Safety and efficacy of sofosbuvir/velpatasvir/voxilaprevir in post-liver transplant patients with previous direct-acting antiviral failure: Six case reports

Abstract

BACKGROUND

Direct-acting antiviral (DAA) therapy regimens are highly effective at eliminating hepatitis C virus (HCV) infection but rates of sustained virologic response (SVR) are lower in patients with decompensated cirrhosis or hepatocellular carcinoma. Since many of these patients will be referred for liver transplant, they will require retreatment after transplantation. Sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) is recommended by guidelines as the preferred regimen to treat HCV in DAA-experienced patients following liver transplant however there is limited data.

CASE SUMMARY

We present the cases of six liver transplant recipients who had previous treatment failure with sofosbuvir-based DAA therapy prior to transplantation and who then received SOF/VEL/VOX after transplant.

CONCLUSION

This case series demonstrate the real-world efficacy and safety of SOF/VEL/VOX in the post liver transplant setting. Treatment was successful with all patients achieving SVR, it was well tolerated, and there were minimal drug-drug interactions with their immunosuppressants.

Keywords: Sofosbuvir/velpatasvir/voxilaprevir; Hepatitis C; Liver transplant; Direct-acting antiviral; Drug-drug interactions; Case report

Core Tip: There have been limited reports published on the use of sofosb-uvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) for the treatment of hepatitis C virus in post-liver transplant patients who had previous direct-acting antiviral failure prior to transplant. Herein, we present what we believe to be the largest case series of SOF/VEL/VOX use in these patients and highlight its efficacy and safety. More so, we discuss potential drug-drug interactions between SOF/VEL/VOX and common immunosuppression regimens.