All‐oral combination of ledipasvir, vedroprevir, tegobuvir, and ribavirin in treatment‐naïve patients with genotype 1 HCV infection

This phase II trial assessed the efficacy and safety of a combination regimen of the nonstructural protein (NS)5A inhibitor ledipasvir (LDV), NS3 protease inhibitor vedroprevir (VDV), non‐nucleoside NS5B inhibitor tegobuvir (TGV), and ribavirin (RBV) in treatment‐naïve patients with chronic hepatiti...

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Published inHepatology (Baltimore, Md.) Vol. 60; no. 1; pp. 56 - 64
Main Authors Wyles, David L., Rodriguez‐Torres, Maribel, Lawitz, Eric, Shiffman, Mitchell L., Pol, Stanislas, Herring, Robert W., Massetto, Benedetta, Kanwar, Bittoo, Trenkle, James D., Pang, Phil S., Zhu, Yanni, Mo, Hongmei, Brainard, Diana M., Subramanian, G. Mani, McHutchison, John G., Habersetzer, François, Sulkowski, Mark S.
Format Journal Article
LanguageEnglish
Published United States Wolters Kluwer Health, Inc 01.07.2014
Wiley-Blackwell
Subjects
Online AccessGet full text
ISSN0270-9139
1527-3350
1527-3350
DOI10.1002/hep.27053

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Abstract This phase II trial assessed the efficacy and safety of a combination regimen of the nonstructural protein (NS)5A inhibitor ledipasvir (LDV), NS3 protease inhibitor vedroprevir (VDV), non‐nucleoside NS5B inhibitor tegobuvir (TGV), and ribavirin (RBV) in treatment‐naïve patients with chronic hepatitis C virus (HCV) genotype 1 without cirrhosis. Patients were randomized 1:2 to LDV 30 mg once daily (QD; Arm 1; n = 46) or LDV 90 mg QD (Arm 2; n = 94); patients in both arms also received VDV 200 mg QD, TGV 30 mg twice‐daily, and RBV 1,000‐1,200 mg/day. Patients in Arm 2 with vRVR, defined as HCV RNA below the lower limit of quantification (LLOQ) from treatment weeks 2 to 10, were randomized 1:1 to stop treatment at 12 weeks or continue for 24 weeks. Sustained virologic response 12 weeks after treatment (SVR12) was higher in patients receiving 90 mg of LDV for 24 weeks (63%), compared with LDV 90 mg for 12 weeks (54%) and LDV 30 mg for 24 weeks (48%). In patients with very rapid virologic response (vRVR) in Arm 2, SVR12 was achieved by 68% and 81% of patients treated for 12 and 24 weeks, respectively. Virologic breakthrough was more common in patients with HCV genotype 1a and was associated with resistance‐associated variants for all three direct‐acting antiviral agents (DAAs); however, in all but 1 patient who relapsed, resistance‐associated variants directed against only one or two of the DAAs were detected. The most common adverse events were fatigue, headache, nausea, rash, and diarrhea. Conclusion: In patients with HCV genotype 1, an interferon‐free regimen containing LDV/VDV/TGV/RBV was well tolerated and led to SVR12 in up to 63% of patients. LDV 90 mg is currently being investigated in combination with the nucleotide polymerase inhibitor, sofosbuvir. (Hepatology 2014;60:56–64)
AbstractList This phase II trial assessed the efficacy and safety of a combination regimen of the nonstructural protein (NS)5A inhibitor ledipasvir (LDV), NS3 protease inhibitor vedroprevir (VDV), non-nucleoside NS5B inhibitor tegobuvir (TGV), and ribavirin (RBV) in treatment-naive patients with chronic hepatitis C virus (HCV) genotype 1 without cirrhosis. Patients were randomized 1:2 to LDV 30 mg once daily (QD; Arm 1; n = 46) or LDV 90 mg QD (Arm 2; n = 94); patients in both arms also received VDV 200 mg QD, TGV 30 mg twice-daily, and RBV 1,000-1,200 mg/day. Patients in Arm 2 with vRVR, defined as HCV RNA below the lower limit of quantification (LLOQ) from treatment weeks 2 to 10, were randomized 1:1 to stop treatment at 12 weeks or continue for 24 weeks. Sustained virologic response 12 weeks after treatment (SVR12) was higher in patients receiving 90 mg of LDV for 24 weeks (63%), compared with LDV 90 mg for 12 weeks (54%) and LDV 30 mg for 24 weeks (48%). In patients with very rapid virologic response (vRVR) in Arm 2, SVR12 was achieved by 68% and 81% of patients treated for 12 and 24 weeks, respectively. Virologic breakthrough was more common in patients with HCV genotype 1a and was associated with resistance-associated variants for all three direct-acting antiviral agents (DAAs); however, in all but 1 patient who relapsed, resistance-associated variants directed against only one or two of the DAAs were detected. The most common adverse events were fatigue, headache, nausea, rash, and diarrhea. CONCLUSION: In patients with HCV genotype 1, an interferon-free regimen containing LDV/VDV/TGV/RBV was well tolerated and led to SVR12 in up to 63% of patients. LDV 90 mg is currently being investigated in combination with the nucleotide polymerase inhibitor, sofosbuvir.
This phase II trial assessed the efficacy and safety of a combination regimen of the nonstructural protein (NS)5A inhibitor ledipasvir (LDV), NS3 protease inhibitor vedroprevir (VDV), non-nucleoside NS5B inhibitor tegobuvir (TGV), and ribavirin (RBV) in treatment-naïve patients with chronic hepatitis C virus (HCV) genotype 1 without cirrhosis. Patients were randomized 1:2 to LDV 30 mg once daily (QD; Arm 1; n=46) or LDV 90 mg QD (Arm 2; n=94); patients in both arms also received VDV 200 mg QD, TGV 30 mg twice-daily, and RBV 1,000-1,200 mg/day. Patients in Arm 2 with vRVR, defined as HCV RNA below the lower limit of quantification (LLOQ) from treatment weeks 2 to 10, were randomized 1:1 to stop treatment at 12 weeks or continue for 24 weeks. Sustained virologic response 12 weeks after treatment (SVR12) was higher in patients receiving 90 mg of LDV for 24 weeks (63%), compared with LDV 90 mg for 12 weeks (54%) and LDV 30 mg for 24 weeks (48%). In patients with very rapid virologic response (vRVR) in Arm 2, SVR12 was achieved by 68% and 81% of patients treated for 12 and 24 weeks, respectively. Virologic breakthrough was more common in patients with HCV genotype 1a and was associated with resistance-associated variants for all three direct-acting antiviral agents (DAAs); however, in all but 1 patient who relapsed, resistance-associated variants directed against only one or two of the DAAs were detected. The most common adverse events were fatigue, headache, nausea, rash, and diarrhea. Conclusion: In patients with HCV genotype 1, an interferon-free regimen containing LDV/VDV/TGV/RBV was well tolerated and led to SVR12 in up to 63% of patients. LDV 90 mg is currently being investigated in combination with the nucleotide polymerase inhibitor, sofosbuvir. (Hepatology 2014;60:56-64) [PUBLICATION ABSTRACT]
This phase II trial assessed the efficacy and safety of a combination regimen of the nonstructural protein (NS)5A inhibitor ledipasvir (LDV), NS3 protease inhibitor vedroprevir (VDV), non‐nucleoside NS5B inhibitor tegobuvir (TGV), and ribavirin (RBV) in treatment‐naïve patients with chronic hepatitis C virus (HCV) genotype 1 without cirrhosis. Patients were randomized 1:2 to LDV 30 mg once daily (QD; Arm 1; n = 46) or LDV 90 mg QD (Arm 2; n = 94); patients in both arms also received VDV 200 mg QD, TGV 30 mg twice‐daily, and RBV 1,000‐1,200 mg/day. Patients in Arm 2 with vRVR, defined as HCV RNA below the lower limit of quantification (LLOQ) from treatment weeks 2 to 10, were randomized 1:1 to stop treatment at 12 weeks or continue for 24 weeks. Sustained virologic response 12 weeks after treatment (SVR12) was higher in patients receiving 90 mg of LDV for 24 weeks (63%), compared with LDV 90 mg for 12 weeks (54%) and LDV 30 mg for 24 weeks (48%). In patients with very rapid virologic response (vRVR) in Arm 2, SVR12 was achieved by 68% and 81% of patients treated for 12 and 24 weeks, respectively. Virologic breakthrough was more common in patients with HCV genotype 1a and was associated with resistance‐associated variants for all three direct‐acting antiviral agents (DAAs); however, in all but 1 patient who relapsed, resistance‐associated variants directed against only one or two of the DAAs were detected. The most common adverse events were fatigue, headache, nausea, rash, and diarrhea. Conclusion: In patients with HCV genotype 1, an interferon‐free regimen containing LDV/VDV/TGV/RBV was well tolerated and led to SVR12 in up to 63% of patients. LDV 90 mg is currently being investigated in combination with the nucleotide polymerase inhibitor, sofosbuvir. (Hepatology 2014;60:56–64)
