Real-world effectiveness of sofosbuvir/velpatasvir/voxilaprevir in 573 direct-acting antiviral experienced hepatitis C patients
Real-world effectiveness of sofosbuvir/velpatasvir/voxilaprevir in 573 direct-acting antiviral experienced hepatitis C patients
复制标题
DOI：
10.1111/jvh.13115
复制
发表时间：
2019-08-01
影响因子：
2.5
通讯作者：
Backus, Lisa I.
中科院分区：
文献类型：
--
作者：
Belperio, Pamela S.;Shahoumian, Troy A.;Backus, Lisa I.
索非布韦/维帕他韦/伏西瑞韦（SOF/VEL/VOX）为直接作用抗病毒药物（DAA）经验丰富的患者提供了所需的丙型肝炎病毒（HCV）抗病毒药物选择。我们评估了SOF/VEL/VOX在临床实践中治疗的基因型1-4的DAA患者中12周的有效性。在这项来自退伍军人事务部临床病例登记处的观察性队列分析中，纳入了573例开始SOF/VEL/VOX治疗的DAA患者：490例基因型1，20例基因型2，51例基因型3和12例基因型4。肝硬化的发生率分别为32.7%、30.0%、49.0%和58.3%;基因型1-4的既往NS 5A经验的发生率分别为100.0%、95.0%、90.2%和100.0%。基因型1-4的总SVR率分别为90.7%（429/473）、90.0%（18/20）、91.3%（42/46）和100.0%（12/12），基因型1-4的总SVR率分别为91.3%（274/300）、88.9%（16/18）、对于既往有NS 5A + NS 5 B经验的患者，为90.2%（37/41）和100.0%（11/11）。对于基因型1，既往接受ledipasvir/SOF（90.6%，298/329）、elbasvir/grazoprevir（91.2%，73/80）和ombitasvir/paritaprevir/ritonavir/dasabuvir（90.9%，70/77）方案的患者的SVR率相似。有SOF/VEL病史的1、2和3型患者的SVR率分别为78.9%（15/19）、86.7%（13/15）和84.6%（11/13）。在完成12周SOF/VEL/VOX的基因型1-4患者中，总体SVR率分别为95.1%（409/430）、89.5%（17/19）、93.3%（42/45）和100%（12/12）。在这个多元化的、接受过大量NS 5A预治疗的患者的现实世界队列中，所有基因型中，经历过DAA的患者的SOF/VEL/VOX SVR率都很高。基因型1患者既往接受过最常用的NS 5A方案治疗，当接受SOF/VEL/VOX复治时，其SVR率相似。对于基因型1、2和3，既往有SOF/VEL经验的患者SVR率较低。
Sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) provides a needed hepatitis C virus (HCV) antiviral option for direct-acting antiviral (DAA)-experienced patients. We evaluated the effectiveness of SOF/VEL/VOX for 12 weeks in DAA-experienced patients with genotype 1-4 treated in clinical practice. In this observational cohort analysis from the Veterans Affairs' Clinical Case Registry, 573 DAA-experienced patients initiating SOF/VEL/VOX were included: 490 genotype 1, 20 genotype 2, 51 genotype 3 and 12 genotype 4. Rates of cirrhosis were 32.7%, 30.0%, 49.0% and 58.3%; rates of prior NS5A-experience were 100.0%, 95.0%, 90.2% and 100.0% for genotypes 1-4, respectively. Overall SVR rates were 90.7% (429/473), 90.0% (18/20), 91.3% (42/46) and 100.0% (12/12) for genotypes 1-4, respectively, and were 91.3% (274/300), 88.9% (16/18), 90.2% (37/41) and 100.0% (11/11) for those with prior NS5A + NS5B experience. For genotype 1, SVR rates were similar in patients with prior regimens of ledipasvir/SOF (90.6%, 298/329), elbasvir/grazoprevir (91.2%, 73/80) and ombitasvir/paritaprevir/ritonavir/dasabuvir (90.9%, 70/77). SVR rates in genotype 1, 2 and 3 patients with prior SOF/VEL experience were 78.9% (15/19), 86.7% (13/15) and 84.6% (11/13). In genotype 1-4 patients completing 12 weeks of SOF/VEL/VOX, overall SVR rates were 95.1% (409/430), 89.5% (17/19), 93.3% (42/45) and 100% (12/12). In this diverse real-world cohort of heavily NS5A pretreated patients, SOF/VEL/VOX SVR rates in DAA-experienced patients were high across all genotypes. Genotype 1 patients who had prior experience with the most commonly prescribed NS5A regimens achieved similarly high SVR rates when retreated with SOF/VEL/VOX. For genotypes 1, 2 and 3, patients with prior SOF/VEL experience had lower SVR rates.