Background Some patients do not achieve successful results after treatment with older hepatitis C virus (HCV) antiviral drugs. We made a bibliographic research in PubMed and did not find any similar study in this area.
Purpose To assess the effectiveness of new direct acting antivirals (DAA) in previously treated HCV patients, and its relation to the type of previous treatment received.
Material and methods An observational, descriptive, retrospective study of previously treated patients with HCV that ended their treatment with DAA before February 2016 was conducted. Patients were selected after online clinical history and from a pharmacy service database, analysing the following variables: genotype, degree of fibrosis, HIV coinfection, previous treatment, treatment using DAA, viral load at the end of treatment (VLET) and after 12 weeks (VR12).
Results Of 250 patients that finished treatment, 160 (64%) had received previous treatment, 146 with pegylated interferon–ribavirin (INF-RBV) and 14 with first generation protease inhibitors (boceprevir/telaprevir). 16 patients had HIV coinfection. The distribution of patients according to genotype (G) was: 15 (9.37%) G4, 14 (8.7%) G3, 4 (2.5%) G1 untyped, 39 (24.37%) G1a and 88 (55%) G1b. According to the degree of fibrosis (F): 1 (0.62%) had F0, 8 (5%) F1, 34 (21.25%) F2, 35 (21.87%) F3 and 82 (51.25%) F4. Following the recommendations of the Clinical Practice Guidelines and the Strategic Plan of the Spanish NHS, 11 combinations of DAA were used (daclatasvir, ledipasvir, sofosbuvir, dasabuvir, ombitasvir, paritaprevir/r, simeprevir), ribavirin and pegylated interferon. VLET was undetectable in 100% of patients. Data were available concerning 121 patients after 12 weeks, 117 of whom (96.7%) maintained a sustained VR12 (SVR12). 4 patients (3.3%) who failed had been treated previously with INF-RBV; 2 had G1b F4, 1 had G1a F4 and 1 had G3 F2.
Conclusion The effectiveness of DAA in patients who had received previous treatment in clinical practice was within the percentages presented in clinical trials. Although there were too few failures in the treatment to conclude significant associations, there may be some relation between failures with DAA and pretreatment with INF-RBV. All patients who had not achieved SVR12 relapsed after an undetectable VLET.
References and/or acknowledgements Acknowledgements to Mireya Amat for the help offered.
No conflict of interest
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