Elbasvir/Grazoprevir, Ledipasvir/Sofosbuvir And Velpatisvir/Sofosbuvir Therapy Among People Who Use Drugs (PWUD): Real World Experience

Author: Conway B, Alimohammadi A, Holeksa J, Truong D

Theme: Clinical Research Year: 2018

To meet WHO HCV elimination goals specific programs will be needed to engage vulnerable
populations with a high prevalence of HCV infection, such as PWUD. The most prescribed
regimens in Canada include elbasvir/grazoprevir (E/G), ledipasvir/sofosbuvir (L/S) and
velpatasvir/sofosbuvir (V/S). While clinical trials have highlighted the efficacy of these regimens,
real world data is required to confirm these results, especially among PWUD.
A retrospective analysis was performed on all HCV-infected PWUD, initiating HCV treatment
(rx) at our centre between 06/15-10/17. All subjects were enrolled in a multidisciplinary model of
care, addressing medical, psychologic, social and addiction-related needs. The primary
outcome was achievement of SVR12. A secondary outcome was maintenance of SVR in longterm follow-up in subjects with ongoing risk behaviors for recurrent viremia.
A total of 148 individuals (all PWUD, 66% heroin/58% cocaine) have initiated therapy with one
of E/G, L/S, or V/S. The E/G cohort (n = 39) includes 6 HIV+, 18 on opiate substitution therapy
(OST), 31 Rx naïve, 21 GT1a, and 4 cirrhotic. To date, 34/36 achieved SVR12, with no virologic
failures (2 LTFU). The L/S cohort (n = 64) includes 7 HIV+, 6 on OST, 36 Rx naïve, 43 GT1a, 19
cirrhotic. To date, 49/55 achieved SVR12, with 2 virologic relapses, 4 LTFU, one unrelated
opioid overdose death. The V/S cohort (n=45) includes 6 HIV+, 13 on OST, 30 Rx naïve, 9
GT1a, 23 GT3a, 10 cirrhotic. To date, 29/29 achieved SVR12.
Currently prescribed all-oral HCV treatment regimens appear to be highly and equally effective
in a real world PWUD cohort. This provides support for expanded access to HCV treatment.
Pending complete and ongoing follow-up in this important cohort, health care providers have
three excellent options to provide HCV treatment to PWUD engaged in care, in support of the
WHO’s global elimination targets.
AA– Travel grants from AbbVie and Merck & Co.
JH – Nothing to declare
DT – Honoraria from Merck & Co.
BC – Grants, honoraria, travel funding, and advisory board positions with AbbVie, Merck & Co,
Gilead Sciences, and ViiV.

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