Three-drug combo an effective salvage option for refractory HCV

Patients with hepatitis C virus (HCV) who failed a previous direct-acting antiviral agent (DAA) therapy appear to respond well to the fixed-dose sofosbuvir/velpatasvir/voxilaprevir (SVV) treatment combination, as shown in a study.

The study included 128 HCV-infected patients who did not respond to DAAs and were prescribed SVV from a prospective Canadian registry (CANUHC) including 17 sites across Canada. The cohort had a median age of 57.5 years (interquartile range, 31–86) and had male predominance (80 percent); 44 percent of the patients had cirrhosis, and 17 were liver transplant recipients.

First-line DAA regimens used included sofosbuvir/velpatasvir (27.3 percent), sofosbuvir/ledipasvir (26.5 percent), grazoprevir/elbasvir (12.5 percent), and others (33.5 percent). Ribavirin was given with SVV in 26 patients owing to previous sofosbuvir/velpatasvir exposure (n=8), complex resistance associated substitution profiles (n=16), and/or cirrhosis (n=9).

Retreatment with SVV yielded an overall sustained virological response (SVR) rate of 96 percent (123/128). Of the 35 patients who previously failed sofosbuvir/velpatasvir, 31 (88.5 percent) achieved SVR.

Meanwhile, SVR occurred in 92 out of 93 patients (99 percent) receiving any other regimen (p=0.01).

There were several factors associated with failure to achieve SVR with SVV therapy, including genotype 3, presence of cirrhosis, past liver transplantation, past exposure to sofosbuvir/velpatasvir, and/or complex resistance profiles.

The findings indicate that SVV is highly effective as a salvage therapy for patients who failed a previous DAA therapy.