Author information
1Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore.
2Division of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT 84112, USA.
3Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ 85004, USA.
4Education Resource Centre, Medical Board, Singapore General Hospital, Singapore 169608, Singapore.
5Department of Mental Health and Preventive Medicine, University of Campania "L. Vanvitelli", 81100 Napoli, Italy.
6Clinical Institute of Fundeni, Gastroenterology and Hepatology, 022328 Bucharest, Romania.
7Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore 529889, Singapore.
8Duke-NUS Academic Medicine Programme, SingHealth, Singapore 169608, Singapore.
Abstract
About 5% of chronic hepatitis C (CHC) patients experienced treatment failure with direct-acting antiviral (DAA) treatment. The global data on the practice and treatment outcomes of Sofosbuvir/Velpatasvir/Voxilaprevir (SOF/VEL/VOX) in DAA-experienced CHC patients remains sparse. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of SOF/VEL/VOX as a salvage treatment in DAA-experienced CHC patients. We searched five electronic databases from inception to 31 January 2023. The study outcomes were SVR12 and treatment-related adverse effects, with subgroup analysis performed based on genotype, cirrhosis, HCC, prior SOF/VEL exposure, and region. We identified and analyzed data from 24 studies (2877 DAA-experienced CHC patients); 17.2% had prior SOF/VEL exposure, 25% received ribavirin with SOF/VEL/VOX, and 42% had pre-treatment resistance-associated substitution (RAS) testing performed. Eastern Mediterranean had a higher pooled SVR12 than the America and Europe regions (p < 0.05). Predictors of SOF/VEL/VOX failure were genotype 3, active HCC, baseline cirrhosis, and prior SOF/VEL. Baseline RAS mutation and ribavirin supplementation were not associated with higher SVR12. Treatment discontinuation because of drug-related adverse events was uncommon (10 studies, 0.2%). In summary, SOF/VEL/VOX is efficacious and safe for retreatment in DAA-experienced CHC patients, even with RAS mutation. Our findings support SOF/VEL/VOX as a first-line rescue treatment for DAA-experienced CHC patients.