surely there must be some losers to go with all those winners (it's not exactly a zero sum game but as prospects for some candidates rise others must drop)
i haven't gone through all the data, but my overall gist from EASL this year is the following (in no particular order and focusing on genotype 1 pts):
1. 2 DAAs alone may achieve some SVR, and it may be good enough for some patients intolerant of or in whom interferon and/or ribavirin are contraindicated, but addition of one or both components of SOC is likely to add significant enough efficacy that any new standard will likely include either interferon or rib or more likely both. the exception may be VRUS's 2 nuke combo given the potency coupled with the high resistance barrier, although this is far from clear at this point, particularly given BMY's combo - the only to achieve SVR as stand alone to date - had viral breakthroughs despite also achieving a high RVR rate, albeit in the most difficult to treat population (nulls). also, the higher than expected breakthrough data with VRUS's first generation nuke as stand alone with SOC somewhat lowers my expectation for the 2 nuke combo achieving total success without at least some component of current SOC (although again might be good enough for those unwilling or who cannot take soc)
2. combos of 2 DAAs + SOC are likely to achieve SVRs in excess of 90% for those who can stay on treatment. this will put a premium on safety and tolerability since most failures will be due to dropouts. in this regard BMY has an edge over every other 2DAA combo when added to SOC if lambda pans out since lambda's tolerabilty is markedly better than that for interferon alpha. on an ITT basis efficacy obviously won't be as good so the added benefit and commercial potential of 2DAAs over the soon to be standard of PI+ing+rib is not entirely clear for naives who already will be getting 75% SVRs, but this difference will be more marked for difficult to treat pts like nulls
3. i think we're likely to see combos of 3DAAs within a year, which very well may yeild SVRs as good as or better than current treatments. my hunch is that either inerferon or rib will likely continue to play some role for the most difficult to treat patients even in an environment where 3DAAs ultimately becomes standard of care
AI
