibitor velpatasvir and the NS3/4A protease inhibitor GS-9857, in patients with hepatitis C virus (HCV) infection. METHODS We enrolled 161 treatment-naïve or previously treated patients infected with HCV genotypes 1 or 3 with or without compensated cirrhosis at 2 centers in New Zealand, from September 2014 through March 2015. All patients received sofosbuvir (400 mg) and velpatasvir (100 mg) plus GS-9857 (100 mg) once daily. The primary efficacy end point was sustained virologic response at 12 weeks after therapy (SVR12). The duration of therapy was determined by baseline patient characteristics: 4 or 6 weeks for treatment-naïve patients without cirrhosis, 6 weeks for treatment-naïve patients with cirrhosis, and 6 or 8 weeks for treatment-experienced patients with or without cirrhosis. RESULTS Four weeks of sofosbuvir, velpatasvir, and GS-9857 produced an SVR12 in 4 of 15 (27%) treatment-naïve patients with HCV genotype 1 without cirrhosis. Six weeks of this combination produced a SVR12 in 14 of 15 (93%) treatment-naïve patients with HCV genotype 1 without cirrhosis, in 13 of 15 (87%) treatment-naïve genotype 1 patients with cirrhosis, in 15 of 18 (83%) treatment-naïve patients with HCV genotype 3 with cirrhosis, and in 20 of 30 (67%) patients with HCV genotype 1 who had failed an all-oral regimen of 2 or more direct-acting antiviral agents. Eight weeks of the drug combination produced an SVR12 in 17 of 17 (100%) patients with HCV genotype 1, in 19 of 19 (100%) patients with HCV genotype 3 and cirrhosis who had failed pegylated interferon plus ribavirin, in 25 of 28 (89%) patients with HCV genotype 1 who had failed protease inhibitor-based triple therapy, and in 4 of 4 (100%) patients with HCV genotype 3 who had failed an all-oral regimen of ≥2 direct-acting antiviral agents. The most common reported adverse events were headache, nausea, and fatigue. CONCLUSIONS Eight weeks of treatment with the combination of sofosbuvir, velpatasvir, and GS-9857 produced an SVR12 in most treatment-naïve or previously treated patients with HCV genotype 1 or 3 infections, including those with compensated cirrhosis. ClinicalTrials.gov, Number: NCT02202980.
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Affiliation(s)
- Edward J Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
| | | | | | - Yin Yang
- Gilead Sciences, Inc, Foster City, California
| | | | | | | | | | - Catherine A Stedman
- Gastroenterology Department, Christchurch Hospital, and University of Otago, Christchurch, New Zealand
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Clinical Resistance to Velpatasvir (GS-5816), a Novel Pan-Genotypic Inhibitor of the Hepatitis C Virus NS5A Protein. Antimicrob Agents Chemother 2016; 60:5368-78. [PMID: 27353271 DOI: 10.1128/aac.00763-16] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/22/2016] [Indexed: 02/07/2023] Open
Abstract
Velpatasvir (VEL, GS-5816) is a novel pan-genotypic hepatitis C virus (HCV) nonstructural protein 5A (NS5A) inhibitor with activity against genotype 1 (GT1) to GT6 HCV replicons. In a phase 1b 3-day monotherapy study, patients treated with a 150-mg dose of GS-5816 had a mean maximal HCV RNA decline of ≥3.3 log10 IU/ml in GT1a, -1b, -2, -3, and -4. This report characterizes virologic resistance to VEL in these patients. NS5A resistance-associated substitutions (RASs) were detected by deep sequencing (1% cutoff) pretreatment in 22/70 patients, i.e., 10/35 (29%) patients with GT1a, 1/8 (13%) with GT1b, 4/8 (50.0%) with GT2, 5/17 (29.4%) with GT3, and 2/2 (100.0%) with GT4. In GT1a and GT3 patients, pretreatment RASs were associated with a slightly reduced HCV RNA response compared to that of patients without pretreatment RASs; among patients with GT1b, GT2, and GT4, no significant difference in response was observed in those with or without pretreatment RASs. Following treatment, the pattern of emergent RASs was more complex for GT1a than for the other genotypes. In GT1a, substitutions emerged at positions M28, Q30, L31, P32, H58, E92, and Y93, with the most prevalent substitutions at positions Y93, M28, and L31. RASs were observed at two positions in GT1b and GT2 (Y93 and L31), three positions in GT3 (Y93, L31, and E92), and four positions in GT4 (L28, M31, P32L, and Y93). RASs that were present pretreatment persisted through the 48-week follow-up period; however, RASs emerging during treatment were more likely to decline both in prevalence and in frequency within the viral population during follow-up. (This study has been registered at ClinicalTrials.gov under registration no. NCT01740791.).
