Efficacy of antiviral treatment with Velpatasvir + Sofosbuvir and Glecaprevir + Pibrentasvir in patients with chronic VHC
Keywords:
Sofosbuvir, velpatasvir, Glecaprevir, Pibrentasvir, VHCAbstract
Failure to treat with direct-acting antiviral drugs (DAA) is associated with resistance to HCV mutations. Common mutations have been found for groups of drugs and for genotypes. The most common mutations to GT1b are A30K, L31M, and Y93H. The study was performed in 118 patients with chronic VHC. 40 naïve and 40 patients with virologic failure to NS5A inhibitors received velpatasvir 100 mg+sofosbuvir 400 mg for 12 weeks and 38 experienced patients - gecaprevir 100 mg+pibrentasvir 40 mg for 12 weeks. In naïve patients, treated with SOF+VEL for 12 weeks, SVR was 95%, and in patients with virologic failure to DAA, who followed SOF+VEL, SVR was significantly lower - 70% (P = 0 .0035). VHC resistance tests to NS5A, NS5B and NS3-protease inhibitors were performed in 3 patients with virologic failure to first-line DAAs. Y93H was a widespread common mutation for NS5A inhibitors, including velpatasvir. They received glecaprevir+pibrentasvir for which sensitivity was recorded. Treatment with glecaprevir+pibrentasvir recorded SVR in 100% patients (p=0.0003). Treatment with SOF+VEL in naïve patients recorded SVR in 95% of cases, a significantly better result compared to experienced ones – in 70%. Failure to treat velpatasvir in patients without SVR may be associated with common group mutations in NS5A inhibitors. The treatment with GLE+PIB, in the experienced patients registered SVR in 100% of cases.
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