8 weeks versus 12 weeks of sofosbuvir–velpatasvir for treatment-naive, non-cirrhotic, chronic hepatitis C (RESOLVE): a multicentre, open-label, non-inferiority, randomised controlled trial in India

BACKGROUND Chronic hepatitis C virus (HCV) infection without cirrhosis can be treated with 12 weeks of sofosbuvir-velpatasvir combination therapy. We aimed to assess whether a shorter 8-week treatment regimen of this combination was non-inferior to the standard 12-week regimen in successfully clearing HCV infection in HCV-infected patients without evidence of cirrhosis. METHODS RESOLVE was a multicentre, open-label, non-inferiority, randomised controlled trial, conducted in five publicly funded hospitals in India. We randomly assigned (1:1) treatment-naive adults (aged ≥18 years) with non-cirrhotic HCV mono-infection to receive sofosbuvir 400 mg and velpatasvir 100 mg (orally, daily) for either 8 weeks or 12 weeks. The primary outcome was the proportion of participants with sustained virological response-ie, absence of quantifiable HCV RNA at 12 weeks after treatment completion (SVR12), with 95% assumed proportion with 12-week treatment, 5% non-inferiority margin, 2·5% one-sided alpha error, and 90% study power in the per-protocol population. The trial was registered with the Clinical Trial Registry of India, CTRI/2022/03/041368, and is complete. FINDINGS Between May 15, 2022, and Sept 10, 2024, we screened 1620 participants, of whom 880 (54·3%) were enrolled in the study and randomly assigned to the 12-week (n=437 [50%]) or 8-week (n=443 [50%]) groups. 455 (52%) participants were women, 425 (48%) were men, and the median age was 35 years (IQR 28 to 47). 816 (93%) participants completed the intended 12-week (401 [92%] of 437) or 8-week (415 [94%] of 443) treatment and SVR12 testing. On per-protocol analysis, the proportion reaching SVR12 with 8-week treatment (410/415; 98·8% [95% CI 97·2 to 99·6]) was non-inferior to 12-week treatment (397/401; 99·0% [97·5 to 99·7]), with a risk difference of 0·2% (-1·5 to 1·9). Further, on intention-to-treat analysis, the proportion of participants reaching SVR12 with 8-week treatment (414/443; 93·5% [90·9 to 95·5]) was non-inferior to 12-week treatment (401/437; 91·8% [88·8 to 94·2]) with a risk difference of -1·7% (-5·2 to 1·9). No participant had any drug-related serious adverse event or drug discontinuation due to an adverse event. INTERPRETATION An 8-week regimen of sofosbuvir-velpatasvir was similar in efficacy to the standard 12-week treatment in individuals with chronic HCV infection without cirrhosis. This finding supports shortening the duration of treatment in such patients.