I am waiting for Vosevi, a few questions

[mcmaklin]

I have relapsed after Viekira and Exviera in November 2015, genotype 1b.

Now I am waiting for Vosevi which I hope to get in October. I am still thinking if I should not take Ribavirin additionally. I do not want to take it.


1. How many people from the forum where taking Vosevi for genotype 1b? Do you know anyone, any real-time data? If you know anyone on the forum please let me know.
 
2. I am trying to explain WHY Viekira+Exviera did not work for the L31M. Is it supposed not to work for this well? 


From my findings:
NS-3 condones covered 1-181
NS3 region (w.r.t M58335) - S7A, V48I, A66G, P86Q, K87A, P89S, F147L, V170l
Ns3 region (w.r.t H77) - I35V, T42S,T61S, R62K, I64L, S66G, V71I,I72T, P86Q, Q89S, , S91A, I132V, A147L, L153I, N174S, L175M
 
Resistance Analysis
Drug     Predicition Scored mutations
Asunaprevir suspecitble none
Boceprevir susbstituion on second position.      170I
Grazoprevir suspectible none
Paritaprevir suspectible none
Simeprevir substitution on scored position     170l
Telaprevir substitution on scored position 170I
 
 

NS5A condons covered. 1-104
NS5A Region (w.r.t. D90208). - K6R, S17A, L31M, L34V, L37F,  G49A, Q54H, K68R, S101A
NS5A region (w.r.t. H77) I8V, E14T, S17A, K24Q, A25S, M28L, Q30R, L31M, I34V, V37F, R44K, G49A, R56T, H58P, E62Q, K68R, T71S, R78K, R81S, M83T, S85H, L101A
 
Resistance Analysis
Drug              Prediction                                           Scored mutations
Daclatasvir    reduced suspectibility                        31M
Elbasvir          resistant                                             31M
Ledipasvir      suspectible                                        31M
Ombitasvir    substitution on scored position         31M
 
Velpatasvir      supsectible                                       none



(Compl. Viekira+Exviera no Riba Nov2015. 1b,TT,F1, 1400000U start of treatm. After 2 weeks 120U. After a month below possib of detect. After 3 months UND.3EOT UND. 4wEOT RELAPSED,14Dec2016 VL 27000 IU.mL,Feb 2016 VL 24296 IU/mL,  May 2016 VL 106675 IU/mL .L31M in NS5A.Y93H not pres. No NS3 D168/A/F/H/N/Y)

[Lynn K]

For your first question per the AASLD it looks like your odds of cure from clinical trial data is 100% I see no recommendation for ribavirin. See below

For your second question your reasearch is well beyond my capabilities so I leave that up to the molecular biologists. However, unless the odds of your initial treatment were 100% that would indicate it doesn’t work for everyone all the time. I relapsed with a 12 week treatment Sovaldi/ Olysio and later treated successfully with 24 weeks of Harvoni ribavirin. I know we will wonder why we fell on the wrong side of the data but we will likely never know. Several people here have had to be treated again and are now cured. I wish you the best and a successful treatment.

https://www.hcvguidelines.org/treatment-experienced/gt1/ns5a

NS5A Inhibitor DAA-Experienced, Genotype 1 Patients With or Without Compensated Cirrhosis

Recommended Regimen
Sofosbuvir/Velpatasvir/Voxilaprevir
The placebo-controlled, phase 3 POLARIS-1 trial evaluated a 12-week course of the daily fixed-dose combination of sofosbuvir (400 mg)/velpatasvir (100 mg)/voxilaprevir (100mg) in patients with a prior NS5A inhibitor-containing DAA regimen. The majority (61%) experienced a failure with a combination regimen of an NS5B inhibitor plus an NS5A inhibitor, such as sofosbuvir/ledipasvir (Bourliere, 2017). The overall SVR12 rate was 97% (146/150) in genotype 1-infected patients. SVR12 rates were 96% (97/101) for participants with genotype 1a infection and 100% (45/45) for those with genotype 1b infection. A single genotype 1-infected patient experienced relapse; this individual had subtype 1a infection and cirrhosis. Baseline RASs and the presence of cirrhosis were not significant predictors of virologic failure in genotype 1 infection. Serious adverse events were similar between the placebo and treatment arms; only 1 patient discontinued therapy due to an adverse event. Headache, diarrhea, and nausea were more common in those patients receiving sofosbuvir/velpatasvir/voxilaprevir compared to placebo.