Treatment and re-treatment results of HCV patients in the DAA era

  • Background: 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. Therefore, we investigated the success rate of treatment and re-treatment regimens used at our center from October 2011 to March 2018. Methods: A 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. Results: 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. 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. Conclusion: Overall, 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.
Author:Felix PiechaORCiDGND, Jan-Michael Gänßler, Ann-Kathrin Ozga, Malte Hermann Wehmeyer, Julia DietzORCiDGND, Johannes KluweGND, Alena Laschtowitz, Johann von FeldenORCiDGND, Martina Sterneck, Sabine Jordan, Sven Pischke, Ansgar W. Lohse, Julian Constantin Raimar Schulze zur WieschORCiDGND
Pubmed Id:
Parent Title (English):PLoS one
Place of publication:Lawrence, Kan.
Contributor(s):Jason Blackard
Document Type:Article
Year of Completion:2020
Date of first Publication:2020/05/05
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2020/05/06
Tag:Antiviral immune response; Cirrhosis; HIV; Hepatitis C virus; Hepatocellular carcinoma; Interferons; Liver transplantation; Protease inhibitor therapy
Issue:(5): e0232773
Page Number:14
First Page:1
Last Page:14
Copyright: © 2020 Piecha et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Licence (German):License LogoCreative Commons - Namensnennung 4.0