@article{44f5bd5ef52f45c5a1248b4e001a10b8,
title = "Prevalence of Resistance-Associated Substitutions in HCV NS5A, NS5B, or NS3 and Outcomes of Treatment With Ledipasvir and Sofosbuvir",
abstract = "Background & Aims We evaluated the effects of baseline hepatitis C virus (HCV) NS5A, NS5B, and NS3 resistance-associated substitutions (RASs) on response to the combination of ledipasvir and sofosbuvir, with or without ribavirin, in patients with HCV genotype 1 infection. Methods We analyzed data from 2144 participants in phase 2 and 3 studies of patients with HCV genotype 1a or b infection who received the combination of ledipasvir (90 mg) and sofosbuvir (400 mg) (ledipasvir/sofosbuvir) once daily, with or without ribavirin twice daily. Population and/or deep sequence analyses of the HCV NS3, NS5A, and NS5B genes were performed on blood samples collected at baseline. Results Overall, 16.0% of patients had detectable baseline RASs in NS5A. Among patients with HCV genotype 1b infection, there was no significant effect of baseline RASs in NS5A on sustained viral response 12 weeks after the end of treatment (SVR12) with ledipasvir/sofosbuvir and only a small effect in patients with HCV genotype 1a infection. RASs in NS5A that increased the half-maximal effective concentration to ledipasvir by more than 100-fold reduced the rate of SVR12 in treatment-naive patients given ledipasvir/sofosbuvir for 8 weeks (P =.011), but not for 12 weeks. These same baseline NS5A RASs reduced the percentage of treatment-experienced patients who achieved an SVR12 to 12 weeks (but not 24 weeks) ledipasvir/sofosbuvir (P <.001). These RASs had a small effect in patients given ledipasvir/sofosbuvir in combination with ribavirin for 12 weeks. Overall, 2.5% of patients had baseline NS5B nucleotide inhibitor RASs (L159F, N142T, S282G, or L320S) and all achieved an SVR12. Of patients previously treated with protease inhibitors, 53.7% had RASs in NS3 and 96.5% achieved an SVR12. Conclusions Baseline RASs in NS5A have minimal effects on patient responses to ledipasvir/sofosbuvir therapy. When these RASs do have effects, they could be largely overcome by extending treatment duration or through treatment intensification.",
keywords = "Direct-Acting Antivirals, ION-1, ION-2, ION-3",
author = "Christoph Sarrazin and Hadas Dvory-Sobol and Svarovskaia, {Evguenia S.} and Doehle, {Brian P.} and Pang, {Phillip S.} and Chuang, {Shu Min} and Julie Ma and Xiao Ding and Afdhal, {Nezam H.} and Kowdley, {Kris V.} and Gane, {Edward J.} and Eric Lawitz and Brainard, {Diana M.} and McHutchison, {John G.} and Miller, {Michael D.} and Hongmei Mo",
note = "Funding Information: Conflicts of interest The authors disclose the following: Hadas Dvory-Sobol, Evguenia S. Svarovskaia, Brian Doehle, Phil S. Pang, Shu-Min Chuang, Julie Ma, Xiao Ding, Diana M. Brainard, John G. McHutchison, Michael D. Miller, and Hongmei Mo are employees and stock holders of Gilead Sciences; Christoph Sarrazin was supported by a grant (DZIF [Deutsches Zentrum f{\"u}r Infektionsforschung], German Centre for Infection Research, TTU [Thematische Translationseinheit], Hepatitis), and received research support and fees for advisory boards or speaking activities from Abbott, AbbVie, Achillion, BMS, Gilead Sciences, Janssen, Merck/MSD, and Roche; Kris V. Kowdley received research support and personal fees from AbbVie, Gilead, Intercept, Merck, and Trio Health, has received research support from Evidera, Galectin, Immuron, NGM Biopharma, Novartis, and Tobira, has received personal fees from Enanta and Verlyx, and has received royalties from Up-To-Date; Eric Lawitz has received research/grant support from AbbVie, Achillion Pharmaceuticals, Boehringer Ingelheim, Bristol-Myers Squibb, Enanta Pharmaceuticals, Gilead Sciences, GlaxoSmithKline, Janssen, Merck & Co, Roche, Salix, Santaris Pharmaceuticals, Tacere, and Theravance, is on the speakers{\textquoteright} bureau of AbbVie, Bristol-Myers Squibb, Gilead, Janssen, and Merck & Co, and consults/advises for AbbVie, Achillion Pharmaceuticals, Bristol-Myers Squibb, Enanta, Gilead Sciences, Janssen, Merck & Co, Novartis, Santaris Pharmaceuticals, Regulus, and Theravance; Nezam Afdhal has received grant support within the past 2 years from Gilead Sciences, AbbVie, and Bristol Myers Squibb, has received consulting/advisory board fees from Merck, Gilead Sciences, Echosens, GlaxoSmithKline PLC, Ligand Pharmaceuticals, Inc, Janssen Pharmaceuticals, Inc, Roivant Sciences, Inc, Co-Crystal Pharma, Inc, Trio Health, and Shionogi, Inc, and currently is an employee of Spring Bank Pharmaceuticals and has an equity interest in SpringBank Pharmaceuticals, Allurion Technologies, and Gilead Sciences; Edward Gane is a board member of, and has received grants from, AbbVie, Janssen, Gilead Sciences, and Merck, is on the speaker{\textquoteright}s bureau for, and has received grants from, AbbVie, Gilead Sciences, and Merck. Publisher Copyright: {\textcopyright} 2016 AGA Institute",
year = "2016",
month = sep,
day = "1",
doi = "10.1053/j.gastro.2016.06.002",
language = "English (US)",
volume = "151",
pages = "501--512.e1",
journal = "Gastroenterology",
issn = "0016-5085",
publisher = "W.B. Saunders Ltd",
number = "3",
}