Background The new direct antiviral agents (DAAs) have substantially modified the situation of hepatitis C virus (HCV) infection patients, achieving very high viral response rates.1 However, in certain patients, treatment with DAAs fails.
Purpose Our objective was to assess the effectiveness of a new treatment with DAAs in patients with HCV, in whom previous interferon-free therapies were ineffective.
Material and methods Retrospective descriptive observational study in which patients with HCV who were portrayed with DAAs between April 2013 and June 2018, were included. Demographic, analytical and clinical data were collected: age, sex, genotype, liver fibrosis (F), treatment with previous DAAs, resistance profile, baseline viral load (VL) and VL 12 weeks after the end of treatment. Effectiveness was assessed by sustained viral response (SVR), defined as undetectable viral load at 12 weeks after the end of treatment (SVR12).
Results In our hospital, 1410 patients were treated with DAAs, of which 24 needed to be portrayed with these, 75% male, with a mean age of 53 (38–75) years, 20 infected by genotype 1 (12 1a and 8 1b), three genotype 3 and one genotype 4: 38% presented baseline VL >800,000 IU/ml and 90% grade fibrosis ≥3 (38% F4).The therapies that failed were: ledipasvir/sofosvubir (LDV/SOF)(12)+ribavirin (RBV) (three of them), daclatasvir/sofosbuvir (DCV/SOF) (five)+RBV (one), ombitasvir/paritaprevir/ritonavir/dasabuvir (OMB/PAR/RIT/DAS) (four) and simeprevir/sofosbuvir (SMV/SOF)+RBV (three). Resistance was detected in five patients: Q80K (one), Q30H (one), Y93H (two) and substitution S556G (one). Failure was due to relapse except for one case of reinfection. The rescue treatments were: LDV/SOF ( seven), SMV/SOF (seven), OMB/PAR/RIT/DAS (two), sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX) (three) and glecaprevir/pibrentasvir (GLE/PIB) (one) in genotype 1, DCV/SOF (one), GLE/PIB (one) and LDV/SOF (one) in genotype 3 and SOF/VEL/VOX (one) in genotype 4. The duration of treatment was 24 weeks in 64% of cases. Eighty-eight per cent reached SVR12: for two patients we had no data and one died during the course of treatment.
Conclusion In our case the treatment with DAAs, after a previous failure of these, has turned out to be effective, consolidating other studies already published,2 but further studies with more patients are required.
References and/or acknowledgements 1. Shah ND, Fried MW. Opciones terapéuticas para los pacientes con hepatitis C crónica y fracaso terapéutico previo. Clin Liv Dis 2016,8:S25–S29.
2. Gonzalez MM, Moreno-Garcia M, Castellano-Herrador J, et al. All-oral direct-acting antiviral combination therapy:chronic hepatitis C treatment after unsuccessful therapy with DAAs agents. Eur J Hosp Pharm 2018;25:A83.
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.