1Faculty of Medicine, University of Auckland, Auckland, New Zealand.
2Centre d'Investigation de la Fibrose Hépatique, Bordeaux University Hospital, Pessac, France.
3INSERM U1053, Bordeaux University, Bordeaux, France.
4AbbVie Inc, North Chicago, Illinois, USA.
51st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy.
6Liver Institute of Virginia, Bon Secours Mercy Health, Richmond, Virginia, USA.
7Department of Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK.
8Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
9Scripps Center for Organ and Cell Transplantation, La Jolla, California, USA.
Sustained virologic response at posttreatment Week 12 (SVR12) is the widely accepted efficacy endpoint for direct-acting antiviral agents. Those with hepatitis C virus (HCV) are presenting younger with milder liver disease, potentially reducing need for long-term liver posttreatment monitoring. This analysis aimed to determine the positive predictive value (PPV) of SVR at posttreatment Week 4 (SVR4) for achieving SVR12 in patients with HCV, without cirrhosis or with compensated cirrhosis, receiving glecaprevir/pibrentasvir (G/P) in clinical trials. An integrated dataset from 20 Phase 2 and 3 clinical trials of G/P was evaluated in patients with 8-, 12- or 16-week treatment duration consistent with the current label (label-consistent group), and in all patients regardless of treatment duration consistency with the current label (overall group). Sensitivity analyses handled missing data either by backward imputation or were excluded. SVR4 PPV, negative predictive value (NPV), sensitivity and specificity were calculated for achieving SVR12 in both groups, and by treatment duration in the label-consistent group. SVR was defined as HCV ribonucleic acid <lower limit of quantification. The label-consistent group and overall group included 2890 and 4390 patients, respectively. PPV of SVR4 for SVR12 was >99% in both groups regardless of treatment duration. Not achieving SVR4 had 100% NPV and sensitivity for all groups. SVR4 measure had 79.5% specificity for identifying patients who did not achieve SVR12. Across 20 Phase 2/3 clinical trials of G/P, SVR4 was highly predictive of SVR12. Long-term follow-up to confirm SVR may not be necessary for certain populations of patients with HCV.