Shafran S D, Shaw D, Charafeddine M, Agarwal K, Foster G R, Abunimeh M, Pilot-Matias T, Pothacamury R K, Fu B, Cohen E, Cohen D E, Gane E
Division of Infectious Diseases, Department of Medicine, University of Alberta Hospital, Edmonton, AB, Canada.
Royal Adelaide Hospital, Adelaide, SA, Australia.
J Viral Hepat. 2018 Feb;25(2):118-125. doi: 10.1111/jvh.12782. Epub 2017 Sep 14.
The efficacy and safety of an investigational combination of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) plus sofosbuvir (SOF) ± ribavirin (RBV) in patients with HCV genotype 2 or 3 infection with or without cirrhosis was evaluated. Patients with HCV genotype 3 infection without cirrhosis were randomized to receive OBV/PTV/r + SOF ± RBV for 12 weeks; OBV/PTV/r + SOF + RBV was administered to genotype 3-infected patients with cirrhosis for 12 weeks and to genotype 2-infected patients without cirrhosis for either 6 or 8 weeks. Efficacy was assessed by sustained virologic response [HCV RNA <25 IU/mL] 12 weeks post-treatment (SVR12). Safety was assessed in all treated patients. In patients with genotype 3 infection with or without cirrhosis treated with 12 weeks of OBV/PTV/r + SOF ± RBV, the overall SVR12 rate was 98% (50/51), with no virologic failures. Patients with genotype 2 infection treated with OBV/PTV/r + SOF + RBV had SVR12 rates of 90% (9/10) and 44% (4/9) following 8- and 6-week treatment durations, respectively; failure to achieve SVR12 for these patients was due to relapse without baseline or treatment-emergent resistance-associated substitutions. Thus, the investigational combination of OBV/PTV/r with SOF ± RBV was well tolerated and achieved high SVR rates with no virologic failures in patients with genotype 3 infection. Combining direct-acting antivirals with complementary mechanisms of action and different viral targets may be an effective treatment strategy that may allow for shorter durations of therapy.
评估了ombitasvir/paritaprevir/ritonavir(OBV/PTV/r)联合索磷布韦(SOF)±利巴韦林(RBV)用于丙型肝炎病毒(HCV)2型或3型感染伴或不伴肝硬化患者的有效性和安全性。无肝硬化的HCV 3型感染患者被随机分组,接受OBV/PTV/r + SOF ± RBV治疗12周;OBV/PTV/r + SOF + RBV用于治疗有肝硬化的3型感染患者12周,以及用于治疗无肝硬化的2型感染患者6或8周。通过治疗后12周的持续病毒学应答[HCV RNA <25 IU/mL](SVR12)评估疗效。在所有接受治疗的患者中评估安全性。在接受12周OBV/PTV/r + SOF ± RBV治疗的有或无肝硬化的3型感染患者中,总体SVR12率为98%(50/51),无病毒学失败情况。接受OBV/PTV/r + SOF + RBV治疗的2型感染患者,在8周和6周治疗疗程后的SVR12率分别为90%(9/10)和44%(4/9);这些患者未实现SVR12是由于复发,且无基线或治疗中出现的与耐药相关的替代突变。因此,OBV/PTV/r与SOF ± RBV的联合用药耐受性良好,在3型感染患者中实现了高SVR率且无病毒学失败情况。将具有互补作用机制和不同病毒靶点的直接抗病毒药物联合使用可能是一种有效的治疗策略,有望缩短治疗疗程。