{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T09:24:14Z","timestamp":1784366654401,"version":"3.55.0"},"reference-count":36,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T00:00:00Z","timestamp":1688083200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>About 5% of chronic hepatitis C (CHC) patients experienced treatment failure with direct-acting antiviral (DAA) treatment. The global data on the practice and treatment outcomes of Sofosbuvir\/Velpatasvir\/Voxilaprevir (SOF\/VEL\/VOX) in DAA-experienced CHC patients remains sparse. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of SOF\/VEL\/VOX as a salvage treatment in DAA-experienced CHC patients. We searched five electronic databases from inception to 31 January 2023. The study outcomes were SVR12 and treatment-related adverse effects, with subgroup analysis performed based on genotype, cirrhosis, HCC, prior SOF\/VEL exposure, and region. We identified and analyzed data from 24 studies (2877 DAA-experienced CHC patients); 17.2% had prior SOF\/VEL exposure, 25% received ribavirin with SOF\/VEL\/VOX, and 42% had pre-treatment resistance-associated substitution (RAS) testing performed. Eastern Mediterranean had a higher pooled SVR12 than the America and Europe regions (p &lt; 0.05). Predictors of SOF\/VEL\/VOX failure were genotype 3, active HCC, baseline cirrhosis, and prior SOF\/VEL. Baseline RAS mutation and ribavirin supplementation were not associated with higher SVR12. Treatment discontinuation because of drug-related adverse events was uncommon (10 studies, 0.2%). In summary, SOF\/VEL\/VOX is efficacious and safe for retreatment in DAA-experienced CHC patients, even with RAS mutation. Our findings support SOF\/VEL\/VOX as a first-line rescue treatment for DAA-experienced CHC patients.<\/jats:p>","DOI":"10.3390\/v15071489","type":"journal-article","created":{"date-parts":[[2023,6,30]],"date-time":"2023-06-30T16:08:32Z","timestamp":1688141312000},"page":"1489","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Treatment Outcomes of Sofosbuvir\/Velpatasvir\/Voxilaprevir in Direct-Acting Antiviral-Experienced Hepatitis C Virus Patients: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"15","author":[{"given":"Pooja","family":"Devan","sequence":"first","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai Le Ashley","family":"Tiong","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean Ee","family":"Neo","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Babu P.","family":"Mohan","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, University of Utah Health, Salt Lake City, UT 84112, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6232-6343","authenticated-orcid":false,"given":"Karn","family":"Wijarnpreecha","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ 85004, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yew Chong Steve","family":"Tam","sequence":"additional","affiliation":[{"name":"Education Resource Centre, Medical Board, Singapore General Hospital, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5897-4949","authenticated-orcid":false,"given":"Nicola","family":"Coppola","sequence":"additional","affiliation":[{"name":"Department of Mental Health and Preventive Medicine, University of Campania \u201cL. Vanvitelli\u201d, 81100 Napoli, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen Monica","family":"Preda","sequence":"additional","affiliation":[{"name":"Clinical Institute of Fundeni, Gastroenterology and Hepatology, 022328 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0727-1183","authenticated-orcid":false,"given":"Yu Jun","family":"Wong","sequence":"additional","affiliation":[{"name":"Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore"},{"name":"Department of Gastroenterology & Hepatology, Changi General Hospital, Singapore 529889, Singapore"},{"name":"Duke-NUS Academic Medicine Programme, SingHealth, Singapore 169608, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1016\/S2468-1253(21)00472-6","article-title":"Polaris Observatory HCV Collaborators. 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