The Texas Liver Institute/University of Texas Health, San Antonio, Texas.
Medical Associates Research Group, San Diego, California.
J Med Virol. 2019 Jul;91(7):1307-1312. doi: 10.1002/jmv.25448. Epub 2019 Mar 19.
Despite high efficacy of current direct-acting antiviral agents (DAAs) in treating chronic hepatitis C virus (HCV) infection, a small portion of patients fail treatment. QUARTZ-I was a phase 2, open-label, multicenter, two-part study that assessed the safety and efficacy of ombitasvir/paritaprevir/ritonavir (OBV/PTV/r) with dasabuvir (DSV) with or without the addition of sofosbuvir (SOF) and/or ribavirin (RBV) in DAA treatment-experienced adults with chronic HCV GT1 infection.
Genotype 1 HCV-infected patients with or without compensated cirrhosis had prior treatment failure to any DAA (part 1) or ledipasvir/SOF (part 2). Patients received OBV/PTV/r + DSV ± SOF with or without RBV for 12 or 24 weeks. The primary endpoint of this study is the percentage of patients achieving sustained virologic response at post-treatment week 12 (SVR12).
In part 1 of the study, 95.5% (21/22) of patients achieved SVR12, and in part 2, the SVR12 rate was 85.7% (6/7). Most adverse events (AEs) were mild and moderate in severity. Two serious AEs occurred and were assessed as not being related to study drug, of which one resulted in study drug discontinuation. Two patients experienced grade 3 elevations of serum alanine aminotransferase, and no other grade ≥3 laboratory abnormalities were observed.
The multi-targeted regimen of OBV/PTV/r + DSV ± SOF with or without RBV was effective in the treatment of patients who failed previous DAA regimens including NS3/4A protease and NS5A and NS5B polymerase inhibitors. These results provide a promising outcome for patients that traditionally had limited treatment options.
尽管目前直接作用抗病毒药物(DAA)在治疗慢性丙型肝炎病毒(HCV)感染方面具有很高的疗效,但仍有一小部分患者治疗失败。QUARTZ-I 是一项 2 期、开放标签、多中心、两部分研究,评估了 ombitasvir/paritaprevir/ritonavir(OBV/PTV/r)联合 dasabuvir(DSV)与或不联合 sofosbuvir(SOF)和/或利巴韦林(RBV)在 DAA 治疗经验丰富的慢性 HCV GT1 感染成人中的安全性和疗效。
有或无代偿性肝硬化的基因 1 型 HCV 感染患者既往对任何 DAA(第 1 部分)或 ledipasvir/SOF(第 2 部分)治疗失败。患者接受 OBV/PTV/r+DSV+/-SOF 联合或不联合 RBV 治疗 12 或 24 周。本研究的主要终点是治疗后第 12 周(SVR12)时达到持续病毒学应答的患者比例。
研究第 1 部分,95.5%(21/22)的患者达到 SVR12,第 2 部分 SVR12 率为 85.7%(6/7)。大多数不良事件(AE)为轻度和中度。发生 2 例严重 AE,评估与研究药物无关,其中 1 例导致研究药物停药。2 例患者出现血清丙氨酸氨基转移酶 3 级升高,未观察到其他任何≥3 级实验室异常。
OBV/PTV/r+DSV+/-SOF 联合或不联合 RBV 的多靶点方案对既往 DAA 方案(包括 NS3/4A 蛋白酶和 NS5A 和 NS5B 聚合酶抑制剂)治疗失败的患者有效。这些结果为传统治疗选择有限的患者提供了有希望的结果。