COMMAND GT2/3 Study: daclatasvir + PEG-IFN + RBV for genotype 2 or 3
        Daclatasvir Plus Peginterferon and Ribavirin Is Noninferior to Peginterferon and Ribavirin Alone, and Reduces the Duration of Treatment for HCV Genotype 2 or 3 Infection
Dore GJ. Gastroenterology 2015;148:355-66
		
		
		  Anti-HCV
Daclatasvir
PEG-IFNα 2a
Ribavirin
		
	    Daclatasvir
PEG-IFNα 2a
Ribavirin
		  Genotype
2
3
		
	    2
3
		  Treatment history
Naive
		
	    Naive
		  Cirrhosis
Yes
		
		Yes
Design

   * Randomisation stratified on genotype (2 or 3) 
- DCV : 60 mg qd or matching placebo (2 pills) ; PEG-IFNα-2a : 180 mg SC once weekly
 - RBV : 1000 or 1200 mg/day (bid dosing) according to body weight (< or ≥ 75 kg)
 
Objective
- SVR24 (HCV RNA undetectable) : non-inferiority of DCV regimens (lower limit of the 80% CI : - 20%), 85% power
 
Baseline characteristics and patient disposition

SVR24 (HCV RNA undetectable), % (95% CI)

- DCV 12W or 16W was non inferior to placebo (lower bound of the 80% CIs for the difference (DCV - placebo) : 4.9% and 3.9% for genotype 2, respectively ; - 6.8% and - 9.4% for genotype 3, respectively
 
Virologic failure in genotype 3
- Resistance analysis     
    
- All 12 relapses in DCV groups had DCV resistant NS5A variants Y93H or A30K
 - 4/8 patients with baseline Y93H or A30K at baseline relapsed
 - 8/43 patients without these variants at baseline relapsed
 
 - Baseline characteristics associated with post-treatment relapse
      
    
- Cirrhosis : 36% relapse if present vs 21%
 - BMI > 30 kg/m2 : 56% vs 16%
 - Baseline HCV RNA > 800,000 IU/ml : 30% vs 0%
 
 
Adverse events and laboratory abnormalities, n (%)

Summary
-  12 or 16 weeks of treatment with DCV, in combination with 
PEG-IFN + RBV, is a well tolerated and effective therapy for patients with HCV genotype 2 or 3 infections
    
- For the primary end point of SVR24 , the differences between both DCV arms and placebo met statistical criteria for noninferiority in patients with genotype 2 and genotype 3 infection
 - DCV containing regimens could reduce the duration of therapy for these patients, when given with PEG-IFN + RBV
 
 - These results suggest that combinations of DCV with other potent oral antiviral agents may offer alternatives to the current standard of care for genotypes 2 and 3 infection
 






