1
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Inzaule S, Easterbrook P, Latona A, Ford NP, Irving W, Matthews PC, Vitoria M, Duncombe C, Giron A, McCluskey S, Lesi O, Tchamgoue S, Halford R, Adda D, Thomson E, Dusheiko G, Jordan MR. Prevalence of Drug Resistance Associated Substitutions in Persons With Chronic Hepatitis C Infection and Virological Failure Following Initial or Re-treatment With Pan-genotypic Direct-Acting Antivirals: A Systematic Review and Meta-analysis. Clin Infect Dis 2024:ciae431. [PMID: 39361017 DOI: 10.1093/cid/ciae431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND The advent of short-course, curative treatment with direct-acting antivirals (DAA) has given promise for the global elimination of hepatitis C virus (HCV) infections by 2030. Virological failure occurs in 2%-12% of persons receiving curative DAA treatment and may be presaged by pre-existing polymorphisms or result from selection of drug resistant variants during therapy. METHODS We conducted a systematic review to assess the prevalence of HCV resistance associated substitutions (RAS) among individuals with chronic hepatitis C infection who had virological failure following initial or re-treatment with pan-genotypic DAA regimens. We included 34 and 22 studies assessing RAS in people with virological failure published between January 2014 and July 2023. Pooled RAS prevalence was estimated using random-effects meta-analysis. RESULTS The pooled prevalence of RAS in people with virological failure following initial DAA treatment was 78.0% (95% confidence interval [CI]: 62.0-92.0) for sofosbuvir/velpatasvir, 81.0% (95% CI: 67.0-93.0) for sofosbuvir/daclatasvir, and 79.0% (95% CI: 70.0-87.0) for glecaprevir/pibrentasvir, with a high prevalence of resistance to the NS5A inhibitors. Among those with virological failure following re-treatment regimens, RAS were present in 93.0% (95% CI: 83.0-99.0) for sofosbuvir/velpatasvir/voxilepravir and in 100% (95% CI: 92.0-100) for glecaprevir/pibrentasvir, with resistance driven by RAS to NS5A inhibitors. DISCUSSION At least 1 RAS is present in a high proportion of the few individuals with virological failure following initial or re-treatment with pan-genotypic DAA regimens. There is a need for ongoing surveillance for DAA-associated resistance, to assess risk factors for their development and clinical impact to inform best practice strategies for re-treatment.
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Affiliation(s)
- Seth Inzaule
- Amsterdam Institute for Global Health and Development, and Department of Global Health, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Philippa Easterbrook
- HIV, Hepatitis and Sexually Transmitted Infection Department, World Health Organization, Geneva, Switzerland
| | - Ashley Latona
- Division of Geographic Medicine and Infectious Diseases,Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Nathan P Ford
- HIV, Hepatitis and Sexually Transmitted Infection Department, World Health Organization, Geneva, Switzerland
| | - William Irving
- School of Life Sciences, Division of Microbiology and Infectious Diseases, The University of Nottingham, Nottingham, United Kingdom
| | | | - Marco Vitoria
- HIV, Hepatitis and Sexually Transmitted Infection Department, World Health Organization, Geneva, Switzerland
| | - Chris Duncombe
- International Association of Providers of AIDS Care, Washington, DC, USA
| | - Amalia Giron
- Independent Consultant, Guatemala city, Guatemala
| | - Suzanne McCluskey
- Division of Infectious Diseases, Havard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Olufunmilayo Lesi
- HIV, Hepatitis and Sexually Transmitted Infection Department, World Health Organization, Geneva, Switzerland
| | - Serge Tchamgoue
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | | | - Emma Thomson
- Medical Research Council-University of Glasgow Centre for Virus Research, Glasgow, United Kingdom
| | - Geoff Dusheiko
- Institute for Global Health, University College London, London, United Kingdom
| | - Michael R Jordan
- Division of Geographic Medicine and Infectious Diseases,Tufts University School of Medicine, Boston, Massachusetts, USA
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Goyal A, Kharkwal H, Piplani M, Singh Y, Murugesan S, Aggarwal A, Kumar P, Chander S. Spotlight on 4-substituted quinolines as potential anti-infective agents: Journey beyond chloroquine. Arch Pharm (Weinheim) 2023; 356:e2200361. [PMID: 36494101 DOI: 10.1002/ardp.202200361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/10/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022]
Abstract
Continued emerging resistance of pathogens against the clinically approved candidates and their associated limitations continuously demand newer agents having better potency with a more suited safety profile. Quinoline nuclei containing scaffolds of natural and synthetic origin have been documented for diverse types of pharmacological activities, and a number of drugs are clinically approved. In the present review, we unprecedentedly covered the biological potential of 4-substituted quinoline and elaborated a rationale for its special privilege to afford the significant number of approved clinical drugs, particularly against infectious pathogens. Compounds with 4-substituted quinoline are well documented for antimalarial activity, but in the last two decades, they have been extensively explored for activity against cancer, tuberculosis, and several other pathogens including viruses, bacteria, fungi, and other infectious pathogens. In the present study, the anti-infective spectrum of this scaffold is discussed against viruses, mycobacteria, malarial parasites, and fungal and bacterial strains, along with recent updates in this area, with special emphasis on the structure-activity relationship.
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Affiliation(s)
- Ankush Goyal
- School of Pharmacy, Maharaja Agrasen University, Solan, Himachal Pradesh, India
| | - Harsha Kharkwal
- Amity Institute of Phytochemistry & Phytomedicine, Amity University Uttar Pradesh, Noida, Uttar Pradesh, India
| | - Mona Piplani
- School of Pharmacy, Maharaja Agrasen University, Solan, Himachal Pradesh, India
| | - Yogendra Singh
- School of Pharmacy, Maharaja Agrasen University, Solan, Himachal Pradesh, India
| | | | - Amit Aggarwal
- School of Pharmacy, Maharaja Agrasen University, Solan, Himachal Pradesh, India
| | - Piyush Kumar
- Department of Chemistry, Indian Institute of Technology, Jammu, Jammu and Kashmir, India
| | - Subhash Chander
- Amity Institute of Phytochemistry & Phytomedicine, Amity University Uttar Pradesh, Noida, Uttar Pradesh, India
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3
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Sabry N, Kamel AM, Cordie A, Esmat G. Daclatasvir as a hepatitis C infection treatment option: an up-to-date evaluation. Expert Opin Pharmacother 2023; 24:159-170. [PMID: 36369914 DOI: 10.1080/14656566.2022.2145883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Globally, it is estimated that 290,000 patients infected with hepatitis C virus (HCV) died from hepatitis C consequences, including cirrhosis and hepatocellular carcinoma in 2019. Although daclatasvir (DCV), combined with sofosbuvir (SOF), is effective in HCV patients, the new pan-genotypic combinations are considered by many as more cost-effective and successful in eradicating HCV infection. AREAS COVERED This review discusses the safety, efficacy, and cost-effectiveness of DCV as an HCV treatment option based on real-world studies and pharmacoeconomic evaluations. EXPERT OPINION Real-life studies suggest that SOF/DCV has acceptable sustained virological response and can be used successfully to manage HCV. Nonetheless, the use of SOF/DCV is limited by the longer treatment duration in genotype (GT)-3 patients and the need for ribavirin (RBV) in treatment-experienced patients which increases the likelihood of adverse effects. DCV is likely to remain as a therapeutic option for the management of GT-1, GT-2, and GT-4 patients in resource limited settings, while GT-3 patients are more likely to benefit from RBV-free direct-acting antiviral combinations such as SOF/velpatasvir for 12 weeks or glecaprevir/pibrentasvir for 8 weeks. The introduction of generics for these new pan-genotypic drugs would likely eliminate the need for SOF/DCV in the near future.
