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Treatment intensification with sofosbuvir permits cure after failure of previous HCV treatment
Keith Alcorn, 2015-11-17 16:20:00

Re-treating with an interferon-free regimen that previously failed to cure hepatitis C can result in success if treatment is intensified with the addition of sofosbuvir, two studies presented at the AASLD Liver Meeting have shown.

Although direct-acting antiviral treatment results in cure rates above 90% in most groups of patients with hepatitis C genotypes 1 and 2, including people with cirrhosis, a small proportion of people experience viral relapse. For those with advanced liver disease it may not be possible to wait until new drugs become available, and other options are needed.

One concern is that failure of a regimen that contains an NS5A inhibitor (ledipasvir in Harvoni, ombitasvir in Viekira Pak / Viekira) may result in the emergence of NS5A-resistant virus that can take up to 96 weeks to disappear. NS5A inhibitors may have some activity against these variants, but further treatment with an NS5A inhibitor could result in higher-level resistance if hepatitis C is not rapidly suppressed. Adding an agent of a new class could increase antiviral activity.

Two companies presented data at the Liver Meeting showing successful re-treatment when sofosbuvir was added to the regimen used previously, or people were re-treated with a new regimen to which they might have some resistance. Merck reported findings from a study of treatment intensification in people who failed a short course of treatment lasting less than eight weeks with its investigational protease inhibitor / NS5A inhibitor combination, and AbbVie reported findings from a study of treatment intensification in people who failed treatment with ombitasvir, paritaprevir/r and dasabuvir (Viekira Pak / Viekirax & Exviera)(paritaprevir levels are boosted by ritonavir).

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