Ombitasvir/paritaprevir/ritonavir and dasabuvir±ribavirin for chronic HCV infection in US veterans with psychiatric disorders

Autor: Michael J. Kozal, Michael Fuchs, Yao Yu, Gretja Schnell, Warren N. Schmidt, Doris Toro, Daniel E. Cohen, Norbert Bräu, Susanna Naggie, Kristine Richards, Victoria M. Mullally, Mariem Charafeddine, Alexander Monto, Ramsey Cheung
Rok vydání: 2019
Předmět:
Zdroj: Journal of Medical Virology
ISSN: 1096-9071
Popis: Hepatitis C virus (HCV) infections are more common among US veterans receiving care through Veterans Affairs (VA) Medical Centers than among the general population. Historically, HCV therapies had lower efficacy rates in VA patients, possibly due to common comorbidities such as psychiatric disorders and substance abuse. The direct‐acting antivirals ombitasvir/paritaprevir/ritonavir and dasabuvir (OBV/PTV/r+DSV)±ribavirin (RBV) are approved in the US for HCV genotype 1 (GT1)‐infected adults with or without cirrhosis. This study prospectively evaluated the safety and efficacy of OBV/PTV/r+DSV±RBV in VA patients with HCV GT1 infection. TOPAZ‐VA was a phase 3b, open‐label trial. Adult US veterans with HCV GT1 infection, without cirrhosis or with compensated cirrhosis, were eligible for enrollment. Patients with GT1a infection received OBV/PTV/r +DSV+RBV for 12 weeks or 24 weeks (for those with cirrhosis); GT1b‐infected patients without cirrhosis received OBV/PTV/r +DSV for 12 weeks; those with cirrhosis received OBV/PTV/r +DSV with RBV. The primary endpoint was sustained virologic response at posttreatment week 12 (SVR12); safety was also assessed. Ninety‐nine patients were enrolled at 10 sites from May through November 2015. The majority were male (96%), white (60%), and with GT1a infection (68%); 49% reported ongoing psychiatric disorders. Overall, 94% (93/99) achieved SVR12; three patients had a virologic failure. The most common AEs were fatigue (28%), headache (20%), and nausea (15%); six patients discontinued treatment due to AEs. In US veterans with HCV GT1 infection, OBV/PTV/r +DSV±RBV yielded a 94% overall SVR12 rate and was well tolerated. The presence of psychiatric disorders and/or injection drug use did not impact efficacy.
Highlights Chronic hepatitis C virus (HCV) infection occurs at a higher prevalence in the VA Health System than in the general population.These patients are also at a higher risk of psychiatric disorders and substance abuse, which were historically risk factors for successful treatment of HCV.We treated 99 patients in the VA Health System with ombitasvir/paritaprevir/ritonavir and dasabuvir with or without ribavirin for 12 to 24 weeks.Sustained virologic response was achieved in 93 of 99 patients, with safety and tolerability comparable to the general population.The presence of psychiatric or substance abuse disorders did not impact treatment success.
Databáze: OpenAIRE
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