This phase II trial assessed the efficacy and safety of a combination regimen of the nonstructural protein (NS)5A inhibitor ledipasvir (LDV), NS3 protease inhibitor vedroprevir (VDV), non-nucleoside NS5B inhibitor tegobuvir (TGV), and ribavirin (RBV) in treatment-naïve patients with chronic hepatitis C virus (HCV) genotype 1 without cirrhosis. Patients were randomized 1:2 to LDV 30 mg once daily (QD; Arm 1; n = 46) or LDV 90 mg QD (Arm 2; n = 94); patients in both arms also received VDV 200 mg QD, TGV 30 mg twice-daily, and RBV 1,000-1,200 mg/day. Patients in Arm 2 with vRVR, defined as HCV RNA below the lower limit of quantification (LLOQ) from treatment weeks 2 to 10, were randomized 1:1 to stop treatment at 12 weeks or continue for 24 weeks. Sustained virologic response 12 weeks after treatment (SVR12) was higher in patients receiving 90 mg of LDV for 24 weeks (63%), compared with LDV 90 mg for 12 weeks (54%) and LDV 30 mg for 24 weeks (48%). In patients with very rapid virologic response (vRVR) in Arm 2, SVR12 was achieved by 68% and 81% of patients treated for 12 and 24 weeks, respectively. Virologic breakthrough was more common in patients with HCV genotype 1a and was associated with resistance-associated variants for all three direct-acting antiviral agents (DAAs); however, in all but 1 patient who relapsed, resistance-associated variants directed against only one or two of the DAAs were detected. The most common adverse events were fatigue, headache, nausea, rash, and diarrhea.UNLABELLEDThis phase II trial assessed the efficacy and safety of a combination regimen of the nonstructural protein (NS)5A inhibitor ledipasvir (LDV), NS3 protease inhibitor vedroprevir (VDV), non-nucleoside NS5B inhibitor tegobuvir (TGV), and ribavirin (RBV) in treatment-naïve patients with chronic hepatitis C virus (HCV) genotype 1 without cirrhosis. Patients were randomized 1:2 to LDV 30 mg once daily (QD; Arm 1; n = 46) or LDV 90 mg QD (Arm 2; n = 94); patients in both arms also received VDV 200 mg QD, TGV 30 mg twice-daily, and RBV 1,000-1,200 mg/day. Patients in Arm 2 with vRVR, defined as HCV RNA below the lower limit of quantification (LLOQ) from treatment weeks 2 to 10, were randomized 1:1 to stop treatment at 12 weeks or continue for 24 weeks. Sustained virologic response 12 weeks after treatment (SVR12) was higher in patients receiving 90 mg of LDV for 24 weeks (63%), compared with LDV 90 mg for 12 weeks (54%) and LDV 30 mg for 24 weeks (48%). In patients with very rapid virologic response (vRVR) in Arm 2, SVR12 was achieved by 68% and 81% of patients treated for 12 and 24 weeks, respectively. Virologic breakthrough was more common in patients with HCV genotype 1a and was associated with resistance-associated variants for all three direct-acting antiviral agents (DAAs); however, in all but 1 patient who relapsed, resistance-associated variants directed against only one or two of the DAAs were detected. The most common adverse events were fatigue, headache, nausea, rash, and diarrhea.In patients with HCV genotype 1, an interferon-free regimen containing LDV/VDV/TGV/RBV was well tolerated and led to SVR12 in up to 63% of patients. LDV 90 mg is currently being investigated in combination with the nucleotide polymerase inhibitor, sofosbuvir.CONCLUSIONIn patients with HCV genotype 1, an interferon-free regimen containing LDV/VDV/TGV/RBV was well tolerated and led to SVR12 in up to 63% of patients. LDV 90 mg is currently being investigated in combination with the nucleotide polymerase inhibitor, sofosbuvir.