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Affiliation(s)
- Nirmeen Sabry
- Clinical Pharmacy Department, College of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Ahmed M Kamel
- Clinical Pharmacy Department, College of Pharmacy, Cairo University, Cairo, 11562, Egypt
| | - Ahmed Cordie
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt.,Kasr Alaini HIV and Viral Hepatitis Fighting Group, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
| | - Gamal Esmat
- Endemic Medicine Department, Faculty of Medicine, Cairo University, Cairo, 11562, Egypt
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4
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Chen M, Xu Y, Li N, Yin P, Zhou Q, Feng S, Wu T, Wei L, Wang H, Fu Y, Li YP. Development of full-length cell-culture infectious clone and subgenomic replicon for a genotype 3a isolate of hepatitis C virus. J Gen Virol 2021; 102. [DOI: 10.1099/jgv.0.001704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Hepatitis C virus (HCV) genotype 3 is widely distributed, and genotype 3-infected patients achieve a lower cure rate in direct-acting antiviral (DAA) therapy and are associated with a higher risk of hepatic steatosis than patients with other genotypes. Thus, the study of the virology and pathogenesis of genotype 3 HCV is increasingly relevant. Here, we developed a full-length infectious clone and a subgenomic replicon for the genotype 3a isolate, CH3a. From an infected serum, we constructed a full-length CH3a clone, however, it was nonviable in Huh7.5.1 cells. Next, we systematically adapted several intergenotypic recombinants containing Core-NS2 and 5′UTR-NS5A from CH3a, and other sequences from a replication-competent genotype 2 a clone JFH1. Adaptive mutations were identified, of which several combinations facilitated the replication of CH3a-JFH1 recombinants; however, they failed to adapt to the full-length CH3a and the recombinants containing CH3a NS5B. Thus, we attempted to separately adapt CH3a NS5B-3′UTR by constructing an intragenotypic recombinant using 5′UTR-NS5A from an infectious genotype 3a clone, DBN3acc, from which L3004P/M in NS5B and a deletion of 11 nucleotides (Δ11nt) downstream of the polyU/UC tract of the 3′UTR were identified and demonstrated to efficiently improve virus production. Finally, we combined functional 5′UTR-NS5A and NS5B-3′UTR sequences that carried the selected mutations to generate full-length CH3a with 26 or 27 substitutions (CH3acc), and both revealed efficient replication and virus spread in transfected and infected cells, releasing HCV of 104.2 f.f.u. ml−1. CH3acc was inhibited by DAAs targeting NS3/4A, NS5A and NS5B in a dose-dependent manner. The selected mutations permitted the development of subgenomic replicon CH3a-SGRep, by which L3004P, L3004M and Δ11nt were proven, together with a single-cycle virus production assay, to facilitate virus assembly, release, and RNA replication. CH3acc clones and CH3a-SGRep replicon provide new tools for the study of HCV genotype 3.
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Affiliation(s)
- Mingxiao Chen
- Joint Program in Pathology, Department of Internal Medicine, Guangzhou Women and Children’s Medical Center, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510623, PR China
| | - Yi Xu
- Joint Program in Pathology, Department of Internal Medicine, Guangzhou Women and Children’s Medical Center, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510623, PR China
| | - Ni Li
- Institute of Human Virology, Zhongshan School of Medicine, and Key Laboratory of Tropical Disease Control of Ministry of Education, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Ping Yin
- Department of Clinical Laboratory, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, PR China
| | - Qing Zhou
- Institute of Human Virology, Zhongshan School of Medicine, and Key Laboratory of Tropical Disease Control of Ministry of Education, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Shengjun Feng
- Institute of Human Virology, Zhongshan School of Medicine, and Key Laboratory of Tropical Disease Control of Ministry of Education, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Tiantian Wu
- Institute of Human Virology, Zhongshan School of Medicine, and Key Laboratory of Tropical Disease Control of Ministry of Education, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Lai Wei
- Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, PR China
| | - Haihe Wang
- Department of Biochemistry, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, PR China
| | - Yongshui Fu
- Guangzhou Blood Center, Guangzhou 510095, PR China
| | - Yi-Ping Li
- Institute of Human Virology, Zhongshan School of Medicine, and Key Laboratory of Tropical Disease Control of Ministry of Education, Sun Yat-sen University, Guangzhou 510080, PR China
- Department of Infectious Diseases, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, PR China
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5
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Peribañez-Gonzalez M, Cheinquer H, Rodrigues L, Lima MP, Álvares-da-Silva MR, Madruga J, Parise ER, Pessoa MG, Furtado J, Villanova M, Ferreira A, Mazzoleni F, Nascimento E, Silva GF, Fredrick L, Krishnan P, Burroughs M, Reuter T. Efficacy and safety of glecaprevir/pibrentasvir in treatment-naïve adults with chronic hepatitis C virus genotypes 1-6 in Brazil. Ann Hepatol 2021; 20:100257. [PMID: 32949786 DOI: 10.1016/j.aohep.2020.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Glecaprevir/pibrentasvir is a highly effective and well tolerated treatment for hepatitis C infection. Brazilian patients were not included in the original development studies for glecaprevir/pibrentasvir. This study aimed to assess safety and efficacy of glecaprevir/pibrentasvir in treatment-naïve Brazilian adults without cirrhosis or with compensated cirrhosis. PATIENTS AND METHODS EXPEDITION-3 was a Phase 3, open-label, multicenter study in treatment-naïve Brazilian adults with hepatitis C infection genotype 1-6. Patients without cirrhosis (F2 or F3) or with compensated cirrhosis (F4) received 8 or 12 weeks of glecaprevir/pibrentasvir, respectively. The primary efficacy endpoint was the rate of sustained virologic response at post-treatment Week 12. Secondary endpoints were on-treatment virologic failure and relapse rates. Baseline polymorphisms were assessed in NS3 and NS5A. Adverse events and laboratory abnormalities were monitored. RESULTS 100 patients were enrolled, 75 received 8 weeks of treatment and 25 received 12 weeks; all patients completed treatment. Overall sustained virologic response at post-treatment Week 12 rate was high (98.0%; 98/100; 95% confidence interval: 93.0-99.4) and remained high regardless of baseline viral or host factors, including demographics, hepatitis C virus RNA levels, polymorphisms in NS3 and/or NS5A, genotype, and relevant comorbidities. 55% of patients reported ≥1 adverse event, the most common being headache (18.0%). Four patients reported serious adverse events; none were considered drug related or led to study drug discontinuation. No hepatic decompensations were observed. CONCLUSIONS Glecaprevir/pibrentasvir was effective and well tolerated in treatment-naïve Brazilian patients with hepatitis C infection without cirrhosis and with compensated cirrhosis. TRIAL REGISTRATION ClinicalTrials.gov NCT03219216.
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Affiliation(s)
| | - Hugo Cheinquer
- Ramiro Barcelos 2350, CPC Sala, 21216, Porto Alegre, Brazil.
| | | | - Maria Patelli Lima
- Instituto de Infectologia Campinas, Rua Dr. Quirino, 524, Sala 72, Centro, Campinas, Brazil.
| | - Mário Reis Álvares-da-Silva
- Hospital de Clinicas de Porto Alegre, GI/Liver Division, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - José Madruga
- Rua Santa Cruz, 81, Vila Mariana, São Paulo, Brazil.
| | | | - Mário Guimarães Pessoa
- Division of Gastroenterology and Hepatology University of São Paulo School of Medicine, Avenida Enéas de Carvalho Aguiar, 255 - Bloco B - 4º andar, São Paulo, Brazil.
| | - Juvencio Furtado
- Rua Cônego Xavier, 276 - Amb de Infectologia, São Paulo, Brazil.
| | - Marcia Villanova
- Hospital das ClÍnicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Campus Universitário s/n, Monte Alegre, Bloco G Subsolo 2, Unidade de Pesquisa Clinica, Ribeirão Preto, Brazil.
| | - Adalgisa Ferreira
- Centro de Pesquisa Clínica Hospital Universitario da Universidade Federal do Maranhão, Rua Almirante Tamandaré, 01. Centro, São Luís, Brazil.
| | - Felipe Mazzoleni
- Hospital Ernesto Dornelles, Av. Ipiranga 1801, 7ºAndar, Cpda-Pesquisa, Porto Alegre, Brazil.
| | | | - Giovanni Faria Silva
- Unesp Campus de Botucatu, Rua Prof Dr Armanda Alves, s/n(0) Bairro: Botucatu, Brazil.
| | | | | | | | - Tania Reuter
- Marechal Campos Av. 1355, Outclinic number 5, Vitoria, Brazil.
