Real-world Effectiveness of Sofosbuvir/Velpatasvir for Treatment of Chronic Hepatitis C in British Columbia, Canada: A Population-Based Cohort Study

James Wilton; Stanley Wong; Amanda Yu; Alnoor Ramji; Darrel Cook; Zahid A Butt; Maria Alvarez; Mawuena Binka; Maryam Darvishian; Dahn Jeong; Sofia R Bartlett; Margo E Pearce; Prince A Adu; Eric M Yoshida; Mel Krajden; Naveed Z Janjua

doi:10.1093/ofid/ofaa055

Real-world Effectiveness of Sofosbuvir/Velpatasvir for Treatment of Chronic Hepatitis C in British Columbia, Canada: A Population-Based Cohort Study

Open Forum Infect Dis. 2020 Feb 29;7(3):ofaa055. doi: 10.1093/ofid/ofaa055. eCollection 2020 Mar.

Authors

James Wilton¹, Stanley Wong¹, Amanda Yu¹, Alnoor Ramji², Darrel Cook¹, Zahid A Butt^{1

3}, Maria Alvarez¹, Mawuena Binka¹, Maryam Darvishian^{1

4

5}, Dahn Jeong^{1

6}, Sofia R Bartlett^{1

7

8}, Margo E Pearce^{1

6}, Prince A Adu^{1

6}, Eric M Yoshida², Mel Krajden^{1

7}, Naveed Z Janjua^{1

6}

Affiliations

¹ British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
² Division of Gastroenterology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
³ School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
⁴ Cancer Control Research, BC Cancer Research Center, Vancouver, British Columbia, Canada.
⁵ Population Oncology, BC Cancer Research Center, Vancouver, British Columbia, Canada.
⁶ School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
⁷ Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
⁸ Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.

Abstract

Background: Clinical trials show high efficacy of sofosbuvir/velpatasvir (SOF/VEL), but there are limited data from "real-world" settings. We aimed to evaluate SOF/VEL effectiveness for all hepatitis C virus (HCV) genotypes (GTs) in British Columbia (BC), Canada.

Methods: We used the BC Hepatitis Testers Cohort, which includes all HCV cases in the province (1990-2015) linked to administrative databases, including prescriptions to end of 2018. We measured sustained virologic response (SVR; negative RNA ≥10 weeks after treatment end) and identified characteristics associated with non-SVR. Conservatively, we excluded individuals with no assessment for SVR if their last RNA test after treatment initiation was negative (but included if positive).

Results: Of 2821 eligible participants, most were infected with GT1 (1076, 38.1%) or GT3 (1072, 38.0%), and a minority (278, 9.9%) were treated with RBV. SVR was 94.6% (2670/2821) overall and 94.5% (1017/1076) for GT1, 96.4% (512/531) for GT2, and 93.7% (1004/1072) for GT3. When disaggregated by GT, treatment regimen, and cirrhosis/treatment experience, SVR was lowest (30/40, 75.0%) among treatment-experienced GT3 individuals treated with RBV. Characteristics associated with non-SVR in multivariable analysis included younger age, RBV addition, and being a person with HIV (PWH) or who injects/injected drugs (PWID). When treatment regimen (±RBV) was removed from multivariable model, treatment experience was associated with non-SVR for GT3. Of 151 non-SVR individuals, 56.3% were nonvirological failures (treatment incomplete/no assessment for SVR) and 43.7% were virological failures (nonresponse/relapse). A disproportionately high percentage of non-SVR among PWID was due to nonvirological failure.

Conclusions: SOF/VEL was highly effective in this "real-world" population-based cohort. Additional support is required for PWID/PWH to reach SVR.

Keywords: administrative data; hepatitis C; observational study; ribavirin; sofosbuvir; treatment effectiveness; velpatasvir.