sustained virologic response rates of sofosbuvir and velpatasvir in patients with hepatitis c genotype 3: a meta-analysis

Context: patients with hepatitis c virus (hcv) genotype 3 are regarded as a difficult-to-cure population in an era of direct-acting antiviral treatment. objectives: this meta-analysis aimed to evaluate sustained virologic response rates resulting from a fixed-dose combination of sofosbuvir (sof) and velpatasvir (vel), also known as epclusa® (gilead, forster city, ca) in patients with hcv genotype 3. methods: in this study, we searched pubmed/medline, embase, and the cochrane library for relevant studies from inception until may 3rd, 2019. the primary outcome measure used was the rate of the sustained virological response at week-12 (svr12) posttreatment. the heterogeneity of results was evaluated, and influence analyses were performed using the r software. in addition, publication bias was assessed using the funnel and egger tests. results: eleven trials (n = 2246 patients) were included in this meta-analysis. the pooled svr12 rate in patients with hcv-genotype 3 (gt3) was 94.6% with a random effect model by inverse method (95% cl 92.5% 96.1%, i2 = 53%, p = 0.02). a subpopulation analysis indicated that the pooled svr12 rates were 96.3% in gt3 patients with compensated cirrhosis and 94.0% in gt3 patients with prior anti-hcv treatment. moreover, influence analysis suggested that the most significant source of heterogeneities resulted from one trial, which enrolled most patients with hcv subtype 3b. conclusions: our meta-analysis showed a high svr12 rate of sof/vel in gt3 patients regardless of compensated cirrhosis the status and/or a history of previous interferon-based treatments. these results highlight the need for more trials investigating the effectiveness of the sof/vel regimen in patients with hcv subtype 3b.