Global Real-World Evidence of Sofosbuvir/Velpatasvir as a Highly Effective Treatment and Elimination Tool in People with Hepatitis C Infection Experiencing Mental Health Disorders
Heiner Wedemeyer,
Vito Di Marco,
Montserrat Garcia-Retortillo,
Elisabetta Teti,
Chris Fraser,
Luis Enrique Morano Amado,
Sergio Rodriguez-Tajes,
Silvia Acosta-López,
Joss O’Loan,
Michele Milella,
Maria Buti,
María Fernanda Guerra-Veloz,
Alnoor Ramji,
Mary Fenech,
Alexandra Martins,
Sergio M. Borgia,
Kim Vanstraelen,
Michael Mertens,
Cándido Hernández,
Ioanna Ntalla,
Heribert Ramroth,
Scott Milligan
Affiliations
Heiner Wedemeyer
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, OE6810, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Vito Di Marco
University of Palermo, Piazza Marina, 61, 90133 Palermo, Italy
Montserrat Garcia-Retortillo
Liver Section, Gastroenterology Department, Hospital del Mar-Parc de Salut Mar, Hospital del Mar Medical Research Institute (IMIM), C/ del Dr. Aiguader, 88, 08003 Barcelona, Spain
Elisabetta Teti
Tor Vergata University, Via Cracovia, 50, 00133 Rome, Italy
Chris Fraser
Cool Aid Community Health Centre, 713 Johnson St, Victoria, BC V8W 1M8, Canada
Luis Enrique Morano Amado
Unit of Infectious Diseases, Álvaro Cunqueiro University Hospital, Estrada de Clara Campoamor, 341, 36312 Vigo, Spain
Sergio Rodriguez-Tajes
Liver Unit, Hospital Clinic Barcelona, IDIBAPS, CIBERehd, C. de Villarroel, 170, 08036 Barcelona, Spain
Silvia Acosta-López
Digestive Diseases, Hospital Nuestra Señora de Candelaria, Ctra. Gral. del Rosario, 145, 38010 Tenerife, Spain
Hepatitis C virus (HCV) is prevalent in people with mental health disorders, a priority population to diagnose and cure in order to achieve HCV elimination. This integrated analysis pooled data from 20 cohorts in seven countries to evaluate the real-world effectiveness of the pangenotypic direct-acting antiviral (DAA) sofosbuvir/velpatasvir (SOF/VEL) in people with mental health disorders. HCV-infected patients diagnosed with mental health disorders who were treated with SOF/VEL for 12 weeks without ribavirin as part of routine clinical practice were included. The primary outcome was sustained virological response (SVR) in the effectiveness population (EP), defined as patients with an available SVR assessment. Secondary outcomes were reasons for not achieving SVR, characteristics of patients with non-virological failures, adherence, and time from HCV RNA diagnosis to SOF/VEL treatment initiation. A total of 1209 patients were included; 142 did not achieve an SVR for non-virological reasons (n = 112; 83 lost to follow-up, 20 early treatment discontinuations) or unknown reasons (n = 30). Of the 1067 patients in the EP, 97.4% achieved SVR. SVR rates in the EP were ≥95% when stratified by type of mental health disorder and other complicating baseline characteristics, including active injection drug use and antipsychotic drug use. Of 461 patients with data available in the EP, only 2% had an adherence level < 90% and 1% had an adherence level < 80%; all achieved SVR. Patients with mental health disorders can be cured of HCV using a well-tolerated, pangenotypic, protease inhibitor-free SOF/VEL regimen. This DAA allows the implementation of a simple treatment algorithm, with minimal monitoring requirements and fewer interactions with central nervous system drugs compared with protease-inhibitor DAA regimens.
