Impact of Ribavirin on Early Viral Kinetics in Chronic Hepatitis C Patients Receiving Directly Acting Antivirals

Abstract

Background/Aims: Ribavirin (RBV) enhances treatment efficacy in chronic hepatitis C (CHC) patients receiving directly acting antivirals. We aimed to address the impact of RBV on early viral kinetics in CHC patients with DAAs. Methods: HCV genotype-1b infected patients were allocated to daclatasvir/asunaprevir with/without weight-based ribavirin. HCV RNA were compared at day 1, week 1, 2, and 4 of treatment. Results: The HCV RNA levels at treatment week 2 (W2) were significantly lower in the RBV group (n=67) than in the non-RBV group (n=61) (0*42±0*81 logIU/mL vs. 0*79±1*03 logIU/mL, P=0*04). A more significant reduction of HCV RNA between W1 and W2 was observed in patients with ribavirin than those without (1*00±0*89 logIU/mLvs.0*54 ±0*74 logIU/mL, P=0*006). Among the intermediate responders who remained to have detectable RNA after W1 of treatment, patients with ribavirin had a significantly higher rate of undetectable HCV RNA (71*4 % vs. 36*0 %, P=0*003). A more significant magnitude of HCV RNA reduction was also noted from baseline to day 1 (3*15±0*38 logIU/mL vs. 2*80±0*70 logIU/mL, P=0*009) and W1 to W2 (1*40±0*65 logIU/mL vs. 0*88±0*78 logIU/mL, P=0*007) in the RBV group compared to the non-RBV group. Logistic regression analysis revealed that adding RBV independently predicted undetectable HCV RNA at W2 (OR/CI: 4*74/1*54-14*57, P=0*007) in the intermediate responders. Conclusions: Adding RBV to DAAs improved early viral kinetic in particular for intermediate responders. Funding Statement: The study was supported by grants from Kaohsiung Medical University (MOST 107-2314-B-037-121, MOST 107-2314-B-037 -025 -MY2) and Kaohsiung Medical University Hospital (KMUH106-6R05, KMUH106-6M02) Declaration of Interests: The authors state: None. Ethics Approval Statement: The institutional review board of the Kaohsiung Medical University Hospital approved the protocols, which conformed to the guidelines of the International Conference on Harmonization for Good Clinical Practice.