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Ученые из департамента по делам ветеранов, Службы здравоохранения населения, Системы здравоохранения Пало-Альто, Калифорния, США, решили все таки выяснить, что же эффективнее для лечения 2 и 3 генотипа вируса гепатита С софосбувир и даклатасвир или софосбувир и велпатасвир?


Понимание реальной эффективности схем пероральной терапии гепатита С (HCV) позволяет принимать решения о лечении. Мы оценили эффективность даклатасвира + софосбувира ± рибавирина (DCV + SOF ± RBV) и велпатасвира / софосбувира (VEL / SOF) ± RBV у пациентов с генотипом 2 и генотипом 3 инфекции, получавших лечение в обычной практике.
Cравнивали частоту Устойчивых Вирусологических Ответов (далее по тексту УВО) Этот обсервационный анализ был проведен в когорте пациентов с намерением лечить гепатит С генота 2 и генотипа 3. Анализ устойчивого вирусологического ответа (УВО) был получен у 5400 пациентов, начавших лечение DCV + SOF ± RBV или VEL / SOF ± RBV, что действительно может говорить, об серьезности доказательной базы.


Для генотипа 2 показатели УВО не различались между DCV + SOF (94,5%) и VEL / SOF (94,4%) или между DCV + SOF + RBV (88,1%) и VEL / SOF + RBV (89,5%). Для генотипа 3 показатели SVR не различались между DCV + SOF (90,8%) и VEL / SOF (92,0%) или между DCV + SOF + RBV (88,1%) и VEL / SOF + RBV (86,4%). В многомерных моделях пациентов с генотипом 2 и 3, режим лечения не был значимым предиктором шансов УВО. Для генотипа 3 значимыми предикторами снижения шансов УВО были предшествующий опыт лечения ВГС (отношение шансов <OR> 0,51, 95% CI 0,36–0,72; p <0,001), FIB-4> 3,25 (OR 0,60; 95% CI 0,43 –0,84; р ?= 0,002) и декомпенсированный цирроз печени (ОШ 0,68; 95% ДИ 0,47–0,98; р?= 0,04). Для пациентов с генотипом 2 и 3, получавших VEL / SOF ± RBV, 89% и 85% получали 12-недельное лечение соответственно. Для DCV + SOF ± RBV 56% и 20% пациентов с генотипом 2 HCV получали 12-недельное и 24-недельное лечение соответственно; в то время как 53% и 23% пациентов с генотипом 3 ВГС получали 12 недель и 24 недели, а большинство пациентов получали 24 недели.


У пациентов, инфицированных генотипом 2 и 3 ВГС, DCV + SOF ± RBV и VEL / SOF ± RBV вызывали одинаковую частоту УВО в каждом генотипе, и режим не оказывал значительного влияния на шансы УВО. Для пациентов с генотипом 3 предшествующий опыт лечения и прогрессирующее заболевание печени были значимыми предикторами снижения шансов УВО независимо от режима.


В клинической практике показатели излечения для генотипа 2 вируса гепатита С (ВГС) составляли 94%, а показатели излечения для генотипа 3 ВГС - 90%. Вероятность достижения излечения была одинаково независимой от того, получал ли человек даклатасвир плюс софосбувир или велпатасвир / софосбувир. Рибавирин не влиял на показатели излечения. Вероятность излечения была самой низкой у людей, которые получали терапию от ВГС в прошлом.

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