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Abstract
Soon after the hepatitis C virus (HCV) was identified in 1989, it was recognized that the prevalence of infection in patients with ESRD far exceeded that in the general population. Infection with HCV predisposes to the hepatic complications of cirrhosis and hepatocellular carcinoma. However, important extrahepatic manifestations include immune complex glomerular disease, accelerated progression of CKD, increases in cardiovascular event risk, and lymphoproliferative disorders. Advances in understanding the molecular biology of HCV have ushered in a new era in the treatment of this infection. Second generation direct-acting antiviral agents have revolutionized therapy, with sustained virologic response rates (undetectable viral load 12 weeks after completing therapy) of >90% in most patients. Studies using direct-acting antivirals in patients with CKD and those on dialysis are showing excellent safety and efficacy as well. In this context, it is imperative that nephrologists become familiar with this literature, reviewed here, so that the important decisions, including which patients should be treated and the optimal timing to initiate therapy, are vetted in association with the compounding issues of CKD, ESRD, and kidney transplantation.
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Affiliation(s)
- Marco Ladino
- Division of Nephrology and Hypertension, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, Florida
| | - Fernando Pedraza
- Division of Nephrology and Hypertension, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, Florida
| | - David Roth
- Division of Nephrology and Hypertension, University of Miami Miller School of Medicine and the Miami Veterans Administration Hospital, Miami, Florida
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Bonaventura A, Montecucco F. Sofosbuvir/velpatasvir: A promising combination. World J Hepatol 2016; 8:785-789. [PMID: 27429714 PMCID: PMC4937166 DOI: 10.4254/wjh.v8.i19.785] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/23/2016] [Accepted: 06/16/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) affects 3% of the world population. It represents the main cause of chronic liver disease and is responsible for extra-hepatic complications, such as type 2 diabetes and cardiovascular diseases. HCV includes 7 genotypes differing in the nucleotide sequence variability, the geographic distribution, the rates of viral clearance, the risk of progression to liver fibrosis and to hepatocellular carcinoma, and the response to therapy. Last years have seen remarkable advances in the field of HCV infection with the approval of direct antiviral agents (DAAs) targeting key viral proteins involved in the HCV replication. Several oral regimens combining DAAs from different families have been developed and these regimens showed increased and sustained virological response rates to above 90% reducing the treatment duration to 12 wk or less. In particular, sofosbuvir, a nucleotide analogue nonstructural (NS)5B polymerase inhibitor, and velpatasvir, a NS5A inhibitor, have been tested in two phase 3 trials, the ASTRAL-2 (against HCV genotype 2) and the ASTRAL-3 (against HCV genotype 3), demonstrating to be effective, safe, and well tolerated in patients who were 18 years of age or older and had at least a 6-mo history of HCV infection with a compensated liver disease.
