Mark S Sulkowski1, Steve Flamm2, Zeid Kayali3, Eric J Lawitz4, Paul Kwo5, Fiona McPhee6, Anne Torbeyns7, Eric A Hughes8, Eugene S Swenson6, Philip D Yin6, Misti Linaberry8. 1. Viral Hepatitis Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 2. Feinberg School of Medicine Northwestern University, Chicago, IL, USA. 3. Inland Empire Liver Foundation, Rialto, CA, USA. 4. The Texas Liver Institute, University of Texas Health Science Center, San Antonio, TX, USA. 5. Indiana University, Bloomington, IN, USA. 6. Bristol-Myers Squibb, Wallingford, CT, USA. 7. Bristol-Myers Squibb, Braine l'Alleud, Belgium. 8. Bristol-Myers Squibb, Princeton, NJ, USA.
Abstract
BACKGROUND & AIMS: The phase 2, FOURward study (NCT02175966) investigated short-duration therapy (4/6 weeks) with four direct-acting antivirals (DAAs) with distinct mechanisms of action in patients infected with hepatitis C virus (HCV) genotype-1. METHODS:Non-cirrhotic patients were randomized 1:1 to DCV-TRIO (fixed-dose daclatasvir 30 mg, asunaprevir 200 mg and beclabuvir 75 mg) twice-daily + sofosbuvir 400 mg once-daily for 4 or 6 weeks. The primary endpoint was sustained virological response at post-treatment Week 12 (SVR12). Patients without SVR12 were offered retreatment based on the DAA resistance profile at failure; patients with resistance to ≤1 DCV-TRIO component received DCV-TRIO + RBV for 12 weeks. RESULTS:Twenty-eight patients with HCV genotype-1 were enrolled; 79% hadgenotype-1a infection and median baseline HCV-RNA levels were high (9 × 106 IU/mL). Most patients had undetectable HCV-RNA at end of treatment (96% [n=27/28]); however, relapse occurred in 77% (n=10/13) and 43% (n=6/14) treated for 4 and 6 weeks, leading to SVR12 rates of 29% (n=4/14) and 57% (n=8/14) respectively. SVR12 was higher in patients with lower baseline HCV-RNA (<2 million IU/mL, 71% [n=5/7]; ≥2 million IU/mL, 33% [n=7/21]). None of the 16 non-SVR12 patients had NS3 or NS5B resistance-associated substitutions (RAS) detected at failure. All 15 patients retreated with DCV-TRIO + RBV for 12 weeks achieved SVR12. All regimens were well tolerated. CONCLUSIONS: Short-duration treatment with four DAAs with distinct mechanisms of action was insufficient for most patients with genotype-1 infection and high baseline viraemia. Non-SVR12 was not associated with emergence of NS3 or NS5B RAS and retreatment with DCV-TRIO + RBV for 12 weeks led to SVR in all patients.
RCT Entities:
BACKGROUND & AIMS: The phase 2, FOURward study (NCT02175966) investigated short-duration therapy (4/6 weeks) with four direct-acting antivirals (DAAs) with distinct mechanisms of action in patients infected with hepatitis C virus (HCV) genotype-1. METHODS: Non-cirrhotic patients were randomized 1:1 to DCV-TRIO (fixed-dose daclatasvir 30 mg, asunaprevir 200 mg and beclabuvir 75 mg) twice-daily + sofosbuvir 400 mg once-daily for 4 or 6 weeks. The primary endpoint was sustained virological response at post-treatment Week 12 (SVR12). Patients without SVR12 were offered retreatment based on the DAA resistance profile at failure; patients with resistance to ≤1 DCV-TRIO component received DCV-TRIO + RBV for 12 weeks. RESULTS: Twenty-eight patients with HCV genotype-1 were enrolled; 79% had genotype-1a infection and median baseline HCV-RNA levels were high (9 × 106 IU/mL). Most patients had undetectable HCV-RNA at end of treatment (96% [n=27/28]); however, relapse occurred in 77% (n=10/13) and 43% (n=6/14) treated for 4 and 6 weeks, leading to SVR12 rates of 29% (n=4/14) and 57% (n=8/14) respectively. SVR12 was higher in patients with lower baseline HCV-RNA (<2 million IU/mL, 71% [n=5/7]; ≥2 million IU/mL, 33% [n=7/21]). None of the 16 non-SVR12 patients had NS3 or NS5B resistance-associated substitutions (RAS) detected at failure. All 15 patients retreated with DCV-TRIO + RBV for 12 weeks achieved SVR12. All regimens were well tolerated. CONCLUSIONS: Short-duration treatment with four DAAs with distinct mechanisms of action was insufficient for most patients with genotype-1 infection and high baseline viraemia. Non-SVR12 was not associated with emergence of NS3 or NS5B RAS and retreatment with DCV-TRIO + RBV for 12 weeks led to SVR in all patients.
Authors: Thalia Medeiros; Camila de Morais Salviato; Natalia Fonseca do Rosário; Geórgia do Nascimento Saraiva; Eliane Bordalo Cathalá Esberard; Jorge Reis Almeida; Analúcia Rampazzo Xavier; Andrea Alice da Silva Journal: Int J Clin Pharm Date: 2017-10-27
Authors: Ashwin Balagopal; Laura M Smeaton; Jeffrey Quinn; Charles S Venuto; Gene D Morse; Vincent Vu; Beverly Alston-Smith; Daniel E Cohen; Jorge L Santana-Bagur; Donald D Anthony; Mark S Sulkowski; David L Wyles; Andrew H Talal Journal: J Infect Dis Date: 2020-07-23 Impact factor: 7.759
Authors: Paul Kwo; Michael W Fried; K Rajender Reddy; Consuelo Soldevila-Pico; Saro Khemichian; Jama Darling; Phillippe J Zamor; Andrew A Napoli; Beatrice Anduze-Faris; Robert S Brown Journal: Hepatol Commun Date: 2018-02-27