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Ahmed R, Kareem R, Venkatesan N, Botleroo RA, Ogeyingbo OD, Bhandari R, Gyawali M, Elshaikh AO. Sofosbuvir/Velpatasvir - A Promising Treatment for Chronic Hepatitis C Virus Infection. Cureus 2021; 13:e17237. [PMID: 34540464 PMCID: PMC8443867 DOI: 10.7759/cureus.17237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/16/2021] [Indexed: 11/25/2022] Open
Abstract
Hepatitis C virus (HCV) infection is a disease that affects millions of people worldwide and has an enormous global public health impact. Chronic HCV is a long-term infection that goes unnoticed until the virus destroys the liver enough to induce liver disease symptoms. The inadequate and poorly tolerated treatment contributes to the burden of chronic HCV. Treatments have improved over time - direct-acting antivirals (DAAs) that targeted different hepatitis C virus genomic sites have shown to be more effective and well-tolerated. Patients recover to a greater extent following a treatment regimen based on DAAs. We conducted this literature review to investigate the effectiveness of these medications in treating chronic HCV infection. Relevant articles were identified by searching PubMed and Google scholar databases. Our primary goal was to analyze the efficacy and safety of the DAA, sofosbuvir plus velpatasvir, with or without ribavirin, in cirrhotic or non-cirrhotic, naïve or previously treated, chronic HCV patients. We found that treating patients with sofosbuvir-velpatasvir for 12 weeks was highly effective with fewer adverse events, including those with compensated cirrhosis. The outcomes aided in improving HCV treatment, lowering the disease's burden and fatality rate.
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Affiliation(s)
- Rowan Ahmed
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Roaa Kareem
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nanditha Venkatesan
- Internal Medicine, All India Institute of Medical Sciences, Raipur, IND.,Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Rinky A Botleroo
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Opemipo D Ogeyingbo
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Public Health, Walden University, Minneapolis, USA.,Internal Medicine, Saint James School of Medicine, Park Ridge, USA
| | - Renu Bhandari
- Internal Medicine/Family Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Internal Medicine, Manipal College of Medical Sciences, Kaski, NPL
| | - Mallika Gyawali
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Abeer O Elshaikh
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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7
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Wei X, Zhao J, Yang L. Cost-effectiveness of new antiviral treatments for non-genotype 1 hepatitis C virus infection in China: a societal perspective. BMJ Glob Health 2021; 5:bmjgh-2020-003194. [PMID: 33246983 PMCID: PMC7703443 DOI: 10.1136/bmjgh-2020-003194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 12/14/2022] Open
Abstract
Objective This study aimed to estimate the cost-effectiveness of direct-acting antivirals (DAAs) among patients with non-genotype 1 for the eradication of hepatitis C virus (HCV) infection in China. Methods A decision-analytic Markov model was developed to estimate the lifetime costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) for DAAs and pegylated interferon plus ribavirin (PEG-RBV) from a societal perspective. The model inputs were derived from the literature, a patient survey, HCV expert opinions and a specialised drug price database available in China. Sensitivity analysis was conducted to evaluate the model robustness and calculate reasonable prices of DAAs. Results For patients infected with HCV genotype 2, the pan-genotypic regimen sofosbuvir/velpatasvir (SOF/VEL) was the most cost-effective strategy compared with PEG-RBV, with an ICER of US$5653/QALY. For genotype 3, the combination of sofosbuvir plus daclatasvir (SOF-DCV) was the most cost-effective approach, with an ICER of US$3314/QALY. All DAA regimens for genotype 6 were cost-saving, and sofosbuvir plus ribavirin (SOF-RBV) was the optimal regimen. One-way sensitivity analysis demonstrated that the ICERs were most sensitive to the utility values, discount rate and drug costs. Probabilistic sensitivity analysis indicated that using a threshold equal to one time the gross domestic product (GDP) per capita in China (US$9769/QALY, 2018), the probability of SOF/VEL, SOF-DCV and SOF-RBV being cost-effective was 58%, 83% and 71% for genotype 2, 3 and 6, respectively. Threshold analysis showed that the price of DAAs should be reduced by some degree to achieve better affordability. Conclusions DAAs were cost-effective compared with traditional treatments. A reasonable reduction in the price of DAAs will increase drug affordability and is of great significance as a global strategy to eradicate viral hepatitis.
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Affiliation(s)
- Xia Wei
- Department of Health policy and management, School of Public Health, Peking University, Beijing, China
| | - Jingyu Zhao
- Department of Health policy and management, School of Public Health, Peking University, Beijing, China
| | - Li Yang
- Department of Health policy and management, School of Public Health, Peking University, Beijing, China
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8
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Sustained Virologic Remission in an 8-Month-old Pediatric Patient With Carbamoyl Phosphate Synthetase I Deficiency and Hepatitis C Infection Using Direct-acting Antivirals Prior to Liver Transplant. J Pediatr Gastroenterol Nutr 2021; 72:e79-e80. [PMID: 32732637 DOI: 10.1097/mpg.0000000000002856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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9
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Hutchinson SJ, Valerio H, McDonald SA, Yeung A, Pollock K, Smith S, Barclay S, Dillon JF, Fox R, Bramley P, Fraser A, Kennedy N, Gunson RN, Templeton K, Innes H, McLeod A, Weir A, Hayes PC, Goldberg D. Population impact of direct-acting antiviral treatment on new presentations of hepatitis C-related decompensated cirrhosis: a national record-linkage study. Gut 2020; 69:2223-2231. [PMID: 32217640 DOI: 10.1136/gutjnl-2019-320007] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Population-based studies demonstrating the clinical impact of interferon-free direct-acting antiviral (DAA) therapies are lacking. We examined the impact of the introduction of DAAs on HCV-related decompensated cirrhosis (DC) through analysis of population-based data from Scotland. DESIGN Through analysis of national surveillance data (involving linkage of HCV diagnosis and clinical databases to hospital and deaths registers), we determined i) the scale-up in the number of patients treated and achieving a sustained viral response (SVR), and ii) the change in the trend of new presentations with HCV-related DC, with the introduction of DAAs. RESULTS Approximately 11 000 patients had been treated in Scotland over the 8-year period 2010/11 to 2017/18. The scale-up in the number of patients achieving SVR between the pre-DAA and DAA eras was 2.3-fold overall and 5.9-fold among those with compensated cirrhosis (the group at immediate risk of developing DC). In the pre-DAA era, the annual number of HCV-related DC presentations increased 4.6-fold between 2000 (30) and 2014 (142). In the DAA era, presentations decreased by 51% to 69 in 2018 (and by 67% among those with chronic infection at presentation), representing a significant change in trend (rate ratio 0.88, 95% CI 0.85 to 0.90). With the introduction of DAAs, an estimated 330 DC cases had been averted during 2015-18. CONCLUSIONS National scale-up in interferon-free DAA treatment is associated with the rapid downturn in presentations of HCV-related DC at the population-level. Major progress in averting HCV-related DC in the short-term is feasible, and thus other countries should strive to achieve the same.
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Affiliation(s)
- Sharon J Hutchinson
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK .,Blood Borne Virus & Sexually Transmitted Infections Team, Health Protection Scotland, Glasgow, UK
| | - Heather Valerio
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Blood Borne Virus & Sexually Transmitted Infections Team, Health Protection Scotland, Glasgow, UK
| | - Scott A McDonald
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Blood Borne Virus & Sexually Transmitted Infections Team, Health Protection Scotland, Glasgow, UK
| | - Alan Yeung
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Blood Borne Virus & Sexually Transmitted Infections Team, Health Protection Scotland, Glasgow, UK
| | - Kevin Pollock
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Blood Borne Virus & Sexually Transmitted Infections Team, Health Protection Scotland, Glasgow, UK
| | - Shanley Smith
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Blood Borne Virus & Sexually Transmitted Infections Team, Health Protection Scotland, Glasgow, UK
| | - Stephen Barclay
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Glasgow Royal Infirmary, Glasgow, UK
| | | | | | | | - Andrew Fraser
- Aberdeen Royal Infirmary, Aberdeen, UK.,Queen Elizabeth University Hospital, Glasgow, UK
| | | | - Rory N Gunson
- West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK
| | - Kate Templeton
- East of Scotland Specialist Virology Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Hamish Innes
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Blood Borne Virus & Sexually Transmitted Infections Team, Health Protection Scotland, Glasgow, UK
| | - Allan McLeod
- Blood Borne Virus & Sexually Transmitted Infections Team, Health Protection Scotland, Glasgow, UK
| | - Amanda Weir
- Blood Borne Virus & Sexually Transmitted Infections Team, Health Protection Scotland, Glasgow, UK
| | | | - David Goldberg
- Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.,Blood Borne Virus & Sexually Transmitted Infections Team, Health Protection Scotland, Glasgow, UK
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10
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Mei YY, Chen YM, Wu YK, Zhang XH, Xu WX. Efficacy and Safety of Sofosbuvir-Based Direct-Acting Antiviral Agents Treatment for Patients with Genotype 3/6 Hepatitis C Virus Infection. Can J Gastroenterol Hepatol 2020; 2020:8872120. [PMID: 33194875 PMCID: PMC7648714 DOI: 10.1155/2020/8872120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023] Open
Abstract
Aims The aim is to evaluate the efficacy and safety of Sofosbuvir- (SOF-) based direct-acting antiviral agents (DAAs) treatment for patients with genotype (GT) 3/6 hepatitis C virus (HCV) infection. Methods Patients infected with GT 3/6 HCV and treated with SOF-based DAAs were enrolled in this prospective, open, single-center, and real-world study. Drugs included Sofosbuvir (SOF), Velpatasvir (VEL), Daclatasvir (DCV), and Ribavirin (RBV). The treatment regimens included SOF + RBV for 24 weeks, SOF + DCV ± RBV for 12/24 weeks, and SOF/VEL ± RBV for 12 weeks. Results A total of 54 patients were included. Age was 42.5 ± 10.4 years. Baseline HCV RNA was 6.29 ± 0.89log10 IU/mL. The numbers of GT 3a, 3b, and 6a patients were 10, 12, and 32, respectively. The numbers of chronic hepatitis, compensated cirrhosis, and decompensated cirrhosis patients were 39, 9, and 6, respectively. In patients with chronic hepatitis C and liver cirrhosis, sustained virological response 12 weeks after the end of treatment (SVR12) was 97.4% and 96.7%, respectively, and rapid virological response (RVR) was 75.0% and 57.1%, respectively. SVR12 of GT3a, GT3b, and GT6a was 100%, 83.3%, and 97%, respectively. ALT normality rate in chronic hepatitis group is higher than that in cirrhosis group at 4 weeks of treatment (89.7% versus 60.0%, p = 0.033) and at 12 weeks after EOT (94.9% versus 66.7%, p = 0.021). The overall incidence rate of adverse events was 44.4%, with fatigue being the most common (13.0%). Conclusion SOF-based DAAs regimen can achieve ideal SVR12 for Chinese patients with both GT3a and GT6a HCV infection. The tolerance and safety of SOF-based DAAs regimen are good.
