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Gastroenterology. 2016 Feb;150(2):419-29. doi: 10.1053/j.gastro.2015.10.013. Epub 2015 Oct 21.

Effectiveness of Simeprevir Plus Sofosbuvir, With or Without Ribavirin, in Real-World Patients With HCV Genotype 1 Infection.

Author information

1
Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: msulkowski@jhmi.edu.
2
Mayo Clinic-Arizona, Phoenix, Arizona.
3
Saint Louis University School of Medicine, St. Louis, Missouri.
4
University of California, San Diego, California.
5
University of Pennsylvania, Philadelphia, Pennsylvania.
6
Yale University School of Medicine, New Haven, Connecticut.
7
University of Florida School of Medicine, Gainesville, Florida.
8
University of North Carolina School of Medicine, Chapel Hill, North Carolina.
9
Toronto Western Hospital Liver Center, Toronto, Canada.
10
Columbia University, New York, New York.
11
Liver Wellness Center, Little Rock, Arkansas.
12
Mount Sinai Beth Israel, New York, New York.

Abstract

BACKGROUND & AIMS:

The interferon-free regimen of simeprevir plus sofosbuvir was recommended by professional guidelines for certain patients with hepatitis C virus (HCV) genotype 1 infection based on the findings of a phase 2 trial. We aimed to evaluate the safety and efficacy of this regimen in clinical practice settings in North America.

METHODS:

We collected demographic, clinical, and virologic data, as well as reports of adverse outcomes, from sequential participants in HCV-TARGET--a prospective observational cohort study of patients undergoing HCV treatment in routine clinical care settings. From January through October 2014, there were 836 patients with HCV genotype 1 infection who began 12 weeks of treatment with simeprevir plus sofosbuvir (treatment duration of up to 16 weeks); 169 of these patients received ribavirin. Most patients were male (61%), Caucasian (76%), or black (13%); 59% had cirrhosis. Most patients had failed prior treatment with peginterferon and ribavirin without (46%) or with telaprevir or boceprevir (12%). The primary outcome was sustained virologic response (SVR), defined as the level of HCV RNA below quantification at least 64 days after the end of treatment (beginning of week 12 after treatment--a 2-week window). Logistic regression models with inverse probability weights were constructed to adjust for baseline covariates and potential selection bias.

RESULTS:

The overall SVR rate was 84% (675 of 802 patients, 95% confidence interval, 81%-87%). Model-adjusted estimates indicate patients with cirrhosis, prior decompensation, and previous protease inhibitor treatments were less likely to achieve an SVR. The addition of ribavirin had no detectable effects on SVR. The most common adverse events were fatigue, headache, nausea, rash, and insomnia. Serious adverse events and treatment discontinuation occurred in only 5% and 3% of participants, respectively.

CONCLUSIONS:

In a large prospective observational cohort study, a 12-week regimen of simeprevir plus sofosbuvir was associated with high rates of SVR and infrequent treatment discontinuation. ClinicalTrials.gov: NCT01474811.

KEYWORDS:

Chronic Hepatitis; Direct-Acting Agent; NS3/4A Protease Inhibitor; NS5B

PMID:
26497081
PMCID:
PMC4727992
DOI:
10.1053/j.gastro.2015.10.013
[Indexed for MEDLINE]
Free PMC Article

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