Effectiveness of Sofosbuvir-based Regimens for HCV Infection
Effectiveness of Sofosbuvir-based Regimens for HCV Infection
In this large real-world cohort, genotype 1 and 2 HCV-infected veterans with advanced liver disease, prior treatment experience or detectable week 4 on-treatment HCV RNA were significantly less likely to achieve SVR. For genotype 1, use of SOF + SIM ± RBV was associated with a higher likelihood of SVR compared with SOF + PEG + RBV. Overall, SVR rates in the VA with SOF-based regimens were substantially higher than with prior HCV anti-viral regimens but lower than the rates reported in clinical trials. The differences observed in VA with regard to patient characteristics, early treatment discontinuations and lower SVR rates reflect the differences between clinical trials and clinical practice. Thus, patient and provider expectations in real-world settings may need to be tempered accordingly depending on the population being treated. The reporting of real-world experience in VA, the largest provider of HCV care in the USA, is essential to provide practical information to better inform HCV management strategies. Given the public health impact of effective HCV treatment, real-world outcomes data will help inform clinicians and policy makers beyond VA.
Conclusions
In this large real-world cohort, genotype 1 and 2 HCV-infected veterans with advanced liver disease, prior treatment experience or detectable week 4 on-treatment HCV RNA were significantly less likely to achieve SVR. For genotype 1, use of SOF + SIM ± RBV was associated with a higher likelihood of SVR compared with SOF + PEG + RBV. Overall, SVR rates in the VA with SOF-based regimens were substantially higher than with prior HCV anti-viral regimens but lower than the rates reported in clinical trials. The differences observed in VA with regard to patient characteristics, early treatment discontinuations and lower SVR rates reflect the differences between clinical trials and clinical practice. Thus, patient and provider expectations in real-world settings may need to be tempered accordingly depending on the population being treated. The reporting of real-world experience in VA, the largest provider of HCV care in the USA, is essential to provide practical information to better inform HCV management strategies. Given the public health impact of effective HCV treatment, real-world outcomes data will help inform clinicians and policy makers beyond VA.