S1063 Factors Predicting Failure of Hepatitis C Therapy in a Diverse Urban Population

Abstract

INTRODUCTION: Hepatitis C therapy failure is a rare event and it is important to continue to assess reasons for therapy failure in a real-world population. We evaluated the therapy failure rates and reasons for failure in a diverse urban population. METHODS: We evaluated all patients with initiation of therapy for hepatitis C at a single urban hospital between October 2014 and January 2018. Patients were excluded if they had incomplete laboratory data. The population was analyzed based on achieving sustained virologic response (SVR) versus treatment failure. Data analyzed included treatment regimens, viral genotype, cirrhosis status, and transplant status. RESULTS: 1680 patients had initiation of hepatitis C antiviral therapy between October 2014 and January 2018. The antiviral treatments groups studied were ledipasvir/sofosbuvir (79%), sofosbuvir/velpatasvir (8.3%), elbasvir/grazoprevir (7%), glecaprevir/pibrentasvir (4%), sofosbuvir/velpatasvir/voxilaprevir (1.5%), and other therapies including ombitasvir/paritaprevir/ritonavir and ombitasvir/paritaprevir/ritonavir/dasabuvir (0.4%). These therapies were either given alone or in combination with ribavirin (RBV). 33.5% of these patients were treatment-experienced. 36.8% had established cirrhosis and 8.2% had a history of liver transplant. Overall the SVR rate was 95.6%. The SVR rate for each treatment group was 95.4% for ledipasvir/sofosbuvir +/- RBV, 94.2% for sofosbuvir/velpatasvir +/- RBV, 96.7% for elbasvir/grazoprevir +/- RBV, 100% for glecaprevir/pibrentasvir, and 96% for sofosbuvir/velpatasvir/voxilaprevir +/- RBV. There was no statistically significant difference in SVR rate between the treatment groups (P = 0.502). The SVR rate in those with cirrhosis was 93% compared to 97% in those without cirrhosis (P < 0.001). Additionally, patients who required ribavirin in certain combination therapies had a lower likelihood of achieving SVR with SVR of 80% with elbasvir/grazoprevir/RBV compared to 98.2% with elbasvir/grazoprevir alone (P = 0.023). CONCLUSION: There is no difference in achieving SVR based on the treatment chosen. However, patients diagnosed with liver cirrhosis or those who required ribavirin supplementation by clinical standards in certain combination therapies were noted to have SVR failure more frequently.Table 1.: Hepatitis C therapy, viral genotype, known cirrhosis, and liver transplant in SVR success and failure groups