Daclatasvir/asunaprevir/beclabuvir, all-oral, fixed-dose combination for patients with chronic hepatitis C virus genotype 1

Jia Horng Kao, Ming Lung Yu, Cheng Yuan Peng, Jeong Heo, Chi Jen Chu, Ting Tsung Chang, Youn Jae Lee, Tsung Hui Hu, Ki Tae Yoon, Seung Woon Paik, Young Suk Lim, Sang Hoon Ahn, Vasily Isakov, Fiona McPhee, Wenhua Hu, Eugene Scott Swenson, Philip D. Yin, Michelle Treitel

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Abstract

Background and Aim: This multinational (Taiwan, South Korea, Russia) phase 3 study evaluated the all-oral, ribavirin-free, fixed-dose combination (DCV-TRIO) of daclatasvir (NS5A inhibitor) 30 mg, asunaprevir (NS3 inhibitor) 200 mg, and beclabuvir (NS5B inhibitor) 75 mg, in patients with chronic hepatitis C virus genotype-1 infection, with or without compensated cirrhosis. Methods: UNITY-4 (NCT02170727) was an open-label, two-cohort study in which 169 patients, treatment-naive (n = 138) or treatment-experienced (n = 31), received twice-daily DCV-TRIO for 12 weeks with 24 weeks of post-treatment follow-up. The primary efficacy end point was sustained virologic response at post-treatment week 12 (SVR12) in treatment-naive patients. Results: Eighty-eight (52%) patients were men, 81 (48%) Taiwanese, 78 (46%) Korean, and 10 (6%) Russian; 23 (14%) had compensated cirrhosis, and 52 (31%) were IL28B (rs1297860) non-CC genotype. Baseline resistance-associated NS5A polymorphisms (L31 and/or Y93) were detected in 25/165 (15%) patients with available genotype-1 sequencing data. SVR12 was achieved by 98.6% (136/138; 95% confidence interval: 94.9–99.8%) of treatment-naive and 100% (31/31; 95% confidence interval: 88.8–100%) of treatment-experienced patients. Both virologic failures were found to be infected with hepatitis C virus genotype-6g; 100% SVR12 was observed for genotype-1a (n = 8) and genotype-1b (n = 157). Two patients experienced serious adverse events. Eight (5%) patients experienced reversible grade 3/4 alanine aminotransferase or aspartate aminotransferase elevations, leading to discontinuation in four (2%); all achieved SVR12. There were no grade 3/4 total bilirubin increases and no deaths. Conclusions: Twelve weeks of DCV-TRIO was well tolerated and provided 100% SVR12 in treatment-naive and treatment-experienced patients with genotype-1 infection, with or without cirrhosis, including those with baseline NS5A-L31 or NS5A-Y93 resistance-associated substitutions.

Original languageEnglish
Pages (from-to)1998-2005
Number of pages8
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume32
Issue number12
DOIs
Publication statusPublished - 2017 Dec

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

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    Kao, J. H., Yu, M. L., Peng, C. Y., Heo, J., Chu, C. J., Chang, T. T., Lee, Y. J., Hu, T. H., Yoon, K. T., Paik, S. W., Lim, Y. S., Ahn, S. H., Isakov, V., McPhee, F., Hu, W., Scott Swenson, E., Yin, P. D., & Treitel, M. (2017). Daclatasvir/asunaprevir/beclabuvir, all-oral, fixed-dose combination for patients with chronic hepatitis C virus genotype 1. Journal of Gastroenterology and Hepatology (Australia), 32(12), 1998-2005. https://doi.org/10.1111/jgh.13796