Replies to post #137362 on Biotech Values

[genisi]

To date no two DAA (no ifn) has shown good efficacy in G1a patients (G1b is, apparently, a different matter - see #msg-67597202). So why would one DAA + rib (a relatively weak drug) be expected to be a cure?

I don't think expectations were for a cure a la GT2/3 but for a decent SVR and therefore the results were disappointing.
Few reasons I can think of for expectations are: first it's a nuke containing regimen and 7977 is a potent nuke in all HCV genotypes. Also, all 10 nulls achieved RVR. Another possible point is that in PROTON trial all 13 GT1 patients with genotype TT in IL28B (IFN poor responders), achieved RVR and SVR12.

[DewDiligence]

We should run a quiz - in the G1a population what SVR rate should be expected of the best 2DAA option of the first 3 2DAA trials we see.

If you specify the verbatim questions (maximum of 5) and the answer choices for each question (as many as can fit in 50 characters), I’ll be glad to set up the survey.

[dewophile]

i think the disappointment came because:

1. there usually is good correlation between RVR and SVR
2. 7977 surprisingly had some SVRs in naives with just ribavirin

i agree with your point that nulls, being refractory to interferon/rib, does not mean they should necessarily be refractory necessarily to DAAs any more than naives, and so point #2 above becomes more relevant to expecations since you would think the positive data in naives may have translated to nulls

(in a prior post i noted that it is reasonable to think many nulls are just resistant to inf and not ribavirin)

[DewDiligence]

New survey: Dual-Oral SVR Rate in Treatment-Naïve HCV

Q: In treatment-naive genotype-1a* patients, what is the worst-case
SVR rate you expect in the first credible trial testing two direct-acting
antiviral agents without interferon or ribavirin?

a) >90%
b) 80-90%
c) 65-80%
d) 50-65%
e) <50%

*Genotype-1a is the most difficult-to-treat common HCV genotype in the US population.


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