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

Background:
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.
Methods:
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.
Results:
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.
Conclusion:
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.
Disclosures:
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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