Sofosbuvir (SOF) Suppresses Ledipasvir (LDV)-resistant Mutants during SOF/LDV Combination Therapy against Genotype 1b Hepatitis C Virus (HCV)

Sci Rep. 2017 Oct 31;7(1):14421. doi: 10.1038/s41598-017-15007-2.

Abstract

Our objective was to identify drug interactions between ledipasvir (LDV) and sofosbuvir (SOF) against a genotype 1b replicon to determine optimal exposures for each agent that will maximize antiviral activity against susceptible and drug-resistant subpopulations. LDV and SOF were evaluated using a fully factorial experimental design in the BelloCell system. Replicon levels and drug-resistant variants were quantified at various times post-therapy for 14 days and a high-dimensional mathematical model was fit to the data. Mutations associated with SOF resistance were not detected; but LDV-resistant mutants were selected and mutant subpopulations increased as exposure intensity increased. Combination therapy was additive for the total replicon population and the LDV-resistant population, but a threshold concentration of 100 ng/ml of SOF must be attained to suppress LDV-resistant subpopulations. These novel findings hold important implications for not only improving therapeutic outcomes, but also maximizing the clinical utility of LDV and SOF combination regimens.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Antiviral Agents / therapeutic use
  • Benzimidazoles / metabolism
  • Benzimidazoles / pharmacology*
  • Benzimidazoles / therapeutic use*
  • Cell Line
  • Combined Modality Therapy
  • Drug Interactions
  • Drug Resistance, Viral / drug effects
  • Drug Resistance, Viral / genetics*
  • Drug Therapy, Combination
  • Fluorenes / metabolism
  • Fluorenes / pharmacology*
  • Fluorenes / therapeutic use*
  • Genotype
  • Hepacivirus / drug effects
  • Hepacivirus / pathogenicity
  • Hepatitis C, Chronic / drug therapy
  • Humans
  • Models, Theoretical
  • Sofosbuvir / pharmacology
  • Sofosbuvir / therapeutic use
  • Uridine Monophosphate / analogs & derivatives*
  • Uridine Monophosphate / metabolism
  • Uridine Monophosphate / pharmacology
  • Uridine Monophosphate / therapeutic use

Substances

  • Antiviral Agents
  • Benzimidazoles
  • Fluorenes
  • ledipasvir, sofosbuvir drug combination
  • ledipasvir
  • Uridine Monophosphate
  • Sofosbuvir