Abstract
BackgroundRe-treatment in patients with a chronic hepatitis C virus (HCV) infection and a previous failure to direct-acting antiviral (DAA) treatment remains a challenge. Therefore, we investigated the success rate of treatment and re-treatment regimens used at our center from October 2011 to March 2018.MethodsA retrospective analysis of DAA-based HCV therapies of 1096 patients was conducted. Factors associated with a virological relapse were identified by univariable and multivariable logistic regression, treatment success of the re-treatment regimens was evaluated by an analysis of sustained virological response (SVR) rates in patients with a documented follow-up 12 weeks after the end of treatment.ResultsOf 1096 patients treated with DAA-based regimens, 91 patients (8%) were lost to follow-up, 892 of the remaining 1005 patients (89%) achieved an SVR12. Most patients (65/113, 58%) who experienced a virological relapse received an interferon-based DAA regimen. SVR rates were comparable in special cohorts like liver transplant recipients (53/61, 87%) and people with a human immunodeficiency virus (HIV) coinfection (41/45, 91%). On multivariable analysis, interferon-based DAA therapy was associated with treatment failure (odds ratio 0.111, 95%-confidence interval 0.054–0.218) among others. One hundred seventeen patients with multiple DAA treatment courses were identified, of which 97 patients (83%) experienced a single relapse, but further relapses after two (18/117, 15%) or even three (2/117, 2%) treatment courses were also observed. Eighty-two of 96 (85%) re-treatment attempts with all-oral DAA regimens were successful after an initial treatment failure.ConclusionOverall, DAA re-treatments were highly effective in this real-world cohort and only a minority of patients failed more than two treatment courses. Switching to–or addition of–a new drug class seem to be valid options for the re-treatment of patients especially after failure of an interferon-based regimen.
Highlights
Since the introduction of direct-acting antivirals (DAA) for the treatment of chronic hepatitis C virus (HCV) infection, sustained virological response (SVR) rates have steadily and incrementally increased, reaching >90% even in formerly difficult to treat populations [1,2,3,4]
Factors associated with a virological relapse were identified by univariable and multivariable logistic regression, treatment success of the re-treatment regimens was evaluated by an analysis of sustained virological response (SVR) rates in patients with a documented followup 12 weeks after the end of treatment
Of 1096 patients treated with DAA-based regimens, 91 patients (8%) were lost to follow-up, 892 of the remaining 1005 patients (89%) achieved an SVR12
Summary
Since the introduction of direct-acting antivirals (DAA) for the treatment of chronic hepatitis C virus (HCV) infection, sustained virological response (SVR) rates have steadily and incrementally increased, reaching >90% even in formerly difficult to treat populations [1,2,3,4]. The combination regimen glecaprevir/pibrentasvir has been approved in some regions for selected patients in whom a previous interferon-free DAA treatment course had failed [11]. As it contains a protease inhibitor, its use is contraindicated in patients with decompensated liver cirrhosis. Re-treatment in patients with a chronic hepatitis C virus (HCV) infection and a previous failure to direct-acting antiviral (DAA) treatment remains a challenge. We investigated the success rate of treatment and re-treatment regimens used at our center from October 2011 to March 2018
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