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FakhriRavari A, Malakouti M, Brady R. Interferon-Free Treatments for Chronic Hepatitis C Genotype 1 Infection. J Clin Transl Hepatol 2016; 4:97-112. [PMID: 27350940 PMCID: PMC4913075 DOI: 10.14218/jcth.2016.00007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 12/19/2022] Open
Abstract
Hepatitis C virus (HCV) infection affects as many as 185 million people globally, many of whom are chronically infected and progress over time to cirrhosis, decompensated liver disease, hepatocellular carcinoma, and eventually death without a liver transplant. In the United States, HCV genotype 1 constitutes about 75% of all infections. While interferon and ribavirin therapy was the cornerstone of treatment for many years, interferon-free treatments have become the standard of care with the emergence of new direct-acting agents, resulting in more effective treatment, shorter duration of therapy, better tolerability, lower pill burden, and ultimately better adherence. This review will summarize the evidence for the currently available combination therapies as well as emerging therapies in phase 3 trials for treatment of HCV genotype 1.
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Affiliation(s)
- Alireza FakhriRavari
- Department of Pharmacy Practice, University of the Incarnate Word Feik School of Pharmacy, San Antonio, Texas, USA
- *Correspondence to: Alireza FakhriRavari, Department of Pharmacy Practice, University of the Incarnate Word Feik School of Pharmacy, 4301 Broadway CPO 99, San Antonio, Texas 78209, USA. Tel: +1-210-883-1142, Fax: +1-210-822-1516, E-mail:
| | - Mazyar Malakouti
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Rebecca Brady
- Department of Pharmacy Practice, University of the Incarnate Word Feik School of Pharmacy, San Antonio, Texas, USA
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Feld JJ, Jacobson IM, Hézode C, Asselah T, Ruane PJ, Gruener N, Abergel A, Mangia A, Lai CL, Chan HLY, Mazzotta F, Moreno C, Yoshida E, Shafran SD, Towner WJ, Tran TT, McNally J, Osinusi A, Svarovskaia E, Zhu Y, Brainard DM, McHutchison JG, Agarwal K, Zeuzem S. Sofosbuvir and Velpatasvir for HCV Genotype 1, 2, 4, 5, and 6 Infection. N Engl J Med 2015; 373:2599-607. [PMID: 26571066 DOI: 10.1056/nejmoa1512610] [Citation(s) in RCA: 817] [Impact Index Per Article: 90.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND A simple treatment regimen that is effective in a broad range of patients who are chronically infected with the hepatitis C virus (HCV) remains an unmet medical need. METHODS We conducted a phase 3, double-blind, placebo-controlled study involving untreated and previously treated patients with chronic HCV genotype 1, 2, 4, 5, or 6 infection, including those with compensated cirrhosis. Patients with HCV genotype 1, 2, 4, or 6 were randomly assigned in a 5:1 ratio to receive the nucleotide polymerase inhibitor sofosbuvir and the NS5A inhibitor velpatasvir in a once-daily, fixed-dose combination tablet or matching placebo for 12 weeks. Because of the low prevalence of genotype 5 in the study regions, patients with genotype 5 did not undergo randomization but were assigned to the sofosbuvir-velpatasvir group. The primary end point was a sustained virologic response at 12 weeks after the end of therapy. RESULTS Of the 624 patients who received treatment with sofosbuvir-velpatasvir, 34% had HCV genotype 1a, 19% genotype 1b, 17% genotype 2, 19% genotype 4, 6% genotype 5, and 7% genotype 6. A total of 8% of patients were black, 19% had cirrhosis, and 32% had been previously treated for HCV. The rate of sustained virologic response among patients receiving sofosbuvir-velpatasvir was 99% (95% confidence interval, 98 to >99). Two patients receiving sofosbuvir-velpatasvir, both with HCV genotype 1, had a virologic relapse. None of the 116 patients receiving placebo had a sustained virologic response. Serious adverse events were reported in 15 patients (2%) in the sofosbuvir-velpatasvir group and none in the placebo group. CONCLUSIONS Once-daily sofosbuvir-velpatasvir for 12 weeks provided high rates of sustained virologic response among both previously treated and untreated patients infected with HCV genotype 1, 2, 4, 5, or 6, including those with compensated cirrhosis. (Funded by Gilead Sciences; ClinicalTrials.gov number, NCT02201940.).
