Glecaprevir/pibrentasvir for 8 weeks in treatment-naïve patients with chronic HCV genotypes 1-6 and compensated cirrhosis: The EXPEDITION-8 trial
Robert S Brown Jr, Maria Buti, Lino Rodrigues, Vladimir Chulanov, Wan-Long Chuang, Humberto Aguilar, Gábor Horváth, Elimelech Zuckerman, Barbara Rosado Carrion, Federico Rodriguez-Perez, Petr Urbánek, Armand Abergel, Eric Cohen, Sandra S Lovell, Gretja Schnell, Chih-Wei Lin, Jiuhong Zha, Stanley Wang, Roger Trinh, Federico J Mensa, Margaret Burroughs, Franco Felizarta, Robert S Brown Jr, Maria Buti, Lino Rodrigues, Vladimir Chulanov, Wan-Long Chuang, Humberto Aguilar, Gábor Horváth, Elimelech Zuckerman, Barbara Rosado Carrion, Federico Rodriguez-Perez, Petr Urbánek, Armand Abergel, Eric Cohen, Sandra S Lovell, Gretja Schnell, Chih-Wei Lin, Jiuhong Zha, Stanley Wang, Roger Trinh, Federico J Mensa, Margaret Burroughs, Franco Felizarta
Abstract
Background & aims: Eight-week glecaprevir/pibrentasvir leads to high rates of sustained virological response at post-treatment week 12 (SVR12) across HCV genotypes (GT) 1-6 in treatment-naïve patients without cirrhosis. We evaluated glecaprevir/pibrentasvir once daily for 8 weeks in treatment-naïve patients with compensated cirrhosis.
Methods: EXPEDITION-8 was a single-arm, multicenter, phase IIIb trial. The primary and key secondary efficacy analyses were to compare the lower bound of the 95% CI of the SVR12 rate in i) patients with GT1,2,4-6 in the per protocol (PP) population, ii) patients with GT1,2,4-6 in the intention-to-treat (ITT) population, iii) patients with GT1-6 in the PP population, and iv) patients with GT1-6 in the ITT population, to pre-defined efficacy thresholds based on historical SVR12 rates for 12 weeks of glecaprevir/pibrentasvir in the same populations. Safety was also assessed.
Results: A total of 343 patients were enrolled. Most patients were male (63%), white (83%), and had GT1 (67%). The SVR12 rate in patients with GT1-6 was 99.7% (n/N = 334/335; 95%CI 98.3-99.9) in the PP population and 97.7% (n/N = 335/343; 95% CI 96.1-99.3) in the ITT population. All primary and key secondary efficacy analyses were achieved. One patient (GT3a) experienced relapse (0.3%) at post-treatment week 4. Common adverse events (≥5%) were fatigue (9%), pruritus (8%), headache (8%), and nausea (6%). Serious adverse events (none related) occurred in 2% of patients. No adverse event led to study drug discontinuation. Clinically significant laboratory abnormalities were infrequent.
Conclusions: Eight-week glecaprevir/pibrentasvir was well tolerated and led to a similarly high SVR12 rate as the 12-week regimen in treatment-naïve patients with chronic HCV GT1-6 infection and compensated cirrhosis.
Trial registration: ClinicalTrials.gov, NCT03089944.
Lay summary: This study was the first to evaluate an 8-week direct-acting antiviral (DAA) regimen active against all major types of hepatitis C virus (HCV) in untreated patients with compensated cirrhosis. High virological cure rates were achieved with glecaprevir/pibrentasvir across HCV genotypes 1-6, and these high cure rates did not depend on any patient or viral characteristics present before treatment. This may simplify care and allow non-specialist healthcare professionals to treat these patients, contributing to global efforts to eliminate HCV.
Keywords: Chronic HCV infection; Compensated cirrhosis; Direct-acting antiviral; Glecaprevir/pibrentasvir; HCV elimination; Hepatitis C virus; Pangenotypic; Short duration.
Copyright © 2019 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Source: PubMed