The Medical Letter on Drugs and Therapeutics
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Sofosbuvir (Sovaldi) for Chronic Hepatitis C

The FDA has approved the nucleotide polymerase inhibitor sofosbuvir (Sovaldi – Gilead) for use in combination with other antiviral drugs for treatment of chronic hepatitis C virus (HCV) infection.

ACTIVITY — Sofosbuvir is a uridine nucleotide analog prodrug that is converted to an active metabolite in the liver. It inhibits the HCV NS5B RNA-dependent RNA polymerase, which is essential for viral replication. In vitro, sofosbuvir has potent activity against all HCV genotypes (1-6), including strains resistant to protease inhibitors. The prevalence of HCV genotypes in the US is 79% genotype 1, 13% genotype 2, 6% genotype 3, and 2% genotypes 4, 5, and 6 combined.

STANDARD THERAPY — The current standard of care for patients with HCV genotype 1 infection is peginterferon and ribavirin plus a protease inhibitor such as telaprevir (Incivek), boceprevir ... more      

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