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Wang GP, Terrault N, Reeves JD, Liu L, Li E, Zhao L, Lim JK, Morelli G, Kuo A, Levitsky J, Sherman KE, Frazier LM, Ramani A, Peter J, Akuskevich L, Fried MW, Nelson DR. Prevalence and impact of baseline resistance-associated substitutions on the efficacy of ledipasvir/sofosbuvir or simeprevir/sofosbuvir against GT1 HCV infection. Sci Rep 2018; 8:3199. [PMID: 29453451 PMCID: PMC5816647 DOI: 10.1038/s41598-018-21303-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/01/2018] [Indexed: 12/12/2022] Open
Abstract
Baseline resistance-associated substitutions (RASs) have variable impacts in clinical trials but their prevalence and impact in real-world patients remains unclear. We performed baseline resistance testing using a commercial assay (10% cutoff) for 486 patients treated with LDV/SOF or SMV/SOF, with or without ribavirin, in the multi-center, observational HCV-TARGET cohort. Linkage of RASs was evaluated in selected samples using a novel quantitative single variant sequencing assay. Our results showed that the prevalence of NS3, NS5A, NS5B RASs was 45%, 13%, and 8%, respectively, and 10% of patients harbored RASs in 2 or more drug classes. Baseline LDV RASs in GT1a, TE, and cirrhosis LDV/SOF subgroup was associated with 2–4% lower SVR12 rates. SMV RASs was associated with lower SVR12 rates in GT1a, treatment-experienced, cirrhotics SMV/SOF subgroup. Pooled analysis of all patients with baseline RASs revealed that SVR12 was 100% (19/19) in patients treated for longer than 98 days but was 87% (81/93) in patients treated for shorter than 98 days. These results demonstrate that RASs prevalence and their impact in real world practice are in general agreement with registration trials, and suggest that longer treatment duration may overcome the negative impact of baseline RASs on SVR12 rates in clinical practice.
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Affiliation(s)
- Gary P Wang
- University of Florida, Gainesville, USA. .,North Florida/South Georgia Veterans Health System, Gainesville, USA.
| | - Norah Terrault
- University of California, San Francisco, San Francisco, USA
| | | | - Lin Liu
- University of Florida, Gainesville, USA
| | - Eric Li
- University of Florida, Gainesville, USA
| | - Lisa Zhao
- University of Florida, Gainesville, USA
| | - Joseph K Lim
- Yale University School of Medicine, New Haven, USA
| | | | | | - Josh Levitsky
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | | | | | | | - Joy Peter
- University of Florida, Gainesville, USA
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