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Affiliation(s)
- Jordan J Feld
- From the Toronto Centre for Liver Disease, Toronto (J.J.F.), University of British Columbia, Vancouver (E.Y.), and University of Alberta, Edmonton (S.D.S.) - all in Canada; Weill Cornell Medical College, New York (I.M.J.); Université Paris-Est, Créteil (C.H.), Service d'Hépatologie, Hôpital Beaujon, INSERM UMR 1149, Université Paris Diderot, Clichy (T.A.), and Université d'Auvergne, Clermont Ferrand (A.A.) - all in France; Ruane Medical and Liver Health Institute (P.J.R.), Kaiser Permanente Los Angeles Medical Center (W.J.T.), Cedars-Sinai Medical Center (T.T.T.), Los Angeles, and Gilead Sciences, Foster City (J.M., A.O., E.S., Y.Z., D.M.B., J.G.M.) - all in California; Ludwig Maximilian University, Munich (N.G.) and Johann Wolfgang Goethe University Medical Center, Frankfurt am Main (S.Z.) - both in Germany; Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo (A.M.) and Santa Maria Annunziata Hospital, Florence (F.M.) - both in Italy; University of Hong Kong (C.-L.L.) and the Chinese University of Hong Kong (H.L.Y.C.) - both in Hong Kong; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); and King's College Hospital Foundation Trust, London (K.A.)
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Curry MP, O'Leary JG, Bzowej N, Muir AJ, Korenblat KM, Fenkel JM, Reddy KR, Lawitz E, Flamm SL, Schiano T, Teperman L, Fontana R, Schiff E, Fried M, Doehle B, An D, McNally J, Osinusi A, Brainard DM, McHutchison JG, Brown RS, Charlton M. Sofosbuvir and Velpatasvir for HCV in Patients with Decompensated Cirrhosis. N Engl J Med 2015; 373:2618-28. [PMID: 26569658 DOI: 10.1056/nejmoa1512614] [Citation(s) in RCA: 581] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND As the population that is infected with the hepatitis C virus (HCV) ages, the number of patients with decompensated cirrhosis is expected to increase. METHODS We conducted a phase 3, open-label study involving both previously treated and previously untreated patients infected with HCV genotypes 1 through 6 who had decompensated cirrhosis (classified as Child-Pugh-Turcotte class B). Patients were randomly assigned in a 1:1:1 ratio to receive the nucleotide polymerase inhibitor sofosbuvir and the NS5A inhibitor velpatasvir once daily for 12 weeks, sofosbuvir-velpatasvir plus ribavirin for 12 weeks, or sofosbuvir-velpatasvir for 24 weeks. The primary end point was a sustained virologic response at 12 weeks after the end of therapy. RESULTS Of the 267 patients who received treatment, 78% had HCV genotype 1, 4% genotype 2, 15% genotype 3, 3% genotype 4, and less than 1% genotype 6; no patients had genotype 5. Overall rates of sustained virologic response were 83% (95% confidence interval [CI], 74 to 90) among patients who received 12 weeks of sofosbuvir-velpatasvir, 94% (95% CI, 87 to 98) among those who received 12 weeks of sofosbuvir-velpatasvir plus ribavirin, and 86% (95% CI, 77 to 92) among those who received 24 weeks of sofosbuvir-velpatasvir. Post hoc analysis did not detect any significant differences in rates of sustained virologic response among the three study groups. Serious adverse events occurred in 19% of patients who received 12 weeks of sofosbuvir-velpatasvir, 16% of those who received 12 weeks of sofosbuvir-velpatasvir plus ribavirin, and 18% of those who received 24 weeks of sofosbuvir-velpatasvir. The most common adverse events were fatigue (29%), nausea (23%), and headache (22%) in all patients and anemia (31%) in the patients receiving ribavirin. CONCLUSIONS Treatment with sofosbuvir-velpatasvir with or without ribavirin for 12 weeks and with sofosbuvir-velpatasvir for 24 weeks resulted in high rates of sustained virologic response in patients with HCV infection and decompensated cirrhosis. (Funded by Gilead Sciences; ASTRAL-4 ClinicalTrials.gov number, NCT02201901.).
