Thanks for posting this Dr. Freeman.
A quick read shows that the addition of ribavirin (RBV) to VEL/SOF when NS5A RAVs are present yields significantly better results (GT1).
I recall reading about similar trends when RBV is added to DCV/SOF – wonder if this is correct. And I also wonder if the same applies to LDV/SOF.
The GT3 results with the addition of RBV are also interesting - even considering the small number of patients.
Prevalence of NS5A RAVs and Impact on Treatment Outcome
In genotype 1 HCV-infected patients, the SVR12 rates in patients with or without pre-treatment RAVs were similar in the SOF/VEL+RBV 12 Week group, in contrast to the SOF/VEL 12 and 24 Week groups, where patients with baseline RAVs had lower SVR12 rates (80% and 90%) compared to patients without RAVS (96% and 98%), respectively.
Interpretation of the results in patients with genotype 3 HCV infection is limited by the small number of patients with NS5A RAVs in each treatment group. In GT3 patients without baseline NS5A RAVs, SVR12 rates were superior in the SOF/VEL/RBV group (91%) compared to the two SOF/VEL groups (60 and 50%, in the 12 and 24 week groups, respectively).
All patients with genotype 2, 4, or 6 HCV infection achieved SVR12 irrespective of the presence of pre-treatment NS5A RAVs.
Have had my share of RBV to be sure – and have planned to include it yet again for retreatment. Results like this seem to bolster the decision.
GT 1a (~1968)
Diagnosed Non A/B ’85 – HCV ‘89
Rebetron INF/RBV 17 months 2000 – Failure
Infergen INF/RBV 11 months 2002 – Failure
Viekira Pak + RBV 12 weeks 2015 – Failure
VL Und at +3 weeks > EOT – EOT+12 weeks 2,240k
Resistance Tests – NS5a Q30R
SMV/DCV/SOF + RBV 24 weeks 2016
VL Det <15 +2 and +4 weeks – Und +8 weeks > EOT
SVR4, SVR12 and SVR24 Undetected