Sofosbuvir-Based Direct-Acting Antiviral Therapies for HCV in People Receiving Opioid Substitution Therapy: An Analysis of Phase 3 Studies.
Open Forum Infect Dis
MetadataShow full item record
Background: Hepatitis C virus (HCV) direct-acting antiviral therapy is effective among people receiving opioid substitution therapy (OST), but studies are limited by small numbers of nongenotype 1 (GT1) patients. The aim of this study was to evaluate the treatment completion, adherence, SVR12, and safety of sofosbuvir-based therapies in HCV patients receiving and not receiving OST. Methods: Ten phase 3 studies of sofosbuvir-based regimens included ION (ledipasvir/sofosbuvir ± ribavirin for 8, 12, or 24 weeks in GT1), ASTRAL (sofosbuvir/velpatasvir for 12 weeks in GT1-6), and POLARIS (sofosbuvir/velpatasvir and sofosbuvir/velpatasvir/voxilaprevir in GT1-6). Patients with clinically significant drug use (last 12 months) or noncannabinoids detected at screening were ineligible. Results: Among 4743 patients, 4% (n = 194) were receiving OST (methadone; n = 113; buprenorphine, n = 75; other, n = 6). Compared with those not receiving OST (n = 4549), those receiving OST (n = 194) were younger (mean age, 48 vs 54), more often male (73% vs 61%), GT3 (38% vs 17%), treatment-naïve (78% vs 65%), and cirrhotic (36% vs 23%). Among those receiving and not receiving OST, there was no significant difference in treatment completion (97% vs 99%,P= .06), SVR12 (94% vs 97%,P= .06), relapse (0.5% vs 2.1%,P= .19), adverse events (78% vs 77%,P= .79), or serious adverse events (3.6% vs 2.4%,P= .24). There was no difference in SVR12 in patients with cirrhosis (99% vs 95%,P= .25) or those with G3 (95% vs 95%,P= .77) in those receiving OST. Among patients receiving OST, SVR12 was high among those receiving methadone (95%) and buprenorphine (96%). Conclusion: Sofosbuvir-based therapies are effective and safe in patients receiving OST.
AuthorsGrebely, J; Feld, JJ; Wyles, D; Sulkowski, M; Ni, L; Llewellyn, J; Mir, HM; Sajed, N; Stamm, LM; Hyland, RH; McNally, J; Brainard, DM; Jacobson, I; Zeuzem, S; Bourlière, M; Foster, G; Afdhal, N; Dore, GJ
- Immune Systems