Prevalence of Resistance-Associated Substitutions in HCV NS5A, NS5B, or NS3 and Outcomes of Treatment With Ledipasvir and Sofosbuvir.
BACKGROUND & AIMS
We evaluated the effects of baseline hepatitis C virus (HCV) NS5A, NS5B, and NS3 resistance-associated substitutions (RASs) on response to the combination of ledipasvir and sofosbuvir, with or without ribavirin, in patients with HCV genotype 1 infection.


METHODS
We analyzed data from 2144 participants in phase 2 and 3 studies of patients with HCV genotype 1a or b infection who received the combination of ledipasvir (90 mg) and sofosbuvir (400 mg) (ledipasvir/sofosbuvir) once daily, with or without ribavirin twice daily. Population and/or deep sequence analyses of the HCV NS3, NS5A, and NS5B genes were performed on blood samples collected at baseline.


RESULTS
Overall, 16.0% of patients had detectable baseline RASs in NS5A. Among patients with HCV genotype 1b infection, there was no significant effect of baseline RASs in NS5A on sustained viral response 12 weeks after the end of treatment (SVR12) with ledipasvir/sofosbuvir and only a small effect in patients with HCV genotype 1a infection. RASs in NS5A that increased the half-maximal effective concentration to ledipasvir by more than 100-fold reduced the rate of SVR12 in treatment-naive patients given ledipasvir/sofosbuvir for 8 weeks (P = .011), but not for 12 weeks. These same baseline NS5A RASs reduced the percentage of treatment-experienced patients who achieved an SVR12 to 12 weeks (but not 24 weeks) ledipasvir/sofosbuvir (P < .001). These RASs had a small effect in patients given ledipasvir/sofosbuvir in combination with ribavirin for 12 weeks. Overall, 2.5% of patients had baseline NS5B nucleotide inhibitor RASs (L159F, N142T, S282G, or L320S) and all achieved an SVR12. Of patients previously treated with protease inhibitors, 53.7% had RASs in NS3 and 96.5% achieved an SVR12.


CONCLUSIONS
Baseline RASs in NS5A have minimal effects on patient responses to ledipasvir/sofosbuvir therapy. When these RASs do have effects, they could be largely overcome by extending treatment duration or through treatment intensification.
['Sarrazin|Christoph|C|', 'Dvory-Sobol|Hadas|H|', 'Svarovskaia|Evguenia S|ES|', 'Doehle|Brian P|BP|', 'Pang|Phillip S|PS|', 'Chuang|Shu-Min|SM|', 'Ma|Julie|J|', 'Ding|Xiao|X|', 'Afdhal|Nezam H|NH|', 'Kowdley|Kris V|KV|', 'Gane|Edward J|EJ|', 'Lawitz|Eric|E|', 'Brainard|Diana M|DM|', 'McHutchison|John G|JG|', 'Miller|Michael D|MD|', 'Mo|Hongmei|H|']
D000328:Adult D000998:Antiviral Agents D001562:Benzimidazoles D024882:Drug Resistance, Viral D004359:Drug Therapy, Combination D005260:Female D005449:Fluorenes D005838:Genotype D016174:Hepacivirus D006526:Hepatitis C D006801:Humans D008297:Male D008875:Middle Aged D012254:Ribavirin D000069474:Sofosbuvir D000072230:Sustained Virologic Response D014542:Uridine Monophosphate D017361:Viral Nonstructural Proteins
Direct-Acting Antivirals ION-1 ION-2 ION-3