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Affiliation(s)
- Yong-yu Mei
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
- Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
| | - You-ming Chen
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
- Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
| | - Yuan-kai Wu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
- Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
| | - Xiao-hong Zhang
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
- Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
| | - Wen-xiong Xu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
- Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
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11
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Chronic hepatitis C virus infection in the Czech Republic and Slovakia: an analysis of patient and virus characteristics. Int J Public Health 2020; 65:1723-1735. [PMID: 33040165 DOI: 10.1007/s00038-020-01496-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES The MOSAIC study gathered data on chronic hepatitis C virus (HCV) infection and its treatment in various countries worldwide. Here we summarise patient and HCV characteristics in the Czech Republic and Slovakia. METHODS MOSAIC was an observational study that included patients with chronic HCV infection untreated at the time of enrolment. Study collected and descriptively analysed patient demographics, disease stage and viral characteristics. Data were collected between February 2014 to October 2014. RESULTS Among 220 patients enrolled, 51.4% were treatment-naïve. The most prevalent HCV genotype was G1 (78.4%), followed by G3 (19.7%). Higher prevalence of G1 was found in treatment-experienced patients (94.3%) compared to treatment-naïve (63.4%). Most participants (67.7%) presented viral RNA load of ≥ 800,000 IU/mL. Liver cirrhosis was reported in 24.5% of patients. Higher HCV RNA load and duration of HCV infection correlated with the degree of liver fibrosis. Anti-HCV interferon-based treatments were initiated in 88.2% of participants. CONCLUSIONS The study confirmed significant changes in the HCV genotypes partition with G3 genotype rapidly increasing in both countries, with possible impact on the WHO eradication initiative and treatment selection.
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12
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Ruiz-Boy S, Rodriguez-Reyes M, Sotoca-Momblona JM. Effectiveness of sofosbuvir/velpatasvir/voxilaprevir in patients with chronic hepatitis C virus infection and virologic failure to direct-acting antivirals. Med Clin (Barc) 2020; 157:85-86. [PMID: 32807510 DOI: 10.1016/j.medcli.2020.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Sonia Ruiz-Boy
- Servicio de Farmacia, Área del Medicamento, Hospital Clínic de Barcelona, Barcelona, España.
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13
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Increasing uptake of hepatitis C virus infection case-finding, testing, and treatment in primary care: evaluation of the HepCATT (Hepatitis C Assessment Through to Treatment) trial. Br J Gen Pract 2020; 70:e581-e588. [PMID: 32094220 PMCID: PMC7041637 DOI: 10.3399/bjgp20x708785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/25/2019] [Indexed: 01/08/2023] Open
Abstract
Background Hepatitis C virus (HCV) infection is a key cause of liver disease but can be cured in more than 95% of patients. Around 70 000 people in England may have undiagnosed HCV infection and many more will not have been treated. Interventions to increase case-finding in primary care are likely to be cost-effective; however, evidence of effective interventions is lacking. The Hepatitis C Assessment Through to Treatment (HepCATT) trial assessed whether a complex intervention in primary care could increase case-finding, testing, and treatment of HCV. Aim To investigate the feasibility and acceptability of the HepCATT intervention. Design and setting A qualitative study with primary care practice staff from practices in the south west of England taking part in the HepCATT trial. Method Semi-structured interviews were carried out with GPs, nurses, and practice staff to ascertain their views of the HepCATT intervention at least 1 month after implementing the intervention in their practice. Normalisation process theory, which outlines the social processes involved in intervention implementation, informed thematic data analysis. Results Participants appreciated the HepCATT intervention for increasing knowledge and awareness of HCV. Although some initial technical difficulties were reported, participants saw the benefits of using the audit tool to systematically identify patients with HCV infection risk factors and found it straightforward to use. Participants valued the opportunity to discuss HCV testing with patients, especially those who may not have been previously aware of HCV risk. Future implementation should consider fully integrating software systems and additional resources to screen patient lists and conduct tests. Conclusion When supported by a complex intervention, primary care can play a crucial role in identifying and caring for patients with HCV infection, to help stem the HCV epidemic, and prevent HCV-related illness.
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14
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Darvishian M, Wong S, Binka M, Yu A, Ramji A, Yoshida EM, Wong J, Rossi C, Butt ZA, Bartlett S, Pearce ME, Samji H, Cook D, Alvarez M, Chong M, Tyndall M, Krajden M, Janjua NZ. Loss to follow-up: A significant barrier in the treatment cascade with direct-acting therapies. J Viral Hepat 2020; 27:243-260. [PMID: 31664755 DOI: 10.1111/jvh.13228] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/19/2019] [Accepted: 10/22/2019] [Indexed: 12/15/2022]
Abstract
Effectiveness of direct-acting antiviral (DAA) therapies could be influenced by patient characteristics such as comorbid conditions, which could lead to premature treatment discontinuation and/or irregular medical follow-ups. Here, we evaluate loss to follow-up and treatment effectiveness of sofosbuvir/ledipasvir ± ribavirin (SOF/LDV ± RBV), ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin (OBV/PTV/r + DSV ± RBV) for hepatitis C virus (HCV) genotype 1 (GT1) and sofosbuvir + ribavirin (SOF + RBV) for genotype 3 (GT3) in British Columbia Canada: The British Columbia Hepatitis Testers Cohort includes data on individuals tested for HCV since 1992, integrated with medical visit, hospitalization and prescription drug data. HCV-positive individuals who initiated DAA regimens, irrespective of treatment completion, for GT1 and GT3 until 31 December, 2017 were included. Factors associated with sustained virological response (SVR) and loss to follow-up were assessed by using multivariable logistic regression models. In total 4477 individuals initiated DAAs. The most common prescribed DAA was SOF/LDV ± RBV with SVR of 95%. The highest SVR of 99.5% was observed among OBV/PTV/r + DSV-treated patients. Overall, 453 (10.1%) individuals were lost to follow-up. Higher loss to follow-up was observed among GT1 patients treated with OBV (17.8%) and GT3 patients (15.7%). The loss to follow-up rate was significantly higher among individuals aged <60 years, those with a history of injection drug use (IDU), on opioid substitution therapy and with cirrhosis. Our findings indicate that loss to follow-up exceeds viral failure in HCV DAA therapy and its rate varies significantly by genotype and treatment regimen. Depending on the aetiology of lost to follow-up, personalized case management for those with medical complications and supporting services among IDU are needed to achieve the full benefits of effective treatments.
