Sofosbuvir–velpatasvir in adults with hepatitis C virus infection and compensated cirrhosis in Japan

• Published in: Hepatology research 2022-10, Vol.52 (10), p.833-840
• Main Authors: Takehara, Tetsuo, Izumi, Namiki, Mochida, Satoshi, Genda, Takuya, Fujiyama, Shigetoshi, Notsumata, Kazuo, Tamori, Akihiro, Suzuki, Fumitaka, Suri, Vithika, Mercier, Renee‐Claude, Matsuda, Takuma, Matsuda, Kana, Kato, Naoya, Chayama, Kazuaki, Kumada, Hiromitsu
• Format: Article
• Language: English
• Subjects: Adverse events; Chronic infection; Cirrhosis; compensated cirrhosis; Diarrhea; direct‐acting antiviral; Genotype & phenotype; Genotypes; Hepatitis C; Hyperglycemia; Infections; Interferon; Liver cirrhosis; NS5A inhibitor; NS5B polymerase inhibitor; Proteinase inhibitors; sustained virologic response
• ISSN: 1386-6346; 1872-034X
• DOI: 10.1111/hepr.13810

Background & Purpose Protease‐free regimens for chronic hepatitis C virus (HCV) infection are safe and effective for persons with either compensated or decompensated cirrhosis. We examined the efficacy and safety of sofosbuvir–velpatasvir in participants with HCV and compensated cirrhosis in Japan. Methods This was a Phase 3, multi‐center, open‐label study. At 20 sites, 37 individuals with chronic HCV infection of any genotype and compensated cirrhosis received sofosbuvir–velpatasvir (400 mg/100 mg) daily for 12 weeks. Participants were treatment‐naïve or treatment‐experienced with interferon‐based treatments with or without HCV NS3/4A protease inhibitors. Prior exposure with HCV NS5A or NS5B inhibitors was prohibited. The primary study endpoint was sustained virologic response 12 weeks after treatment (SVR12). Results Among participants, 62% had HCV genotype 1 infection, and 38% had HCV genotype 2. More than three quarters (29/37, 78%) were HCV treatment naïve. All participants (37/37, 100%) achieved SVR12. Seventeen participants (46%) and three participants (8%) had pretreatment resistance‐associated substitutions to HCV NS5A and NS5B nucleoside inhibitors respectively, yet no on‐treatment breakthrough or relapse occurred. Sofosbuvir–velpatasvir for 12 weeks treatment was safe and well tolerated. The most commonly reported adverse events were headache (8%, 3/37) and diarrhea (5%, 2/37). One serious adverse event, patella fracture, occurred and was considered not treatment related. No participants discontinued study treatment due to an adverse event. Three participants (8%) had a Grade 3 laboratory abnormality; all were hyperglycemia. Conclusion Sofosbuvir–velpatasvir resulted in high SVR rates and was well tolerated among Japanese patients with HCV and compensated cirrhosis. This single‐tablet regimen offers a highly effective, protease‐inhibitor free regimen for treating HCV. ClinicalTrials.gov Identifier: NCT04112303.