RAVs turn Merck doublet into loser?
Jacobson et al, clearly
demonstrate that in patients with baseline resistant variants (RAVs) who are
GT1a there is a significant difference in SVR12. Based on population
sequencing (high copy number of RAVs for detection), patients with protease
RAVs have an SVR12 of 58% vs 98% for those without (72% vs 98% with
lower cutoff of next-gen sequencing) and for the NS5a a similar pattern holds
where SVR12 is 72% for those with baseline RAVs and 98% for those without
(91% vs 98% with next-gen sequencing). Thus, it is clear the Merck doublet is
impacted by baseline resistance which could hamper its uptake.