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Affiliation(s)
- Maryam Darvishian
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada.,BC Cancer Research Centre, Vancouver, BC, Canada.,Population Oncology, Vancouver, BC, Canada
| | - Stanley Wong
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mawuena Binka
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Amanda Yu
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Alnoor Ramji
- University of British Columbia, Vancouver, BC, Canada
| | - Eric M Yoshida
- Division of Gastroenterology of the Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason Wong
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Carmine Rossi
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Zahid A Butt
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Sofia Bartlett
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Margo E Pearce
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Hasina Samji
- BC Centre for Disease Control, Vancouver, BC, Canada.,Simon Fraser University, Burnaby, BC, Canada
| | - Darrel Cook
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mei Chong
- BC Centre for Disease Control, Vancouver, BC, Canada
| | - Mark Tyndall
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- BC Centre for Disease Control, Vancouver, BC, Canada.,University of British Columbia, Vancouver, BC, Canada
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15
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Roberts K, Macleod J, Metcalfe C, Hollingworth W, Williams J, Muir P, Vickerman P, Clement C, Gordon F, Irving W, Waldron CA, North P, Moore P, Simmons R, Miners A, Horwood J, Hickman M. Cost effectiveness of an intervention to increase uptake of hepatitis C virus testing and treatment (HepCATT): cluster randomised controlled trial in primary care. BMJ 2020; 368:m322. [PMID: 32102782 PMCID: PMC7190058 DOI: 10.1136/bmj.m322] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and cost effectiveness of a complex intervention in primary care that aims to increase uptake of hepatitis C virus (HCV) case finding and treatment. DESIGN Pragmatic, two armed, practice level, cluster randomised controlled trial and economic evaluation. SETTING AND PARTICIPANTS 45 general practices in South West England (22 randomised to intervention and 23 to control arm). Outcome data were collected from all intervention practices and 21/23 control practices. Total number of flagged patients was 24 473 (about 5% of practice list). INTERVENTION Electronic algorithm and flag on practice systems identifying patients with HCV risk markers (such as history of opioid dependence or HCV tests with no evidence of referral to hepatology), staff educational training in HCV, and practice posters/leaflets to increase patients' awareness. Flagged patients were invited by letter for an HCV test (with one follow-up) and had on-screen pop-ups to encourage opportunistic testing. The intervention lasted one year, with practices recruited April to December 2016. MAIN OUTCOME MEASURES Primary outcome: uptake of HCV testing. SECONDARY OUTCOMES number of positive HCV tests and yield (proportion HCV positive); HCV treatment assessment at hepatology; cost effectiveness. RESULTS Baseline HCV testing of flagged patients (six months before study start) was 608/13 097 (4.6%) in intervention practices and 380/11 376 (3.3%) in control practices. During the study 2071 (16%) of flagged patients in the intervention practices and 1163 (10%) in control practices were tested for HCV: overall intervention effect as an adjusted rate ratio of 1.59 (95% confidence interval 1.21 to 2.08; P<0.001). HCV antibodies were detected in 129 patients from intervention practices and 51 patients from control practices (adjusted rate ratio 2.24, 1.47 to 3.42) with weak evidence of an increase in yield (6.2% v 4.4%; adjusted risk ratio 1.40, 0.99 to 1.95). Referral and assessment increased in intervention practices compared with control practices (adjusted rate ratio 5.78, 1.6 to 21.6) with a risk difference of 1.3 per 1000 and a "number needed to help" of one extra HCV diagnosis, referral, and assessment per 792 (95% confidence interval 558 to 1883) patients flagged. The average cost of HCV case finding was £4.03 (95% confidence interval £2.27 to £5.80) per at risk patient and £3165 per additional patient assessed at hepatology. The incremental cost effectiveness ratio was £6212 per quality adjusted life year (QALY), with 92.5% probability of being below £20 000 per QALY. CONCLUSION HepCATT had a modest impact but is a low cost intervention that merits optimisation and implementation as part of an NHS strategy to increase HCV testing and treatment. TRIAL REGISTRATION ISRCTN61788850.
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Affiliation(s)
- Kirsty Roberts
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - John Macleod
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration (BRTC), Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Will Hollingworth
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jack Williams
- Department of Health Service Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR HPRU in Blood Borne Viruses and STI, University College London, London, UK
| | - Peter Muir
- Public Health Laboratory Bristol, National Infection Service, Public Health England, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - Clare Clement
- NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - Fiona Gordon
- University Hospitals Bristol, Bristol Royal Infirmary, Bristol, UK
| | - Will Irving
- NIHR Nottingham Digestive Diseases Biomedical Research Unit, University Hospital Nottingham, Nottingham, UK
| | | | - Paul North
- Public Health Laboratory Bristol, National Infection Service, Public Health England, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Philippa Moore
- Public Health Laboratory Bristol, National Infection Service, Public Health England, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Ruth Simmons
- NIHR HPRU in Blood Borne Viruses and STI, University College London, London, UK
- National Infection Service, Public Health England, London, UK
| | - Alec Miners
- Department of Health Service Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- NIHR HPRU in Blood Borne Viruses and STI, University College London, London, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit (HPRU) in Evaluation of Interventions, University of Bristol, Bristol, UK
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16
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Tamori A, Inoue K, Kagawa T, Takaguchi K, Nouso K, Iwasaki Y, Minami M, Hai H, Enomoto M, Kawada N. Intention-to-treat assessment of glecaprevir + pibrentasvir combination therapy for patients with chronic hepatitis C in the real world. Hepatol Res 2019; 49:1365-1373. [PMID: 31323165 DOI: 10.1111/hepr.13410] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/20/2019] [Accepted: 07/11/2019] [Indexed: 02/08/2023]
Abstract
AIMS We assessed the problems and efficacy of glecaprevir + pibrentasvir (GLE/PIB) therapy for patients infected with hepatitis C virus (HCV) in the real world. METHOD A total of 423 patients infected with HCV who started treatment at eight different centers in Japan were enrolled in the study. Glecaprevir (300 mg) and pibrentasvir (120 mg) were given once daily for 8 weeks to 246 non-cirrhotic direct-acting antiviral (DAA)-naive patients with HCV genotype (GT)-1 or -2, and for 12 weeks to patients who: were DAA-naive cirrhotic (n = 55), had experienced DAA failure (n = 78), were cirrhotic and had DAA failure (n = 37), and were other GT-1/2 (n = 7). Anti-HCV efficacy was defined as a sustained virologic response 12 weeks post-treatment (SVR12). The evaluation was undertaken in an intention-to-treat (ITT) population and in patients who were assessed at SVR12 (modified ITT population). RESULTS In the ITT population, 220 (89%) patients on the 8-week regimen and 164 (93%) patients on the 12-week regimen achieved SVR12. The 30 dropout patients were predominantly men and with GT-2. All other DAA-naive GT-1 patients achieved SVR12. The 12-week regimen resulted in 100% SVR12 in 41 GT-2 patients. Nine patients did not achieve SVR12: two DAA naive with GT-2a, two GT-3b patients, two GT-1 patients with discontinuation, and three other GT-1 patients with a history of DAA failure. Four of seven patients who discontinued treatment due to severe adverse effects were more than 75 years old. CONCLUSIONS Glecaprevir + pibrentasvir had a remarkable anti-HCV effect in GT-1 and GT-2 patients, but not in GT-3b patients. Although this therapy was reasonably safe, it is necessary to carefully consider elderly and dropout patients.
