Ledipasvir/sofosbuvir in chronic hepatitis C: a guide to its use in the EU

Abstract

A single-tablet regimen of ledipasvir and sofosbuvir (ledipasvir/sofosbuvir; Harvoni®) was recently approved in the EU. The phase 3 ION trials included treatment-naive (ION-1 and -3) or treatment-experienced (ION-2) patients with chronic hepatitis C virus (HCV) genotype 1 infection; ≈20 % of patients in ION-1 and -2 had cirrhosis, whereas none of the patients in ION-3 had cirrhosis. In ION-1, a 12-week regimen of ledipasvir/sofosbuvir achieved high rates of sustained virological response 12 weeks’ post-treatment (SVR12) in treatment-naive patients, with no additional benefit conferred by the addition of ribavirin or extending the treatment duration to 24 weeks. An 8-week regimen also achieved high SVR12 rates in patients with a baseline HCV RNA level of <6 million IU/mL in ION-3. High SVR12 rates were seen in treatment-experienced patients who received ledipasvir/sofosbuvir for 12 or 24 weeks in ION-2. Data also support the use of ledipasvir/sofosbuvir in chronic HCV genotype 4 infection, in HCV and HIV co-infection and, in combination with ribavirin, in patients with chronic HCV genotype 1 or 4 infection who have decompensated cirrhosis or are liver transplant recipients and in chronic HCV genotype 3 infection. Oral ledipasvir/sofosbuvir was generally well tolerated.