title: Real-World Experiences With a Direct-Acting Antiviral Agent for Patients With Hepatitis C Virus Infection.
abstract: Traditional hepatitis C virus treatment was limited by low cure rates, side effects, and stringent monitoring requirements. Sofosbuvir, a direct-acting antiviral agent with a cure rate of 96%, was introduced in 2013. However, trials frequently excluded patients with advanced liver disease and prior treatment experience. This study aims to elucidate the real-world cure rates and sofosbuvir safety profile.
  
  
  
  A retrospective cohort study was conducted at Kaiser Permanente Southern California involving patients with hepatitis C virus who received sofosbuvir treatment. Patients age 18 years and older were included, and pregnant patients were excluded. The primary end point was sustained virologic response at 12 weeks posttreatment. Secondary end points were safety and medication adherence. Multiple logistic regression analysis was used to compare patients with genotypes 1 and 2 infections.
  
  
  
  Of the 213 study patients, 42.3% had cirrhosis, and 38% were treatment-experienced. Most patients (69.5%) received dual therapy (sofosbuvir + ribavirin), whereas the remainder (30.5%) received triple therapy (sofosbuvir + ribavirin + interferon). The overall rate of sustained virologic response at 12 weeks posttreatment rate was 72.9% for genotype 1 infection, 64.7% in the treatment-experienced subgroup, and 66.7% in the cirrhosis subgroup. Rates of sustained virologic response at 12 weeks posttreatment for genotypes 2 and 3 were 90.8% and 55%, respectively. Most patients experienced anemia and fatigue. Women and patients with a lower baseline viral load were statistically more likely to be cured.
  
  
  
  Real-world cure rates were similar to rates seen in clinical trials for genotype 2 infection and lower for genotype 1 infection. Patients with genotype 1 and 3 infection did better with triple therapy compared with dual therapy. Patients tolerated therapy well with side effects, serious adverse events, and discontinuation rates similar to clinical trials. Women and patients with lower baseline hepatitis C viral load were more likely to achieve sustained virological response at 12 weeks posttreatment.
authors.affiliation: Ambulatory Care Pharmacist at the Los Angeles Medical Center in CA. vincent.x.louie@kp.org.
authors.forename: Vincent
authors.initials: V
authors.lastname: Louie
authors.affiliation: Gastroenterology Fellow at the Los Angeles Medical Center in CA. latt.nyan@mayo.edu.
authors.forename: Nyan L
authors.initials: NL
authors.lastname: Latt
authors.affiliation: Clinical Operations Manager for Pharmacy Operations at the Los Angeles Medical Center in CA. derenik.x.gharibian@kp.org.
authors.forename: Derenik
authors.initials: D
authors.lastname: Gharibian
authors.affiliation: Hepatologist at the Los Angeles Medical Center in CA. amandeep.sahota@kp.org.
authors.forename: Amandeep
authors.initials: A
authors.lastname: Sahota
authors.affiliation: Gastroenterology Fellow at the Los Angeles Medical Center in CA. beshoy.t.yanny@kp.org.
authors.forename: Beshoy T
authors.initials: BT
authors.lastname: Yanny
authors.affiliation: Gastroenterology Fellow at the Los Angeles Medical Center in CA. drrasham@gmail.com.
authors.forename: Rasham
authors.initials: R
authors.lastname: Mittal
authors.affiliation: Biostatistician in the Department of Research and Evaluation of Kaiser Permanente Southern California in Pasadena. zoe.bider@kp.org.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Bider-Canfield
authors.affiliation: Researcher in the Department of Research and Evaluation for Kaiser Permanente Southern California in Pasadena.
authors.forename: T Craig
authors.initials: TC
authors.lastname: Cheetham
mesh_terms: D000368:Aged; D000740:Anemia / Q000209:etiology; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002140:California; D004359:Drug Therapy, Combination; D005221:Fatigue / Q000209:etiology; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007372:Interferons / Q000627:therapeutic use; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D008103:Liver Cirrhosis / Q000188:drug therapy / Q000821:virology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012254:Ribavirin / Q000627:therapeutic use; D012737:Sex Factors; D000069474:Sofosbuvir / Q000009:adverse effects / Q000627:therapeutic use*; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons; D000069474:Sofosbuvir