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Affiliation(s)
- Akihiro Tamori
- Department of Hepatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuaki Inoue
- Department of Gastroenterology, Showa University, Yokohama, Japan
| | - Tatehiro Kagawa
- Department of Gastroenterology, Tokai University, Isehara, Japan
| | - Koichi Takaguchi
- Department of Gastroenterology, Kagawa Prefectural Central Hospital, Takamatsu, Japan
| | - Kazuhiro Nouso
- Department of Gastroenterology, Okayama City General Medical Center, Okayama, Japan
| | - Yoshiaki Iwasaki
- Department of Gastroenterology, Okayama University, Okayama, Japan
| | | | - Hoang Hai
- Department of Hepatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masaru Enomoto
- Department of Hepatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Norifumi Kawada
- Department of Hepatology, Osaka City University Graduate School of Medicine, Osaka, Japan
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17
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Persico M, Aglitti A, Milella M, Coppola C, Messina V, Claar E, Gentile I, Sogari F, Pierri P, Surace LA, Morisco F, Tundo P, Brancaccio G, Serviddio G, Gatti P, Termite AP, Di Costanzo GG, Caroleo B, Cozzolongo R, Coppola N, Longo A, Fontanella L, Federico A, Rosato V, Terrenato I, Masarone M. Real-life glecaprevir/pibrentasvir in a large cohort of patients with hepatitis C virus infection: The MISTRAL study. Liver Int 2019; 39:1852-1859. [PMID: 31175707 DOI: 10.1111/liv.14170] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS It is paramount to identify predictors of treatment failure with direct antiviral agents in 'field-practice' patients, including people who inject drugs (PWID). Data on the efficacy of glecaprevir/pibrentasvir (GLE/PIB) in a field-practice scenario are scant. The multicentre MISTRAL study enrolled 1177 patients, including PWID, to assess real-life efficacy and safety of GLE/PIB and to identify the predictive factors for this treatment. METHODS This was a prospective, longitudinal study. The outcome variable was the rate of sustained virological response (SVR) at week 12. RESULTS A total of 123 patients (10%) were infected from hepatitis C virus (HCV) 3. METAVIR fibrosis score was F4 in 104 subjects (9%); 118 patients (10%) were PWID. Overall, 1163/1177 (99%) patients achieved SVR. The baseline clinical factors discriminating between treatment success and treatment failure were age at treatment (P = 0.031) and creatinine level (P = 0.034). SVR rates were not influenced by gender, substance abuse, previous treatment, treatment duration, fibrosis or chronic kidney disease stage. Compared with non-substance users, the 118 PWID exhibited a significantly different genotype pattern distribution (χ2 < 0.001). A total of 40/118 (33.9%) of substance users were HCV3 compared to 83/1056 (7.9%) non-substance users. Only 6 patients (0.5%) reported a serious adverse event. CONCLUSIONS The MISTRAL study provides evidence of GLE/PIB efficacy in a field-practice scenario in a highly epidemic HCV area in southern Italy; it unveiled significant differences in genotype distribution among the most underserved and difficult-to-treat patient subgroups including PWID.
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Affiliation(s)
- Marcello Persico
- Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy
| | - Andrea Aglitti
- Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy
| | - Michele Milella
- Clinic of Infectious Diseases, University of Bari, Bari, Italy
| | - Carmine Coppola
- Internal Medicine and Hepatology Unit, Hospital of Gragnano, Gragnano, Italy
| | | | - Ernesto Claar
- Hepatology Unit, "Villa Betania" Evangelical Hospital, Naples, Italy
| | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Fernando Sogari
- Internal Medicine Unit, "S.S. Annunziata" Hospital, Taranto, Italy
| | - Paola Pierri
- Infectious Diseases and Hepatology Unit, Cotugno Hospital, Naples, Italy
| | - Lorenzo A Surace
- Traveler and Migration Medicine Center, ASP Catanzaro, Catanzaro, Italy
| | - Filomena Morisco
- Department of Clinical Medicine and Surgery, Gastroenterology and Hepatology Unit, Federico II University, Naples, Italy
| | - Paolo Tundo
- S. Caterina Novella Hospital, Galatina, Lecce, Italy
| | | | | | | | | | | | | | | | - Nicola Coppola
- Infectious Diseases Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Luca Fontanella
- Liver Diseases Unit, Fatebenefratelli Hospital, Naples, Italy
| | - Alessandro Federico
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Valerio Rosato
- Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy.,Hepatology Unit, "Villa Betania" Evangelical Hospital, Naples, Italy
| | - Irene Terrenato
- Biostatistics-Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mario Masarone
- Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy
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18
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Effect of adding daclatasvir in sofosbuvir-based therapy in genotype 3 hepatitis C: real-world experience in Pakistan. Eur J Gastroenterol Hepatol 2019; 31:1035-1039. [PMID: 31274596 DOI: 10.1097/meg.0000000000001376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To determine real-world effect of adding daclatasvir (DCV) to chronic hepatitis C treatment by comparing sustained viral response of sofosbuvir (SOF)/DCV±ribavirin (RBV) and SOF+RBV combination in patients with genotype 3 hepatitis C. PATIENTS AND METHODS Patients with chronic hepatitis C, genotype 3, presenting at the DHMC Hepatology Clinic from October 2014 till March 2018 were treated initially with 6 months of SOF/RBV, and once DCV was available, with SOF/DCV±RBV for 3 or 6 months. Negative hepatitis C virus RNA by PCR, sustained viral response 12 weeks after treatment (SVR12), was the primary end point for per-protocol analysis. RESULTS The mean age of the 440 enrolled patients was 51.04 (±11.9) years, and male to female ratio was 0.97/1 (217/223). Liver cirrhosis was present in 260 (59.1%) patients, and 89 (20.2%) had decompensated liver disease. Treatment-experienced patients were 124 (28.2%). We included 398 (90.4%) patients with completed follow-up in final analysis, excluding either dropped out, failed to complete therapy or died during follow-up. SVR12 was achieved in 366 (91.9%), being significantly lower (P=0.001) in patients with cirrhosis at 89.9% (205/228), and even lower SVR12 (P=0.006) in decompensated cirrhosis at 87.01% (67/77). SVR12 was also inferior (P=0.005) in treatment experienced patients at 85.8% (97/113) than treatment-naive patients at 94.3% (269/285). Among 285 patients treated with SOF/RBV, SVR12 was achieved in 264 (92.6%), which is not significantly different from SVR12 with SOF/DCV±RBV at 90.2% (102/113) (P=0.57). CONCLUSION In patients with chronic hepatitis C genotype 3, SOF/RBV and SOF/DCV±RBV have similar sustained viral response, and patients with liver cirrhosis and past treatment experience have suboptimal response in Pakistan.
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Abstract
OBJECTIVE Direct-acting antiviral agents (DAAs) have been approved for treating hepatitis C virus (HCV) infection in China. However, they are substantially more expensive. The current analysis will investigate the cost-effectiveness of novel regimens compared with pegylated interferon and ribavirin (PR) therapies for informing Chinese decision-makers. METHODS A Markov model was developed to measure economic and health outcomes of novel regimens for genotype 1b, 2, 3, and 6 HCV infections compared with PR treatment. Clinical, cost, and utility inputs were gathered from published sources. Discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) are shown. The uncertainty was facilitated by one-way and probabilistic sensitivity analyses. RESULTS For genotype 1b HCV infection, the combination of paritaprevir, ritonavir, ombitasvir and dasabuvir was cost-saving compared with four competing alternatives. The ICERs of sofosbuvir plus ribavirin for genotypes 2 and 3 were lower than the threshold ($18,234/QALY). Among available strategies for patients with genotype 6, sofosbuvir in combination with ribavirin was the cost-saving alternative compared with PR. The results were robust to sensitivity analyses. CONCLUSIONS For both genotype 1b and 6 HCV infections in the context of Chinese patients, there were combinations of DAAs that were cost-saving compared with the usual PR treatment, and cost-effective for genotypes 2 and 3.
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Affiliation(s)
- Bin Wu
- a Medical Decision and Economic Group, Department of Pharmacy , Ren Ji Hospital, South Campus , School of Medicine , Shanghai Jiaotong University , Shanghai , PR China
| | - Zhenhua Wang
- b Department of Gastroenterology , Ren Ji Hospital , School of Medicine , Shanghai Jiaotong University , Shanghai , PR China
| | - Qing Xie
- c Department of Infectious Diseases, Ruijin Hospital , Shanghai Jiaotong University School of Medicine , Shanghai , PR China
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20
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Lu J, Feng Y, Chen L, Zeng Z, Liu X, Cai W, Wang H, Guo X, Zhou H, Tao W, Xie Q. Subtype-Specific Prevalence of Hepatitis C Virus NS5A Resistance Associated Substitutions in Mainland China. Front Microbiol 2019; 10:535. [PMID: 30941111 PMCID: PMC6433824 DOI: 10.3389/fmicb.2019.00535] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 03/01/2019] [Indexed: 12/21/2022] Open
Abstract
Resistance associated substitutions (RASs) can reduce the efficacy of direct-acting antiviral agents (DAAs) targeting hepatitis C virus (HCV) and lead to treatment failure. Clinical data of HCV NS5A RASs prevalence are limited in China and need to be investigated. A total of 878 unique patient samples with different genotypes (GT) (1b: n = 489, 2a: n = 203, 3a: n = 60, 3b: n = 78, 6a: n = 48) were collected from around mainland China by KingMed Laboratory and analyzed for NS5A RASs distribution by Sanger sequencing. Phylogeographic analyses based on NS5A domain 1 sequences indicated circulation of both locally and nationally epidemic strains. Relatively high frequency of Y93H (14.1%) was only detected in GT1b but not in other subtypes. High frequency of L31M was found in both GT2a (95.6%) and GT3b (98.7%) sequences. Due to the overlapping incidence of A30K, 96% of GT3b isolates had NS5A RASs combination A30K + L31M, which confers high levels of resistance to most NS5A inhibitors. No RASs were detected in GT6a strains. Meanwhile, baseline NS5A RASs fingerprints were also evaluated in 185 DAA treatment-naive GT1b patients with next generation sequencing method. Patients presenting with Y93H had statistically higher entropy of HCV NS5A sequences. Taken together, subtype-specific distribution patterns of NS5A RASs were observed. GT1b patients with higher HCV complexity tend to have a greater chance of Y93H presence, while GT3b patients are naturally resistant to current NS5A inhibitors and their treatment may pose a challenge to real-world DAA application.
