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The Promise of Pan-Genotype Cure

One treatment which works against all strains of the hepatitis C virus (HCV) appears to be getting closer to reality all the time, as I wrote about on October 20, 2015 in One Pill for All Hepatitis C Strains. Gilead Sciences’ Sovaldi (sofosbuvir) combined in one pill with an NS5A inhibitor called velpatasvir has tested very successfully lately in trials of several HCV genotypes. A “one-size-fits-all” approach would streamline the treatment process of HCV patients. This pill combo already has been granted “breakthrough” status by the Food and Drug Administration (FDA) to speed this cure reaching patients.

There are four clinical trials based on this Sovaldi-velpatasvir combination, thus far, named ASTRAL-1, ASTRAL-2, ASTRAL-3, and ASTRAL-4. The first two of these trials showed strong efficacy, with 97-100% of patients (who had either genotype 1a, 1b, 2, 4, 5, or 6) achieving SVR at 12 weeks. This strong cure rate also was documented in treatment-experienced patients, as well as those with compensated cirrhosis. ASTRAL-3 indicated a 95% SVR for patients with genoype 3, as well as slightly lower efficacies of 89-91% in treatment-experienced patients or those with cirrhosis. ASTRAL-4 brought 94% SVR, when ribavirin was included in treatment, to patients with decompensated cirrhosis, although without ribavirin SVRs were 83% for this difficult-to-treat population.

Altogether, the data paints a very hopeful picture for the potential of this Sovaldi-velpatasvir combo to be used as a pan-genotype treatment. Cure options continue to expand, but they can only be used in patients who are diagnosed. Now, more than ever, I urge all at-risk individuals to get screened for hepatitis C infection.



Ward JW, Mermin JH. Simple, effective, but out of reach? Public health implications of HCV drugs. New Engl J Med Nov 17, 2015 DOI: 10.1056/NEJMe1513245

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