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Epclusa most effective for HCV genotype 3 vs. other DAAs

Researchers in the Netherlands found that Sovaldi plus velpatasvir, known as Epclusa in the United States, was the most effective regimen for the treatment of hepatitis C genotype 3 infection compared with other direct-acting antiviral regimens, according to published findings.

“The findings of our network meta-analysis can be used to prioritize DAA regimens for HCV genotype 3 patients in guidelines and clinical practice,” Joost P.H. Drenth, MD, PhD, professor of gastroenterology and hepatology, Radboud University Medical Center, the Netherlands, and colleagues wrote.

The researchers performed a systematic search of PubMed, Embase and Web of Science databases through March 2016 to identify clinical studies where patients with HCV genotype 3 were treated with DAAs. Twenty-seven studies were included (n = 3,415 patients) and then used in a Bayesian network meta-analysis using a random effects model to indirectly compare regimens among patients with and without cirrhosis.

“Key agents used in HCV genotype 3 patients are [Sovaldi (sofosbuvir, Gilead Sciences)], combined with ribavirin, [Daklinza (daclatasvir, Bristol-Myers Squibb)] or velpatasvir (Gilead Sciences)],” the researchers wrote. “The comparative efficacy of individual combinations is largely unknown, mainly because of the paucity of head-to-head trials, while that information is necessary to steer guideline developmental and clinical decision making.”

Among patients without cirrhosis who underwent 12 weeks of treatment, more achieved SVR when they received Epclusa (sofosbuvir/velpatasvir, Gilead Sciences) with ribavirin (99%); sofosbuvir/velpatasvir without ribavirin (97%); sofosbuvir plus daclatasvir with ribavirin (96%); and sofosbuvir with peginterferon plus ribavirin (95%).

Among patients with cirrhosis, more achieved SVR when they received sofosbuvir/velpatasvir (96%) or sofosbuvir/daclatasvir plus ribavirin (94%) for 24 weeks, and sofosbuvir/velpatasvir plus ribavirin for 12 weeks (94%).

“The key finding is that sofosbuvir/velpatasvir regimens achieve the highest efficacy in HCV genotype 3. … The advantage of sofosbuvir/velpatasvir over other regimens is that ribavirin can be omitted in noncirrhotics and that it shortens duration of treatment in cirrhotics,” the researchers wrote.

The researchers note that ribavirin did add a value to the DAA regimen, despite cirrhosis; however, the actual effect it has on SVR depends on the efficacy of the regimen overall.

“The increase in SVR due to ribavirin is highest with regimens that have a lower intrinsic efficacy,” they wrote.

The researchers concluded: “An indirect comparison of DAA-based treatments, using Bayesian network meta-analysis, found regimens containing sofosbuvir and velpatasvir to be the best option for patients with HCV genotype 3 infection,” adding that choice of treatment varies due to several factors, including adverse events, availability and price of DAAs, among others. – by Melinda Stevens

Disclosures: Drenth reports being on advisory boards for AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen and Merck. Please see the study for a list of all other researchers’ relevant financial disclosures.