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Resistance to Direct Acting Antiviral Therapy

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Presentation on theme: "Resistance to Direct Acting Antiviral Therapy"— Presentation transcript:

1 Resistance to Direct Acting Antiviral Therapy

2 Resistance to HCV DAAs: What is the threat level?

3 HCV Biology is the basis for resistance

4 HCV biology is the basis for cure

5 Frequency of Protease Resistance Mutations Prior to Therapy

6 Emergence of Pre-existing Resistant Variants During Treatment with DAA

7 Resistance Develops Rapidly During telaprevir monotherapy with Protease Inhibitor

8 Barrier to resistance: Combination of DAAs with different mechanism of action

9 Multiple drugs target WT and resistant virus to prevent selection of resistant variants

10 Inhibitors of NS3/4A Protease

11 SVR with PegIFN/RBV + PI requires adequate IFN response to prevent resistance

12 REALIZE: Resistance rates are higher in persons less responsive to PegIFN/RBV

13 Frequency of RAVs detected in Non-SVR Patients; Poor Interferon Responders and Interferon Responders

14 Barrier to resistance: Role of viral characteristics Telaprevir Resistance in patients who failed to achieve SVR: Subtype 1a versus 1b

15 Barrier to resistance: Role of pharmacology Clonal sequence analysis from subjects dosed with ABT-450 for 3 days

16 Barrier to resistance: Combination therapy

17 Inhibitors of NS5A Replicase Protein

18 Daclatasvir: Emergence of resistance with 14 day monotherapy

19 Potent antiviral activity of GS-5885 3-day monotherapy

20 Daclatasvir + Asunaprevir ± PegIFN/RBV in Previous PegIFN/RBV Null Responders

21 Inhibitors of NS5B polymersase: non-nucleoside inhibitors (NNIs)

22 Polymerase mutations in 89 treatment naïve HCV genotype 1 infected patients

23 PI (GS-9256) + NNI (Tegobuvir) with or without RBV for HCV genotype 1

24

25 Inhibitors of NS5B polymersase: nucleoside inhibitors (NIs)

26 Resistance to nucleos(t)ide inhibitors

27 Antiviral Activity of PSI-7977 alone or in combination with PSI-938

28 ELECTRON: SVR following GS-7977 ± RBV ± PegIFN x 12 weeks

29 INFORM-1: Combination of NI + PI may prevent emergence of PI resistant variants

30 Cyclophilin Antagonists: Target the host

31 Clinical implications of pre-existing mutations to DAAs – spontaneous or selected

32 SVR Rates By Treatment Week 4 Response Among Patients With or Without Baseline RAVs Detected

33 Most Common RAVs†: Detectability Declines During Follow-Up

34 ADVANCE Loss of Resistance by NS3 Position

35 EXTEND Study: Long-term Follow-up of Patients Treated with Telaprevir

36 EXTEND study: Follow-up of TLV treated patients

37 C-219: Retreatment of 9 patients after TVR monotherapy with resistance

38 Clinical implications of selection resistance to first generation HCV PIs

39 Resistance to Direct Acting Antiviral Therapy


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