Background New oral interferon-free direct-acting antivirals (DAAs) have demonstrated high effectiveness treating chronic hepatitis C. However, a few patients still do not achieve sustained virological response (SVR).
Purpose To describe those patients treated with new interferon-free DAAs for chronic hepatitis C, who had virological failure (VF), and their retreatment outcomes.
Material and methods A retrospective observational study for patients with VF to DAAs who were retreated in a reference hospital from 2015 to September 2018. Variables analysed: sex, age, genotype, HIV co-infection, METAVIR score (F0–F4), DAA treatment, retreatment therapy, presence of resistance-associated substitutions (RASs) and SVR 12 weeks after the end of retreatment (SVR12).
Results Twenty-four of 1356 patients treated for hepatitis C virus with interferon-free DAAs therapies had a VF (1.8%). Seventeen were retreated (seven are pending). Median age was 51 years (36–60), 88% male. Two patients were HIV co-infected. Genotypes: G1a (n=6); G1b (n=5); G2 (n=1); G3 (n=4); and G4 (n=1). Based on METAVIR score: F4 (n=6); F3 (n=3); F2 (n=4); and F0–F1 (n=4). Previous DAAs treatments were: ombitasvir/paritaprevir/ritonavir/dasabuvir ±ribavirin (RBV) (n=7); ledipasvir/sofosbuvir (SOF) ±RBV (n=3); daclatasvir/SOF ±RBV (n=2); velpatasvir/SOF (n=1); glecaprevir/pibrentasvir (n=1); elbasvir/grazoprevir (n=1); SOF +RBV (n=1); and ombitasvir/paritaprevir/ritonavir+RBV (n=1). Patients retreatment: SOF/velpatasvir/voxilaprevir (n=9); elbasvir/grazoprevir/SOF ±RBV (n=5); daclatasvir/SOF ±RBV (n=1); velpatasvir/SOF +RBV (n=1); and simeprevir/SOF +RBV (n=1). Fifteen patients (88%) were studied for RASs: four had only an available post-treatment sample and all presented a RAS related to the first DAA treatment; three had RASs at baseline and post-treatment samples; and in eight patients the RAS was only present in a post-treatment sample. SVR12 figures were available for 14 patients: 13 reached a SVR and one rebounded (three patients did not yet have analysis). Per protocol analysis, the rate of SVR was 93% for those retreatments. The patient that rebounded was G3, F4, co-infected, received at first daclatasvir/SOF +RBV during 24 weeks and was retreated with velpatasvir/SOF +RBV during 24 weeks.
Conclusion Although only a reduced proportion of treated patients did not achieve a SVR with DAA combinations, retreatment with a new strategy reached 93% of SVR.
References and/or acknowledgements EIPT-VHC project funded by the Spanish Ministry of Health and Carlos III Institute of Health.
No conflict of interest.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.