• DOI:10.1056/NEJMoa1512614
• Corpus ID: 205099297

Sofosbuvir and Velpatasvir for HCV in Patients with Decompensated Cirrhosis.

@article{Curry2015SofosbuvirAV,
  title={Sofosbuvir and Velpatasvir for HCV in Patients with Decompensated Cirrhosis.},
  author={Michael P. Curry and Jacqueline G. O’Leary and Natalie H. Bzowej and Andrew J. Muir and Kevin M. Korenblat and Jonathan M Fenkel and K. Rajender Reddy and Eric Lawitz and Steven L. Flamm and Thomas D Schiano and Lewis W. Teperman and Robert Fontana and Eugene R Schiff and M. W. Fried and Brian P. Doehle and Di An and John McNally and Anu O. Osinusi and Diana M. Brainard and John McHutchison and Robert S. Brown and Michael R. Charlton},
  journal={The New England journal of medicine},
  year={2015},
  volume={373 27},
  pages={
          2618-28
        }
}

• M. Curry, J. O’Leary, +19 authors M. Charlton
• Published 30 December 2015
• Medicine
• The New England journal of medicine

BACKGROUND
As the population that is infected with the hepatitis C virus (HCV) ages, the number of patients with decompensated cirrhosis is expected to increase.

METHODS
We conducted a phase 3, open-label study involving both previously treated and previously untreated patients infected with HCV genotypes 1 through 6 who had decompensated cirrhosis (classified as Child-Pugh-Turcotte class B). Patients were randomly assigned in a 1:1:1 ratio to receive the nucleotide polymerase inhibitor sofosbuvir and the NS5A inhibitor velpatasvir once daily for 12 weeks, sofosbuvir-velpatasvir plus ribavirin for 12 weeks, or sofosbuvir-velpatasvir for 24 weeks. The primary end point was a sustained virologic response at 12 weeks after the end of therapy.

RESULTS
Of the 267 patients who received treatment, 78% had HCV genotype 1, 4% genotype 2, 15% genotype 3, 3% genotype 4, and less than 1% genotype 6; no patients had genotype 5. Overall rates of sustained virologic response were 83% (95% confidence interval [CI], 74 to 90) among patients who received 12 weeks of sofosbuvir-velpatasvir, 94% (95% CI, 87 to 98) among those who received 12 weeks of sofosbuvir-velpatasvir plus ribavirin, and 86% (95% CI, 77 to 92) among those who received 24 weeks of sofosbuvir-velpatasvir. Post hoc analysis did not detect any significant differences in rates of sustained virologic response among the three study groups. Serious adverse events occurred in 19% of patients who received 12 weeks of sofosbuvir-velpatasvir, 16% of those who received 12 weeks of sofosbuvir-velpatasvir plus ribavirin, and 18% of those who received 24 weeks of sofosbuvir-velpatasvir. The most common adverse events were fatigue (29%), nausea (23%), and headache (22%) in all patients and anemia (31%) in the patients receiving ribavirin.

CONCLUSIONS
Treatment with sofosbuvir-velpatasvir with or without ribavirin for 12 weeks and with sofosbuvir-velpatasvir for 24 weeks resulted in high rates of sustained virologic response in patients with HCV infection and decompensated cirrhosis. (Funded by Gilead Sciences; ASTRAL-4 ClinicalTrials.gov number, NCT02201901.).