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Affiliation(s)
- Jie Lu
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yupeng Feng
- Guangzhou Kingmed Center for Clinical Laboratory Co., Ltd., Guangzhou, China
| | - Lichang Chen
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengyu Zeng
- Guangzhou Kingmed Center for Clinical Laboratory Co., Ltd., Guangzhou, China
| | - Xianliang Liu
- Guangzhou Kingmed Center for Clinical Laboratory Co., Ltd., Guangzhou, China
| | - Wei Cai
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wang
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolei Guo
- Guangzhou Kingmed Center for Clinical Laboratory Co., Ltd., Guangzhou, China
| | - Huijuan Zhou
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wanyin Tao
- Hefei National Laboratory for Physical Sciences at Microscale, CAS Key Laboratory of Innate Immunity and Chronic Disease, School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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21
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Sofosbuvir-velpatasvir single-tablet regimen administered for 12 weeks in a phase 3 study with minimal monitoring in India. Hepatol Int 2019; 13:173-179. [PMID: 30790229 PMCID: PMC6418070 DOI: 10.1007/s12072-019-09927-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 01/05/2019] [Indexed: 12/20/2022]
Abstract
Background and aims In clinical studies, sofosbuvir–velpatasvir has demonstrated high cure rates and favorable tolerability in patients chronically infected with chronic hepatitis C virus (HCV) of any genotype. We evaluated the effectiveness and safety of sofosbuvir–velpatasvir administered with minimal medical monitoring to patients in India.
Methods At 16 sites in India, 129 adult patients with chronic HCV infection of any genotype initiated 12 weeks of once-daily sofosbuvir–velpatasvir (400–100 mg). Patients with compensated cirrhosis or prior treatment experience could be included in the study. Study drug was dispensed monthly, but there were no on-treatment study assessments. The primary efficacy endpoint was rate of sustained virologic response (HCV RNA < 15 IU/mL) 12 weeks after treatment (SVR12), which was compared to a pre-specified performance goal of 85%. Results The majority of patients had HCV genotype 3 infection (70%), followed by HCV genotype 1 (22%). The SVR12 rate was 93% (120/129; 95% CI, 87% to 97%) (p = 0.009 compared with the 85% performance goal). Of the nine patients who did not achieve SVR12, 1 experienced virologic failure, 2 relapsed after treatment, 1 withdrew consent after treatment, and 5 were lost to follow-up (1 during and 4 after treatment). Sofosbuvir–velpatasvir was well-tolerated, and no patients discontinued treatment because of an adverse event. The most frequently reported adverse events were headache (3% of patients), upper abdominal pain (2%), and pyrexia (2%). Conclusions In this study conducted at multiple sites in India, sofosbuvir–velpatasvir administered without genotype restriction or on-treatment safety assessments was well-tolerated and highly effective.
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22
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Gane EJ, Stedman CA, Schwabe C, Vijgen L, Chanda S, Kakuda TN, Fry J, Blatt LM, McClure MW. Short-Duration AL-335, Odalasvir, With or Without Simeprevir, in Patients With HCV GT1 or 3 Infection Without Cirrhosis. Hepatology 2018; 68:2145-2157. [PMID: 30070722 DOI: 10.1002/hep.30126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/31/2018] [Indexed: 12/21/2022]
Abstract
This open-label, phase IIa study assessed the safety, pharmacokinetics, and efficacy of direct-acting antiviral agent (DAA) regimens in patients with chronic hepatitis C virus (HCV) infection. Multiple 6-12-week oral regimens of 400-800 mg once daily (QD) AL-335 + 50 mg QD/every other day odalasvir ± 75-150 mg QD simeprevir were evaluated in treatment-naïve, HCV genotype (GT)1/3-infected patients without cirrhosis. Safety/pharmacokinetic parameters, HCV-RNA, and sequencing data were assessed. Treatment regimens for later study cohorts were adjusted based on emerging data. In total, 112 patients were enrolled. Three serious treatment-emergent adverse events occurred, one of which (a Mobitz type 1 second-degree atrioventricular block [Wenckebach]) was possibly related to high odalasvir exposure and resulted in premature discontinuation of study drugs. No other clinically significant safety findings were identified. GT1-infected patients receiving 3-DAA for 6-8 weeks achieved 100% sustained virologic response 12 weeks and 24 weeks after the end of treatment (sustained virologic response [SVR12/24]). GT1-infected patients receiving 2-DAA or GT3-infected patients receiving 3-DAA had SVR12/24 less than 90%, whether treated for 8 weeks or 12 weeks. Virologic failure was associated with the emergence of generally persistent NS5A and/or transient NS5B resistance-associated substitutions in most patients. Pharmacokinetic characteristics of the three drugs were also elucidated. Conclusions: In treatment-naïve subjects without cirrhosis, AL-335 + odalasvir + simeprevir for 6-8 weeks was generally safe and highly efficacious against HCV GT1. However, inadequate efficacy was observed for the 2-DAA regimen in GT1-infected subjects and the 3-DAA regimen in GT3-infected subjects.
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Affiliation(s)
| | | | | | - Leen Vijgen
- Janssen Research & Development, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Sushmita Chanda
- Alios BioPharma Inc. part of the Janssen Pharmaceutical Companies, South San Francisco, California
| | - Thomas N Kakuda
- Alios BioPharma Inc. part of the Janssen Pharmaceutical Companies, South San Francisco, California
| | - John Fry
- Alios BioPharma Inc. part of the Janssen Pharmaceutical Companies, South San Francisco, California
| | - Lawrence M Blatt
- Alios BioPharma Inc. part of the Janssen Pharmaceutical Companies, South San Francisco, California
| | - Matthew W McClure
- Alios BioPharma Inc. part of the Janssen Pharmaceutical Companies, South San Francisco, California
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23
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Krishnan P, Pilot-Matias T, Schnell G, Tripathi R, Ng TI, Reisch T, Beyer J, Dekhtyar T, Irvin M, Xie W, Larsen L, Mensa FJ, Collins C. Pooled Resistance Analysis in Patients with Hepatitis C Virus Genotype 1 to 6 Infection Treated with Glecaprevir-Pibrentasvir in Phase 2 and 3 Clinical Trials. Antimicrob Agents Chemother 2018; 62:e01249-18. [PMID: 30061289 PMCID: PMC6153825 DOI: 10.1128/aac.01249-18] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/26/2018] [Indexed: 12/21/2022] Open
Abstract
Over 2,200 patients infected with hepatitis C virus (HCV) genotypes (GT) 1 to 6, with or without cirrhosis, who were treatment naive or experienced to interferon, ribavirin, and/or sofosbuvir were treated with glecaprevir/pibrentasvir for 8, 12, or 16 weeks in eight registrational phase 2 and 3 clinical studies. High rates of sustained virologic response at 12 weeks postdosing (SVR12) were achieved with a <1% virologic failure (VF) rate. The prevalence of baseline polymorphisms (BPs) in NS3 at amino acid position 155 or 168 was low (<3%) in patients infected with GT1, GT2, GT3, GT4, and GT6, while 41.9% of the GT5-infected patients had NS3-D168E; BPs were not detected at position 156 in NS3. The prevalence of NS5A-BPs was high across genotypes, driven by common polymorphisms at amino acid position 30 or 31 in GT2, 58 in GT4, and 28 in GT6. The prevalence of NS5A T/Y93 polymorphisms was 5.5% in GT1, 4.9% in GT3, and 12.5% in GT6. Consistent with the activity of glecaprevir and pibrentasvir against most amino acid polymorphisms in vitro, BPs in NS3 and/or NS5A did not have an impact on treatment outcome for patients infected with GT1 to GT6, with the exception of treatment-experienced GT3-infected patients treated for 12 weeks, for whom a 16-week regimen of glecaprevir/pibrentasvir was required to achieve SVR12 rates of ≥95%. Among the 22 patients experiencing VF, treatment-emergent substitutions were detected in NS3 in 50% of patients and in NS5A in 82% of patients, frequently as a combination of substitutions that conferred resistance to glecaprevir and/or pibrentasvir. The glecaprevir/pibrentasvir regimen, when the recommended durations are used, allows for a pan-genotypic treatment option without the need for baseline resistance testing.
