1
|
Flower B, Hung LM, Mccabe L, Ansari MA, Le Ngoc C, Vo Thi T, Vu Thi Kim H, Nguyen Thi Ngoc P, Phuong LT, Quang VM, Dang Trong T, Le Thi T, Nguyen Bao T, Kingsley C, Smith D, Hoglund RM, Tarning J, Kestelyn E, Pett SL, van Doorn R, Van Nuil JI, Turner H, Thwaites GE, Barnes E, Rahman M, Walker AS, Day JN, Chau NVV, Cooke GS. Efficacy of ultra-short, response-guided sofosbuvir and daclatasvir therapy for hepatitis C in a single-arm mechanistic pilot study. eLife 2023; 12:e81801. [PMID: 36622106 PMCID: PMC9870305 DOI: 10.7554/elife.81801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/23/2022] [Indexed: 01/10/2023] Open
Abstract
Background World Health Organization has called for research into predictive factors for selecting persons who could be successfully treated with shorter durations of direct-acting antiviral (DAA) therapy for hepatitis C. We evaluated early virological response as a means of shortening treatment and explored host, viral and pharmacokinetic contributors to treatment outcome. Methods Duration of sofosbuvir and daclatasvir (SOF/DCV) was determined according to day 2 (D2) virologic response for HCV genotype (gt) 1- or 6-infected adults in Vietnam with mild liver disease. Participants received 4- or 8-week treatment according to whether D2 HCV RNA was above or below 500 IU/ml (standard duration is 12 weeks). Primary endpoint was sustained virological response (SVR12). Those failing therapy were retreated with 12 weeks SOF/DCV. Host IFNL4 genotype and viral sequencing was performed at baseline, with repeat viral sequencing if virological rebound was observed. Levels of SOF, its inactive metabolite GS-331007 and DCV were measured on days 0 and 28. Results Of 52 adults enrolled, 34 received 4 weeks SOF/DCV, 17 got 8 weeks and 1 withdrew. SVR12 was achieved in 21/34 (62%) treated for 4 weeks, and 17/17 (100%) treated for 8 weeks. Overall, 38/51 (75%) were cured with first-line treatment (mean duration 37 days). Despite a high prevalence of putative NS5A-inhibitor resistance-associated substitutions (RASs), all first-line treatment failures cured after retreatment (13/13). We found no evidence treatment failure was associated with host IFNL4 genotype, viral subtype, baseline RAS, SOF or DCV levels. Conclusions Shortened SOF/DCV therapy, with retreatment if needed, reduces DAA use in patients with mild liver disease, while maintaining high cure rates. D2 virologic response alone does not adequately predict SVR12 with 4-week treatment. Funding Funded by the Medical Research Council (Grant MR/P025064/1) and The Global Challenges Research 70 Fund (Wellcome Trust Grant 206/296/Z/17/Z).
Collapse
Affiliation(s)
- Barnaby Flower
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Department of Infectious Disease, Imperial College LondonLondonUnited Kingdom
| | - Le Manh Hung
- Hospital for Tropical DiseasesHo Chi Minh CityVietnam
| | - Leanne Mccabe
- MRC Clinical Trials Unit at UCL, University College LondonLondonUnited Kingdom
| | - M Azim Ansari
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Chau Le Ngoc
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | - Thu Vo Thi
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | - Hang Vu Thi Kim
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | | | | | - Vo Minh Quang
- Hospital for Tropical DiseasesHo Chi Minh CityVietnam
| | | | - Thao Le Thi
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | - Tran Nguyen Bao
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
| | - Cherry Kingsley
- Department of Infectious Disease, Imperial College LondonLondonUnited Kingdom
| | - David Smith
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
| | - Richard M Hoglund
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Faculty of Tropical MedicineBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Joel Tarning
- Mahidol Oxford Tropical Medicine Research Unit, Mahidol University, Faculty of Tropical MedicineBangkokThailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Evelyne Kestelyn
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Sarah L Pett
- MRC Clinical Trials Unit at UCL, University College LondonLondonUnited Kingdom
| | - Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
- Oxford University Clinical Research UnitHanoiVietnam
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Hugo Turner
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Guy E Thwaites
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Eleanor Barnes
- Peter Medawar Building for Pathogen Research, Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Motiur Rahman
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | - Ann Sarah Walker
- MRC Clinical Trials Unit at UCL, University College LondonLondonUnited Kingdom
- Nuffield Department of Medicine, University of OxfordOxfordUnited Kingdom
- The National Institute for Health Research, Oxford Biomedical Research Centre, University of OxfordOxfordUnited Kingdom
| | - Jeremy N Day
- Oxford University Clinical Research UnitHo Chi Minh CityVietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford UniversityOxfordUnited Kingdom
| | | | - Graham S Cooke
- Department of Infectious Disease, Imperial College LondonLondonUnited Kingdom
| |
Collapse
|