Does Adding Ribavirin to Newer DAA Regimens Affect SVR Rates in HCV-Infected Persons in Actual Clinical Settings? Results from ERCHIVES

Background: Utility of ribavirin in combination with newer DAA regimens is unclear. We determined the SVR rates with Paritaprevir/ritonavir, Ombitasvir, Dasabuvir (PrOD) regimen with and without ribavirin and compared this with sofosbuvir/simeprevir (SOF+SIM) and sofosbuvir/ledipasvir (SOF/LDV) regimens.

Methods: We used ERCHIVES, a well-established national cohort of HCV-infected Veterans to identify HCV genotype 1 infected persons initiated on the above regimens. We excluded those with HIV coinfection, positive HBsAg and missing HCV RNA.

Results: We identified 1,235 persons on PrOD (75.5% ribavirin), 1,254 on SOF+SIM (16.9% ribavirin) and 4,247 on SOF/LDV (23.3% ribavirin). Among HCV genotype 1a infected persons, ribavirin was prescribed to 99.2% on PrOD, 18.2% on SOF+SIM and 23.3% on SOF/LDV. The SVR rates ranged from 92.6% to 100% regardless of the treatment regimen, presence of cirrhosis or HCV subtype, except in PrOD group without ribavirin, HCV genotype 1a without cirrhosis (SVR 83%, N=5/6). There were minor, clinically insignificant differences in SVR rates in those treated with or without ribavirin in each of the treatment groups, regardless of presence of cirrhosis at baseline. In multivariable logistic regression analysis, and with the exception of GT1a cirrhotics treated with PrOD, with too small numbers to evaluate, ribavirin use was not associated with achieving SVR in any group.

Conclusion: PrOD, SOF+SIM and SOF/LDV regimens are associated with high rates of SVR in actual clinical settings, which are comparable to clinical trials results. No meaningful difference in SVR rates was observed in those prescribed or not prescribed ribavirin with SOF+SIM, SOF/LDV or PrOD (for genotype 1b).