Abstract
BackgroundAccording to the EASL and AASLD guidelines, the recommended treatment for patients who failed to achieve a sustained virologic response (SVR) on prior interferon-based triple therapy with protease inhibitors (PI), is a combination of sofosbuvir and NS5A inhibitors. Polish national recommendations also allow the use of paritaprevir/ritonavir/ombitasvir+dasasbuvir±ribavirin (PrODR) in this group of patients. The aim of the study was to evaluate the efficacy and safety of PrODR vs. ledipasvir/sofosbuvir±RBV (LSR) in PI-experienced patients in real-life setting.MethodsOur analysis included patients registered in the nationwide, investigators initiated, multicentre EpiTer-2 database.Among 4530 patients registered, 335 with genotype 1 (93% 1b) were previously treated with IFN-based regimens with PIs: 127 with boceprevir (BOC), 208 with telaprevir (TVR).Patients with advanced fibrosis (F3/F4) were significantly predominant (BOC 28.4%/61.4%, TVR 18.8%/64.4%, respectively).Subjects were assigned to IFN-free retreatment as follows: BOC - 64 (50.4%) PrODR and 63 (49.6%) LSR; TVR- 103 (49.5%) PrODR and 105 (50.5%) LSR.ResultsSVR rates were comparable for particular groups: BOC → PrODR- 100%; BOC → LSR - 98%; TVR → PrODR - 97%; TVR → LSR - 96% (intent-to treat analysis-ITT) and BOC → PrODR→100%; BOC → LSR - 99%; TVR → PrODR - 99%; TVR → LSR - 98% (modified intent-to treat analysis-mITT).Both treatment regimens had a favourable safety profile. Adverse events (AEs) were generally mild or moderate in severity. Three deaths were reported. The treatment was stopped due to AEs in five patients (three treated with PrODR and two with LSR).ConclusionEfficacy and safety of treatment with PrODR and LSR is comparable in BOC or TVR-experienced patients.
Highlights
According to the EASL and AASLD guidelines, the recommended treatment for patients who failed to achieve a sustained virologic response (SVR) on prior interferon-based triple therapy with protease inhibitors (PI), is a combination of sofosbuvir and non-structural protein 5A (NS5A) inhibitors
SVR rates were comparable for particular groups: BOC → PrODR- 100%; BOC → LSR - 98%; TVR → PrODR 97%; TVR → LSR - 96% and BOC → PrODR→100%; BOC → LSR - 99%; TVR → PrODR 99%; TVR → LSR - 98%
The treatment was stopped due to Adverse Adverse event (AE) in five patients
Summary
According to the EASL and AASLD guidelines, the recommended treatment for patients who failed to achieve a sustained virologic response (SVR) on prior interferon-based triple therapy with protease inhibitors (PI), is a combination of sofosbuvir and NS5A inhibitors. Progress achieved in recent years in the treatment of patients with viral hepatitis C has enabled elimination of hepatitis C virus (HCV) infection in most patients. This progress has been achieved through the use of drugs that produce a direct antiviral action (direct-acting antiviralsDAAs). These therapies are highly effective even in patients with advanced fibrosis, as well as hepatic insufficiency. Such substitutions can occur in patients untreated previously; their occurrence is more often associated with ineffective antiviral therapy, which involved DAAs with a low genetic barrier, for example first-generation protease inhibitors (PI) such as boceprevir (BOC) or telaprevir (TVR)
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