This phase II trial assessed the efficacy and safety of a combination regimen of the nonstructural protein (NS)5A inhibitor ledipasvir (LDV), NS3 protease inhibitor vedroprevir (VDV), non-nucleoside NS5B inhibitor tegobuvir (TGV), and ribavirin (RBV) in treatment-naïve patients with chronic hepatitis C virus (HCV) genotype 1 without cirrhosis. Patients were randomized 1:2 to LDV 30 mg once daily (QD; Arm 1; n = 46) or LDV 90 mg QD (Arm 2; n = 94); patients in both arms also received VDV 200 mg QD, TGV 30 mg twice-daily, and RBV 1,000-1,200 mg/day. Patients in Arm 2 with vRVR, defined as HCV RNA below the lower limit of quantification (LLOQ) from treatment weeks 2 to 10, were randomized 1:1 to stop treatment at 12 weeks or continue for 24 weeks. Sustained virologic response 12 weeks after treatment (SVR12) was higher in patients receiving 90 mg of LDV for 24 weeks (63%), compared with LDV 90 mg for 12 weeks (54%) and LDV 30 mg for 24 weeks (48%). In patients with very rapid virologic response (vRVR) in Arm 2, SVR12 was achieved by 68% and 81% of patients treated for 12 and 24 weeks, respectively. Virologic breakthrough was more common in patients with HCV genotype 1a and was associated with resistance-associated variants for all three direct-acting antiviral agents (DAAs); however, in all but 1 patient who relapsed, resistance-associated variants directed against only one or two of the DAAs were detected. The most common adverse events were fatigue, headache, nausea, rash, and diarrhea. In patients with HCV genotype 1, an interferon-free regimen containing LDV/VDV/TGV/RBV was well tolerated and led to SVR12 in up to 63% of patients. LDV 90 mg is currently being investigated in combination with the nucleotide polymerase inhibitor, sofosbuvir.
Author Kanwar, Bittoo
Habersetzer, François
Mo, Hongmei
Herring, Robert W.
Zhu, Yanni
Rodriguez‐Torres, Maribel
Shiffman, Mitchell L.
Pol, Stanislas
Subramanian, G. Mani
Wyles, David L.
Trenkle, James D.
Massetto, Benedetta
Brainard, Diana M.
Lawitz, Eric
Sulkowski, Mark S.
Pang, Phil S.
McHutchison, John G.
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ContentType Journal Article
Copyright 2014 by the American Association for the Study of Liver Diseases
2014 by the American Association for the Study of Liver Diseases.
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Issue 1
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2014 by the American Association for the Study of Liver Diseases.
