Sofosbuvir in combination with ribavirin or simeprevir: real-life study of patients with hepatitis C genotype 4.

Background: The discovery of direct-acting antiviral agents (DAA) is an outstanding achievement of modern medicine in the current century. The current study aimed to explore the effectiveness and safety of two regimens sofosbuvir (SOF) in combination with either ribavirin (RBV) or simeprevir (SMV) in chronic hepatitis C (CHC) genotype (GT) 4 patients in Egypt.

Methods: A total of 201 patients, treatment-naïve and experienced, with CHC GT4 infection were allocated into two groups based on the type of the regimen used. All eligible patients were treated orally with SOF plus daily oral weight-based RBV (24 weeks; group 1), or SOF plus daily oral SMV (12 weeks; group 2).

Results: In the patients who received SOF/RBV therapy for 24 weeks, a sustained virological response (SVR12) was achieved by 89% (90/101) of all patients, 92% (49/53) of naïve patients and 85% (41/48) of experienced patients. In the SOF/SMV group, the SVR12 rate was 92% (92/100) for overall patients, 93% (70/75) of naïve patients and 88% (22/25) of experienced patients. Adverse events (AEs) were reported in 70% of patients in the SOF/RBV group and 42% patients in the SOF/SMV group. The most common AEs in both groups were fatigue, headache, nausea, and dyspnea.

Conclusions: The present comparative study suggests that both SOF/RBV and SOF/SMV combination regimens are highly effective in CHC GT4 treatment. However, the two-DAA regimen (SOF/SMV) may offer well-tolerated treatment, with a shorter duration and better safety compared to SOF/RBV.