Ledipasvir-sofosbuvir for treating Japanese patients with chronic hepatitis C virus genotype 2 infection

Yasuhiro Asahina, Yoshito Itoh, Yoshiyuki Ueno, Yasushi Matsuzaki, Yasuhiro Takikawa, Hiroshi Yatsuhashi, Takuya Genda, Fusao Ikeda, Takuma Matsuda, Hadas Dvory-Sobol, Deyuan Jiang, Benedetta Massetto, Anu O. Osinusi, Diana M. Brainard, John G. McHutchison, Norifumi Kawada, Nobuyuki Enomoto

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)


Background & Aims: Japanese patients with chronic hepatitis C virus (HCV) genotype 2 infection have high rates of sustained virological response (SVR) following 12 weeks of treatment with the nucleotide polymerase inhibitor sofosbuvir in combination with ribavirin, which was the standard of care at the time this study was undertaken. We assessed the efficacy of 12 weeks of treatment with a ribavirin-free regimen of ledipasvir-sofosbuvir. Methods: In an open-label, Phase 3 trial we enrolled Japanese patients with chronic HCV genotype 2 infection, with or without compensated cirrhosis. In Cohort 1, participants were randomized 1:1 to receive ledipasvir-sofosbuvir (n = 106) or sofosbuvir + ribavirin (n = 108) for 12 weeks. In Cohort 2, 25 ribavirin-intolerant or -ineligible patients received ledipasvir-sofosbuvir for 12 weeks. The primary endpoint was SVR 12 weeks after therapy (SVR12). In Cohort 1 non-inferiority was assessed with a prespecified margin of 10%. Results: One-third (33%) of patients were treatment experienced, and 14% had cirrhosis. In Cohort 1, SVR12 rates were 96% (95% CI, 91% to 99%) with ledipasvir-sofosbuvir and 95% (95% CI, 90% to 98%) with sofosbuvir plus ribavirin, thus achieving non-inferiority. Among ribavirin-intolerant/ineligible patients in Cohort 2, SVR12 was 96% (95% CI, 80% to 100%) with ledipasvir-sofosbuvir. Overall, the most common adverse events were nasopharyngitis, anaemia, and headache; anaemia was only observed in patients receiving ribavirin. The percentage of patients who discontinued treatment because of an adverse event was low (1%). Conclusions: Among Japanese patients with HCV genotype 2, 12 weeks of treatment with ledipasvir-sofosbuvir resulted in high rates of SVR12 that were non-inferior to sofosbuvir + ribavirin.

Original languageEnglish
Pages (from-to)1552-1561
Number of pages10
JournalLiver International
Issue number9
Publication statusPublished - Sept 2018


  • Japan
  • anaemia
  • direct-acting antiviral
  • ribavirin-free

ASJC Scopus subject areas

  • Hepatology


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