Distributed under a Creative Commons Attribution 4.0 International License: http://creativecommons.org/licenses/by/4.0
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Notes Potential conflict of interest: Dr. Herring received grants from Gilead. Dr. Pol consults for and received grants and lecture fees from Bristol‐Myers Squibb, Gilead, Roche, and MSD. He consults for and received lecture fees from Boehringer Ingelheim, Tibotec, Vertex, Novartis, Abbott/AbbVie, Sanofi, and GlaxoSmithKline. Dr. Rodriguez‐Torres consults for and received grants from Akros, Bristol‐Myers Squibb, Genentech, Hoffman‐La Roche, Inhibitex, Merck, Pharmasset, Santaris, and Vertex. She consults for Janssen. She received grants from Abbott, Anadys, Beckman, Boehringer Ingelheim, Gilead, GlaxoSmithKline, Human Genome Sciences, Idenix, Idera, Johnson & Johnson, Mochida, Novartis, Pfizer, Scynexis, Siemens, and Zymogenetics. Dr. Pang owns stock in and is employed by Gilead. Dr. McHutchison owns stock in and is employed by Gilead. Dr. Brainard owns stock in and is employed by Gilead. Dr. Trenkle owns stock in and is employed by Gilead. Dr. Subramanian owns stock in and is employed by Gilead. Dr. Massetto owns stock in and is employed by Gilead. Dr. Mo is employed by Gilead. Dr. Shiffman advises, is on the speakers' bureau for, and received grants from Gilead, Merck, and Roche/Genentech. He advises, consults for, and is on the speakers' bureau for Janssen. He advises and received grants from Achillion, Bristol‐Myers Squibb, Boehringer Ingelheim, Globeimmune, and Novartis. He advises and is on the speakers' bureau for Bayer, Salix, and Vertex. He advises and consults for Gen‐Probe and GlaxoSmithKline. He received grants from AbbVie, Beckman‐Colter, Idenix, Intercept, Lumena, and Mochida. Dr. Lawitz advises, is on the speakers' bureau for, and received grants from Merck and Vertex. He is on the speakers' bureau for and received grants from Gilead and GlaxoSmithKline. He advises and received grants from AbbVie, Achillion, Idenix, Janssen, Novartis, and Santaris. He advises BioCryst, Biotica, Enanta, and Theravance. He is on the speakers' bureau for Kadmon. He received grants from Boehringer Ingelheim, Bristol‐Myers Squibb, Intercept, Medtronic, Presidio, and Roche. Dr. Wyles consults for and received grants from Gilead, AbbVie, and Bristol‐Myers Squibb. He received grants from Vertex and Janssen. Dr. Habersetzer consults for and advises Gilead. He consults for Transgene and Boehringer Ingelheim. Dr. Zhu is employed by and owns stock in Gilead. Dr. Kanwar is employed by and owns stock in Gilead. Dr. Sulkowski consults for and received grants from Gilead, Merck, AbbVie, Bristol‐Myers Squibb, Boehringer Ingelheim, Janssen, Vertex, and Idenix. He consults for Pfizer.
This trial was supported by Gilead Sciences, Inc.
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SubjectTerms Administration, Oral
Adolescent
Adult
Aged
Antiviral Agents - administration & dosage
Antiviral Agents - adverse effects
Benzimidazoles - administration & dosage
Benzimidazoles - adverse effects
Drug Resistance, Viral
Drug Therapy, Combination
Female
Fluorenes - administration & dosage
Fluorenes - adverse effects
Genotype
Hepacivirus - drug effects
Hepacivirus - genetics
Hepatitis C, Chronic - drug therapy
Hepatitis C, Chronic - virology
Hepatology
Human health and pathology
Humans
Life Sciences
Male
Middle Aged
Purines - administration & dosage
Purines - adverse effects
Pyridazines - administration & dosage
Pyridazines - adverse effects
Quinolines - administration & dosage
Quinolines - adverse effects
Ribavirin - administration & dosage
Ribavirin - adverse effects
Treatment Outcome
Viral Nonstructural Proteins - antagonists & inhibitors
Young Adult
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Title All‐oral combination of ledipasvir, vedroprevir, tegobuvir, and ribavirin in treatment‐naïve patients with genotype 1 HCV infection
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