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Affiliation(s)
- Preethi Krishnan
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | | | - Gretja Schnell
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Rakesh Tripathi
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Teresa I Ng
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Thomas Reisch
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Jill Beyer
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Tatyana Dekhtyar
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Michelle Irvin
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Wangang Xie
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Lois Larsen
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Federico J Mensa
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
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24
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Tao YC, Deng R, Wang ML, Lv DD, Yuan M, Wang YH, Chen EQ, Tang H. Satisfactory virological response and fibrosis improvement of sofosbuvir-based regimens for Chinese patients with hepatitis C virus genotype 3 infection: results of a real-world cohort study. Virol J 2018; 15:150. [PMID: 30285800 PMCID: PMC6167801 DOI: 10.1186/s12985-018-1066-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023] Open
Abstract
Background Chronic hepatitis C virus (HCV) genotype (GT) 3 infection with advanced liver disease has emerged as a challenging to treat by direct-acting antivirals (DAAs), but the efficacy of DAAs in Chinese HCV-GT3 patients is rarely reported. This study aimed to analyze the efficacy of sofosbuvir (SOF)-based regimens in Chinese patients with HCV-GT3 and compensated liver disease. Methods This was a registered retrospective study. All patients had completed at least 12 weeks SOF-based regimens therapy (with or without RBV), and were followed up for at least 24 weeks after therapy discontinuation. The primary endpoint was sustained virological response 24 weeks after end of therapy (SVR24). Results A total of 102 patients who completed at least 12 weeks therapy were finally included, with 57 in SOF + Daclatasvir (SOF + DCV), 24 in SOF + DCV + ribavirin (RBV) and 21 in SOF/Velpatasvir (SOF/VEL). The total SVR24 rate was achieved in 90.20% (92/102), with 85.96% (49/57) in SOF + DCV, 91.67% (22/24) in SOF + DCV + RBV and 100.00% (21/21) in SOF/VEL. Among 10 relapsed patients (8 in SOF + DCV and 2 in SOF + DCV + RBV), the short course (12 weeks) of therapy and no RBV addition may be the leading cause. In this cohort, the SVR24 rate was not statistically different between patients with and without cirrhosis (81.82% [27/33] vs. 94.20% [65/69], P = 0.073). Additionally, both FIB-4 (4.03 vs. 2.08, P < 0.001) and APRI (2.15 vs. 0.68, P < 0.001) scores were significant improved from baseline to week 24 after completion of therapy, regardless of the presence of cirrhosis. Conclusion SOF-based regimens are highly effective in viral clearance and fibrosis remission for Chinese patients with HCV-GT3 infection. If available, SOF/VEL should be first considered.
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Affiliation(s)
- Ya-Chao Tao
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, People's Republic of China
| | - Rong Deng
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, People's Republic of China
| | - Meng-Lan Wang
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, People's Republic of China
| | - Duo-Duo Lv
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, People's Republic of China
| | - Man Yuan
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, People's Republic of China
| | - Yong-Hong Wang
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, People's Republic of China
| | - En-Qiang Chen
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, People's Republic of China.
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, No.37 Guo Xue Xiang, Wuhou District, Chengdu, 610041, People's Republic of China.
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25
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Bertoli A, Sorbo MC, Aragri M, Lenci I, Teti E, Polilli E, Di Maio VC, Gianserra L, Biliotti E, Masetti C, Magni CF, Babudieri S, Nicolini LA, Milana M, Cacciatore P, Sarmati L, Pellicelli A, Paolucci S, Craxì A, Morisco F, Palitti VP, Siciliano M, Coppola N, Iapadre N, Puoti M, Rizzardini G, Taliani G, Pasquazzi C, Andreoni M, Parruti G, Angelico M, Perno CF, Cento V, Ceccherini-Silberstein F. Prevalence of Single and Multiple Natural NS3, NS5A and NS5B Resistance-Associated Substitutions in Hepatitis C Virus Genotypes 1-4 in Italy. Sci Rep 2018; 8:8988. [PMID: 29895871 PMCID: PMC5997636 DOI: 10.1038/s41598-018-26862-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/16/2018] [Indexed: 12/15/2022] Open
Abstract
Natural resistance-associated substitutions (RASs) are reported with highly variable prevalence across different HCV genotypes (GTs). Frequency of natural RASs in a large Italian real-life cohort of patients infected with the 4 main HCV-GTs was investigated. NS3, NS5A and NS5B sequences were analysed in 1445 HCV-infected DAA-naïve patients. Sanger-sequencing was performed by home-made protocols on 464 GT1a, 585 GT1b, 92 GT2c, 199 GT3a, 16 GT4a and 99 GT4d samples. Overall, 20.7% (301/1455) of patients showed natural RASs, and the prevalence of multiclass-resistance was 7.3% (29/372 patients analysed). NS3-RASs were particularly common in GT1a and GT1b (45.2-10.8%, respectively), mainly due to 80K presence in GT1a (17%). Almost all GTs showed high prevalence of NS5A-RASs (range: 10.2-45.4%), and especially of 93H (5.1%). NS5A-RASs with fold-change >100x were detected in 6.8% GT1a (30H/R-31M-93C/H), 10.3% GT1b (31V-93H), 28.4% GT2c (28C-31M-93H), 8.5% GT3a (30K-93H), 45.5% GT4a (28M-30R-93H) and 3.8% GT4d (28V-30S-93H). Sofosbuvir RAS 282T was never detected, while the 159F and 316N RASs were found in GT1b (13.4-19.1%, respectively). Natural RASs are common in Italian patients infected with HCV-GTs 1-4. High prevalence of clinically-relevant RASs (such as Y93H) supports the appropriateness of HCV resistance-test to properly guide DAA-based therapy.
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Affiliation(s)
- Ada Bertoli
- Department Experimental Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Maria Chiara Sorbo
- Department Experimental Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Marianna Aragri
- Department Experimental Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | - Elisabetta Teti
- Infectious Diseases Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | - Ennio Polilli
- Infectious Diseases Unit, Pescara General Hospital, 65124, Pescara, Italy
| | - Velia Chiara Di Maio
- Department Experimental Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Laura Gianserra
- Infectious Diseases Unit, Sant'Andrea Hospital - "Sapienza" University, 00189, Rome, Italy
| | - Elisa Biliotti
- Tropical Diseases, Umberto I Hospital -"Sapienza" University, 00161, Rome, Italy
| | - Chiara Masetti
- Hepatology Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | - Carlo F Magni
- 1st Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157, Milan, Italy
| | - Sergio Babudieri
- Clinical and Experimental Medicine, University of Sassari, 07100, Sassari, Italy
| | - Laura A Nicolini
- Infectious Diseases Unit, IRCCS AOU San Martino - IST, 16132, Genoa, Italy
| | - Martina Milana
- Hepatology Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | | | - Loredana Sarmati
- Infectious Diseases Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | | | - Stefania Paolucci
- Molecular Virology, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Antonio Craxì
- Gastroenterology, "P. Giaccone" University Hospital, 90127, Palermo, Italy
| | - Filomena Morisco
- Gastroenterology, "Federico II" University, 80131, Naples, Italy
| | | | | | - Nicola Coppola
- Infectious Diseases Unit, "L. Vanvitelli" University of Campania, 80138, Naples, Italy
| | - Nerio Iapadre
- Infectious Diseases Unit, S. Salvatore Hospital, 67100, L'Aquila, Italy
| | - Massimo Puoti
- Infectious Diseases Unit, Niguarda Ca' Granda Hospital, 20162, Milan, Italy
| | - Giuliano Rizzardini
- 1st Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157, Milan, Italy
| | - Gloria Taliani
- Tropical Diseases, Umberto I Hospital -"Sapienza" University, 00161, Rome, Italy
| | - Caterina Pasquazzi
- Infectious Diseases Unit, Sant'Andrea Hospital - "Sapienza" University, 00189, Rome, Italy
| | - Massimo Andreoni
- Infectious Diseases Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, 65124, Pescara, Italy
| | - Mario Angelico
- Hepatology Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | | | - Valeria Cento
- Department Experimental Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy.
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