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Affiliation(s)
- Michael P Curry
- From the Beth Israel Deaconess Medical Center, Boston (M.P.C.); Baylor University Medical Center, Dallas (J.G.O.), and Texas Liver Institute, University of Texas Health Science Center, San Antonio (E.L.) - both in Texas; Ochsner Medical Center, New Orleans (N.B.); Duke University, Durham (A.J.M.), and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill (M.F.) - both in North Carolina; Washington University School of Medicine, St. Louis (K.M.K.); Thomas Jefferson University (J.M.F.) and University of Pennsylvania School of Medicine (K.R.R.) - both in Philadelphia; Northwestern University, Chicago (S.L.F.); Mount Sinai Hospital (T.S.), New York University School of Medicine (L.T.), and Weill Cornell Medical College (R.S.B.) - all in New York; University of Michigan, Ann Arbor (R.F.); University of Miami, Miami (E.S.); Gilead Sciences, Foster City, CA (B.D., D.A., J.M., A.O., D.M.B., J.G.M.); and Intermountain Medical Center, Salt Lake City (M.C.)
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Potent Antiviral Activities of the Direct-Acting Antivirals ABT-493 and ABT-530 with Three-Day Monotherapy for Hepatitis C Virus Genotype 1 Infection. Antimicrob Agents Chemother 2015; 60:1546-55. [PMID: 26711747 PMCID: PMC4775945 DOI: 10.1128/aac.02264-15] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 12/23/2015] [Indexed: 12/17/2022] Open
Abstract
ABT-493 is a hepatitis C virus (HCV) nonstructural (NS) protein 3/4A protease inhibitor, and ABT-530 is an HCV NS5A inhibitor. These direct-acting antivirals (DAAs) demonstrated potent antiviral activity against major HCV genotypes and high barriers to resistance in vitro. In this open-label dose-ranging trial, antiviral activity and safety were assessed during 3 days of monotherapy with ABT-493 or ABT-530 in treatment-naive adults with HCV genotype 1 infection, with or without compensated cirrhosis. The presence of baseline resistance-associated variants (RAVs) was also evaluated. The mean maximal decreases in HCV RNA levels from baseline were approximately 4 log10 IU/ml for all ABT-493 doses ranging from 100 mg to 700 mg and for ABT-530 doses of ≥40 mg. There were no meaningful differences in viral load declines for patients with versus without compensated cirrhosis. Twenty-four (50%) of the baseline samples from patients treated with ABT-493 had RAVs to NS3/4A protease inhibitors. Among 40 patients treated with ABT-530, 6 (15%) carried baseline RAVs to NS5A inhibitors. Viral load declines in patients with single baseline NS5A RAVs were similar to those in patients without RAVs. One patient harbored baseline RAVs at 3 NS5A positions and appeared to have a slightly less robust viral load decline on day 3 of monotherapy. No serious or grade 3 (severe) or higher adverse events and no clinically relevant laboratory abnormalities were observed with either compound. ABT-493 and ABT-530 demonstrated potent antiviral activity and acceptable safety during 3-day monotherapy in patients with HCV genotype 1 infection, with or without compensated cirrhosis. Based on these results, phase II studies assessing the combination of these DAAs for the treatment of chronic HCV infection in patients with or without compensated cirrhosis have been initiated. (This study has been registered at ClinicalTrials.gov under registration no. NCT01995071.)
