High Sustained Virologic Response to Daclatasvir Plus Asunaprevir in Elderly and Cirrhotic Patients with Hepatitis C Virus Genotype 1b Without Baseline NS5A Polymorphisms

Fiona McPhee, Yoshiyuki Suzuki, Joji Toyota, Yoshiyasu Karino, Kasuaki Chayama, Yoshiiku Kawakami, Min Lung Yu, Sang Hoon Ahn, Hiroki Ishikawa, Rafia Bhore, Nannan Zhou, Dennis Hernandez, Patricia Mendez, Hiromitsu Kumada

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Abstract

Introduction: Oral daclatasvir (DCV; pangenotypic NS5A inhibitor) plus asunaprevir (ASV; NS3 protease inhibitor) is approved in Japan and Korea for treatment of chronic hepatitis C virus (HCV) genotype 1. Response to DCV + ASV is affected by DCV resistance-associated polymorphisms (RAPs) in HCV NS5A. The prevalence and influence of these RAPs on 12-week sustained virologic response (SVR12) to DCV + ASV was evaluated in Asian and non-Asian patients. Methods: Data were pooled from 5 national and international studies of patients with HCV genotype 1b (GT-1b) receiving DCV + ASV at their recommended doses. Baseline NS5A RAPs and their effect on SVR12 were assessed overall, in older (≥65 years) patients, patients with cirrhosis, and in patients stratified by baseline HCV RNA or prior treatment experience with interferon-based therapy. Results: Baseline NS5A sequences were available from 988 patients (374 Japanese; 125 Korean/Taiwanese; 489 from non-Asian countries), 979 of whom were assessed for SVR12. Pretreatment NS5A-L31F/I/M/V and/or NS5A-Y93H polymorphisms were present in 18% of Japanese and 12–13% of non-Japanese patients; these RAPs reduced SVR12 by 54.9% overall (93.9% [787/838] SVR12 when absent, 39.0% [55/141] SVR12 when present), with comparable reductions observed in Asians and non-Asians and across all categories of treatment experience, age, and cirrhosis. RAP-associated SVR12 rates declined with increasing baseline HCV RNA (SVR12 with RAPs: 64.7% [11/17] at 5-6 log10 IU/mL, 29.8% [14/47] at 7–8 log10). Without baseline RAPs, very high SVR12 rates (92–100%) were observed in older patients and patients with cirrhosis irrespective of national origin, with similarly high rates observed among treatment-naïve and interferon-experienced patients and those with high baseline HCV RNA. Conclusions: Following DCV + ASV treatment, the SVR12 rates in GT-1b patients without baseline NS5A-L31F/I/M/V and/or NS5A-Y93H polymorphisms were very high (approximately 90–100%), irrespective of age, cirrhosis, prior interferon treatment, or baseline HCV RNA. Funding: Bristol-Myers Squibb.

Original languageEnglish
Pages (from-to)637-649
Number of pages13
JournalAdvances in Therapy
Volume32
Issue number7
DOIs
Publication statusPublished - 2015 Jul 9

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)

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    McPhee, F., Suzuki, Y., Toyota, J., Karino, Y., Chayama, K., Kawakami, Y., Yu, M. L., Ahn, S. H., Ishikawa, H., Bhore, R., Zhou, N., Hernandez, D., Mendez, P., & Kumada, H. (2015). High Sustained Virologic Response to Daclatasvir Plus Asunaprevir in Elderly and Cirrhotic Patients with Hepatitis C Virus Genotype 1b Without Baseline NS5A Polymorphisms. Advances in Therapy, 32(7), 637-649. https://doi.org/10.1007/s12325-015-0221-5