The summaries are free for public
use. The Chronic Liver Disease
Foundation will continue to add and
archive summaries of articles deemed
relevant to CLDF by the Board of
Trustees and its Advisors.
Abstract Details
Salvage Therapy with Sofosbuvir/Velpatasvir/Voxilaprevir in DAA-experienced Patients: Results from a Prospective Canadian Registry
Clin Infect Dis. 2021 Mar 2;ciaa1510. doi: 10.1093/cid/ciaa1510. Online ahead of print.
Fernanda Q Onofrio1, Curtis Cooper2, Sergio M Borgia3, Marie-Louise Vachon4, Alnoor Ramji5, Leslie B Lilly6, Alexander Wong7, Joshua Booth1, Izza Sattar1, Heidy Morales1, Samuel Lee8, Brian Conway9, Jordan J Feld1
Author information
1Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Canada.
2University of Ottawa, Ottawa, Ontario, Canada.
3William Osler Health System, Toronto, Ontario, Canada.
4Centre Hospitalier Universitaire de Québec-Université Laval, Quebec, Canada.
5Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
6Multiorgan Transplant Program, University Health Network, Toronto, Ontario, Canada.
7Department of Medicine, University of Saskatchewan, Saskatchewan, Canada.
8Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
9Vancouver Infectious Diseases Centre, Vancouver, British Columbia, Canada.
Abstract
Background: Despite the current highly effective therapies with direct-acting antiviral agents (DAAs), some patients with chronic hepatitis C virus (HCV) infection still do not achieve sustained virological response (SVR) and require retreatment. Sofosbuvir/velpatasvir/voxilaprevir (SVV) is recommended as the first-line retreatment option for most patients. The aim of this study was to evaluate the efficacy of SVV as salvage therapy after at least one course of DAA.
Methods: Data were collected on all HCV-infected patients who failed DAAs and were prescribed SVV from a prospective Canadian registry (CANUHC) including 17 sites across Canada. Factors associated with failure to achieve SVR with SVV therapy and the utility of RAS testing and ribavirin use were evaluated.
Results: A total of 128 patients received SVV after non-SVR with DAA treatment: 80% male, median age 57.5 (31-86), 44% cirrhotic, and 17 patients post liver transplant. First line regimens included: sofosbuvir/velpatasvir (27.3%), sofosbuvir/ledipasvir (26.5%), grazoprevir/elbasvir (12.5%), other (33.5%). Ribavirin was added to SVV in 26 patients due to past sofosbuvir/velpatasvir use (n = 8), complex resistance associated substitution profiles (n = 16) and/or cirrhosis (n = 9). Overall SVR rate was 96% (123/128). Of 35 patients who previously failed sofosbuvir/velpatasvir, 31 (88.5%) achieved SVR compared to 92 of 93 (99%) among those receiving any other regimen (P = .01).
Conclusions: Similar to reports from phase 3 clinical trials, SVV proved highly effective as salvage therapy for patients who failed a previous DAA therapy. Those who failed SVV had at least 2 of the following factors: genotype 3, presence of cirrhosis, past liver transplantation, past exposure to sofosbuvir/velpatasvir and/or complex resistance profiles.