PIN3 - Predictors of Early Discontinuation of Interferon-Free Direct Antiviral Agents in Patients With HCV and Advanced Fibrosis: Results of A Real-Life Cohort

Abstract

To determinate risk factors for premature treatment discontinuation among patients infected with HCV with advanced fibrosis treated with IFN-free direct antiviral agents (DAA)-based therapy. We included all patients with chronic HCV infection and advanced fibrosis who initiated treatment with IFN-free DAA therapy at an university hospital from December 2015 through June 2016. We prospectively collected data from medical records using standardized questionnaires and evaluated them using EpiInfo 7.1.2.0. Primary outcome was treatment interruption and factors associated. Of total, 214 patients were included in this study, 180 patients treated with sofosbuvir(SOF) + daclatasvir ± ribavirin(RBV), 31 received SOF + simeprevir ± RBV, and 3 treated with SOF+RBV. Treatment discontinuation rate was 8.9% (19), and cirrhotic decompensation was the main reason (8; 42.1%). Among patients with Child B or C cirrhosis (31), 10 (32.2%) prematurely interrupted treatment. Risk factors for treatment discontinuation in univariate analysis were higher age (p 0.0252), higher comorbidity index (p 0.0078), higher Model for end stage liver disease (MELD) (p<0.0001), higher FIB-4 (p 0.0122), and lower hemoglobin (p 0.0185) at baseline. Multivariate analysis demonstrated that higher age (OR 1.1, CI 1.02-1.19) and higher MELD (OR 1.27, CI 1.03-1.56) were associated with premature treatment interruption. Older age and advanced liver disease were related to treatment interruption. Identifying risk factors associated to treatment discontinuation is important to recognize patients that possibly would not benefit from immediate DAA treatment or should be followed up closely during treatment. This strategy could spare patients from risky situations such as worsening cirrhotic decompensation.