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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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Pianko S, Flamm SL, Shiffman ML, Kumar S, Strasser SI, Dore GJ, McNally J, Brainard DM, Han L, Doehle B, Mogalian E, McHutchison JG, Rabinovitz M, Towner WJ, Gane EJ, Stedman CA, Reddy KR, Roberts SK. Sofosbuvir Plus Velpatasvir Combination Therapy for Treatment-Experienced Patients With Genotype 1 or 3 Hepatitis C Virus Infection: A Randomized Trial. Ann Intern Med 2015; 163:809-17. [PMID: 26551263 DOI: 10.7326/m15-1014] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Effective treatment options are needed for patients with genotype 1 or 3 hepatitis C virus (HCV) infection in whom previous therapy has failed. OBJECTIVE To assess the efficacy and safety of sofosbuvir plus velpatasvir, with and without ribavirin, in treatment-experienced patients. DESIGN Randomized, phase 2, open-label study. (ClinicalTrials.gov: NCT01909804). SETTING 58 sites in Australia, New Zealand, and the United States. PATIENTS Treatment-experienced adults with genotype 3 HCV infection without cirrhosis (cohort 1) and with compensated cirrhosis (cohort 2) and patients with genotype 1 HCV infection that was unsuccessfully treated with a protease inhibitor with peginterferon and ribavirin (50% could have compensated cirrhosis) (cohort 3). INTERVENTION All patients received 12 weeks of treatment that included 400 mg of sofosbuvir once daily. Patients in each cohort were randomly assigned to 25 mg of velpatasvir once daily with or without ribavirin or 100 mg of velpatasvir once daily with or without ribavirin. MEASUREMENTS Proportion of patients with sustained virologic response at week 12 after treatment (SVR12). RESULTS In cohort 1, SVR12 rates were 85% with 25 mg of velpatasvir, 96% with 25 mg of velpatasvir plus ribavirin, 100% with 100 mg of velpatasvir, and 100% with 100 mg of velpatasvir plus ribavirin. In cohort 2, SVR12 rates were 58% with 25 mg of velpatasvir, 84% with 25 mg of velpatasvir plus ribavirin, 88% with 100 mg of velpatasvir, and 96% with 100 mg of velpatasvir plus ribavirin. In cohort 3, SVR12 rates were 100% with 25 mg of velpatasvir, 97% with 25 mg of velpatasvir plus ribavirin, 100% with 100 mg of velpatasvir, and 96% with 100 mg of velpatasvir plus ribavirin. The most common adverse events were headache, fatigue, and nausea. LIMITATION Treatment assignments were not blinded, and no inferential statistics were planned. CONCLUSION Treatment with 400 mg of sofosbuvir plus 100 mg of velpatasvir for 12 weeks was well-tolerated and highly effective in treatment-experienced patients with genotype 1 or 3 HCV infection. PRIMARY FUNDING SOURCE Gilead Sciences.
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Affiliation(s)
- Stephen Pianko
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Steven L. Flamm
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Mitchell L. Shiffman
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Sonal Kumar
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Simone I. Strasser
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Gregory J. Dore
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - John McNally
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Diana M. Brainard
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Lingling Han
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Brian Doehle
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Erik Mogalian
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - John G. McHutchison
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Mordechai Rabinovitz
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - William J. Towner
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Edward J. Gane
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Catherine A.M. Stedman
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - K. Rajender Reddy
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Stuart K. Roberts
- From Monash Health and Monash University, Clayton, Victoria, Australia; Northwestern University, Chicago, Illinois; Liver Institute of Virginia, Richmond, Virginia; Weill Cornell Medical College, New York, New York; Royal Prince Alfred Hospital and University of Sydney, Camperdown, New South Wales, Australia; Kirby Institute, University of New South Wales, and St. Vincent's Hospital, Sydney, New South Wales, Australia; Gilead Sciences, Foster City, California
- University of Pittsburgh, Pittsburgh, Pennsylvania; Kaiser Permanente Medical Center, Los Angeles, California; Auckland Clinical Studies, Auckland, New Zealand; Christchurch Clinical Studies Trust and University of Otago, Christchurch, New Zealand; University of Pennsylvania, Philadelphia, Pennsylvania; and Alfred Health and Monash University, Melbourne, Victoria, Australia
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