Hello again

I got back to my Doctor with your question and he said the European protocoll for treatment of the genotype 2 is Sofosbuvir with Ribavirine. He meant that the prescription is all right that way.

Do you have any doubts? Should I get a second opinion?

Best regards

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Hello #####,

There is nothing particularly wrong with using Sofosbuvir + Ribavirin for genotype 2.

Up until the latest 2016 guidelines the recommendations were either Sofosbuvir + Ribavirin OR Sofosbuvir + Daclatasvir however…. in the new 2016 EASL guidelines (see page 17)

http://www.easl.eu/medias/cpg/HCV2016/English-report.pdf

This recommendation for Sofosbuvir + Ribavirin has been removed. The current recommendation is now either Sofosbuvir + Velpatasvir OR Sofosbuvir + Daclatasvir.

So what your doctor has suggested is just a little out of date. It is no longer the recommended treatment.

We have used a lot of generic Sofosbuvir + Daclatasvir in genotype 2. In fact we now have the biggest clinical trial of it ever done with 33/33 at SVR12.

The reasons we chose to use Daclatasvir, rather than Ribavirin were that:

1. The side effects are much more mild – Ribavirin is a much harsher drug than Daclatasvir
2. You need to make many blood tests on treatment when taking Ribavirin because it often causes anaemia and other problems
3. The cure rate looked to be at least as good, and that has indeed proven to be the case.

I still favour Sofosbuvir+Daclatasvir over Sofobuvir+Velpatasvir because we have very good real world data for it.

With Velpatasvir being so new we really only have the drug company data to go on. It should be good, but my feeling is that it’s better to stick with proven to be good at this point. I will revise that opinion if/when better data becomes available for Velpatasvir.

So my suggestion would be to see your doctor again or seek a second opinion as there are much more gentle, but equally effective (probably more effective) options now recommended by the experts at EASL.

Kind Regards

Dr James Freeman