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Poordad F. NEJM 2014;368:45-53 2D Phase IIa  Design  Treatment regimens – Paritaprevir/rironavir (PTV/r) : PTV 250 or 150 mg qd/ritonavir 100 mg qd (2.

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Presentation on theme: "Poordad F. NEJM 2014;368:45-53 2D Phase IIa  Design  Treatment regimens – Paritaprevir/rironavir (PTV/r) : PTV 250 or 150 mg qd/ritonavir 100 mg qd (2."— Presentation transcript:

1 Poordad F. NEJM 2014;368:45-53 2D Phase IIa  Design  Treatment regimens – Paritaprevir/rironavir (PTV/r) : PTV 250 or 150 mg qd/ritonavir 100 mg qd (2 tablets) – Dasabuvir (DSV) : 400 mg bid – RBV : 1000 or 1200 mg/day (bid dosing) according to body weight (< or ≥ 75 kg)  Endpoints – Primary : eRVR (undetectable HCV RNA from W4-W12), with 95% CI – Secondary : SVR 12 (HCV RNA < 25 IU/mL), with 95% CI PTV250/r + DSV + RBV Not randomised Open label 18-65 years Chronic HCV genotype 1 Detectable HCV RNA No cirrhosis No HBV or HIV co-infection 2D Phase IIa Study: paritaprevir/ritonavir + dasabuvir + ribavirin for genotype 1 N = 14 N = 19 W12 PTV150/r + DSV + RBV SVR 12 PTV150/r + DSV + RBV SVR 12 N = 17 Treatment naïve Null or partial response to PEG-IFN + RBV

2 2D Phase IIa Study: paritaprevir/ritonavir + dasabuvir + ribavirin for genotype 1 Treatment-naïveTreatment-experienced PTV250/r + DSV + RBV N = 19 PTV150/r + DSV + RBV N = 14 PTV150/r + DSV + RBV N = 17 Mean age, years545152 Female47%035% Race : white/black79% / 21%86% / 14%76% / 24% Body mass index, mean27.324.627.6 Genotype 1a / 1b89% / 11%79% / 21%94% / 6% IL28B CC genotype53%36%0 HCV RNA log 10 IU/mL, mean6.256.446.91 Response to previous therapy Partial Null --10 7 Discontinued treatment, N 1 ALT elevation 1 Inability to comply 0 Baseline characteristics and patient disposition 2D Phase IIa Poordad F. NEJM 2014;368:45-53

3 HCV RNA < 25 IU/mL, % (95% CI) PTV250/r + DSV + RBVPTV150/r + DSV + RBVPTV150/r + DSV + RBV exp 25 50 100 75 89 (67-99) % 100 eRVREOTSVR 12 95 (74-100) 79 (49-95) 65 59 (33-82) N 19 1417 14 17 93 47 (23-72) 93 (66-100) eRVREOTSVR 12 eRVREOTSVR 12  SVR 12 in IL28B non-CC naïve patients : 18/18 vs 13/15 in CC 2D Phase IIa Study: paritaprevir/ritonavir + dasabuvir + ribavirin for genotype 1 2D Phase IIa Poordad F. NEJM 2014;368:45-53

4 2D Phase IIa Study: paritaprevir/ritonavir + dasabuvir + ribavirin for genotype 1  Virologic breakthrough –None in naïve patients –Six (35%) in previous non-responders  Relapse –None in naïve patients –3 in pre-treated patients  Resistance testing (population sequencing) of the 9 failures –8/9 had ≥ 1 mutant resistant variants in NS3 and NS5B NS3 : position 168 (N = 8) + 155 (N = 1) NS5B : position 316 (N = 2), 414 (N = 3), 554 (N = 2), 556 (N = 4), 559 (N = 1) –1 patient had a baseline NS3 168 mutation 2D Phase IIa Poordad F. NEJM 2014;368:45-53

5 2D Phase IIa Study: paritaprevir/ritonavir + dasabuvir + ribavirin for genotype 1 Adverse events, n (%) Treatment-naïveExperienced PTV250/r + DSV + RBV N = 19 PTV150/r + DSV + RBV N = 14 PTV150/r + DSV + RBV N = 17 Adverse event in > 10% in any group Fatigue47%43%35% Nausea21% 24% Headache26%14%18% Dizziness5%29%24% Insomnia26%21%0 Pruritus21%012% Rash21%7%6% Vomiting5%21%0 Laboratory abnormalities Total bilirubin ≥ 2 x ULN330 Creatinine ≥ 1.5 mg/dL200 ALT ≥ 5 x ULN100 2D Phase IIa Poordad F. NEJM 2014;368:45-53

6 2D Phase IIa Study: paritaprevir/ritonavir + dasabuvir + ribavirin for genotype 1  Summary –This preliminary study suggests that the all-oral combination of paritaprevir/r, dasabuvir, and ribavirin for 12 weeks is associated with a sustained virologic response in a high proportion of previously untreated patients with HCV genotype 1 infection –This regimen is less effective in patients who have HCV genotype 1 infection with a null or partial response to previous therapy –In most cases, virologic failure was associated with the emergence of variants with substitutions in both NS3 and NS5B, at positions known to confer resistance in vitro to PTV and DSV, respectively –Discontinuation for adverse event occurred in 1 patient (asymptomatic ALT elevation) 2D Phase IIa Poordad F. NEJM 2014;368:45-53


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