Clinical characteristics and antiviral therapy in patients infected with hepatitis C virus in the interferon-free era

Brzdęk, Michał; Dobrowolska, Krystyna; Pabjan, Paweł; Zarębska-Michaluk, Dorota

doi:10.20452/pamw.16282

Cited by 5 publications

(3 citation statements)

References 31 publications

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“…Although the two-peak pattern was described previously not only in the Polish population with CHC, we noted only one peak at ages 60 to 70 in women in all six-time intervals. We observed a second peak around the age of 41 to 45, only in men in 2018-2021[ 11 , 13 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

Changes in characteristics of patients with hepatitis C virus-related cirrhosis from the beginning of the interferon-free era

Brzdęk¹,

Zarębska-Michaluk²,

Rzymski³

et al. 2023

World J Gastroenterol

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BACKGROUND Nearly 290000 patients with chronic hepatitis C die annually from the most severe complications of the disease. One of them is liver cirrhosis, which occurs in about 20% of patients chronically infected with the hepatitis C virus (HCV). Direct-acting antivirals (DAAs), which replaced interferon (IFN)-based regimens, significantly improved the prognosis of this group of patients, increasing HCV eradication rates and tolerability of therapy. Our study is the first to assess changes in patient profile, effectiveness, and safety in the HCV-infected cirrhotic population in the IFN-free era. AIM To document changes in patient characteristics and treatment regimens along with their effectiveness and safety profile over the years. METHODS The studied patients were selected from 14801 chronically HCV-infected individuals who started IFN-free therapy between July 2015 and December 2021 in 22 Polish hepatology centers. The retrospective analysis was conducted in real-world clinical practice based on the EpiTer-2 multicenter database. The measure of treatment effectiveness was the percentage of sustained virologic response (SVR) calculated after excluding patients lost to follow-up. Safety data collected during therapy and the 12-wk post-treatment period included information on adverse events, including serious ones, deaths, and treatment course. RESULTS The studied population ( n = 3577) was balanced in terms of gender in 2015-2017, while the following years showed the dominance of men. The decline in the median age from 60 in 2015-2016 to 57 years in 2021 was accompanied by a decrease in the percentage of patients with comorbidities and comedications. Treatment-experienced patients dominated in 2015-2016, while treatment-naive individuals gained an advantage in 2017 and reached 93.2% in 2021. Genotype (GT)-specific options were more prevalent in treatment in 2015-2018 and were supplanted by pangenotypic combinations in subsequent years. The effectiveness of the therapy was comparable regardless of the period analyzed, and patients achieved an overall response rate of 95%, with an SVR range of 72.9%-100% for the different therapeutic regimens. Male gender, GT3 infection, and prior treatment failure were identified as independent negative predictors of therapeutic success. CONCLUSION We have documented changes in the profile of HCV-infected cirrhotic patients over the years of accessibility to changing DAA regimens, confirming the high effectiveness of IFN-free therapy in all analyzed periods.

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Section: Discussionmentioning

confidence: 99%

Changes in characteristics of patients with hepatitis C virus-related cirrhosis from the beginning of the interferon-free era

Brzdęk¹,

Zarębska-Michaluk²,

Rzymski³

et al. 2023

World J Gastroenterol

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“…Since the 1990s, recombinant clotting factor concentrates have been used for children, which has further increased the safety of the treatment of hemophilia [1, 2,4,6,7,8,9]. The highly effective and safe interferon-free options were a breakthrough in the treatment of patients infected with HCV and improved their prognosis [10]. Given that an understanding of the epidemiology of infection and associated factors would be useful in planning more effective programs to control the disease and its complications, the aim of this study was to determine the prevalence of chronic HCV in patients with congenital hemophilia from the Greater Poland region.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the prevalence of HCV infections in patients with hemophilia treated in one hemophilia center in Poland

Schneider¹,

Wojtasińska²,

Pielaszkiewicz³

et al. 2023

Polish Archives of Internal Medicine

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“…The introduction of direct-acting antivirals (DAA) for the treatment of hepatitis C virus (HCV) infections ensured the effectiveness of therapy in patients infected with the dominant genotype 1b HCV at the level of 98%, which even in difficult-to-treat subpopulations exceeds 90% [1][2][3][4]. However, despite such excellent treatment effects, there are still patients in whom treatment does not allow for a sustained virologic response (SVR) [5,6].…”

Section: Introductionmentioning

confidence: 99%

Pangenotypic triple versus double therapy in HCV-infected patients after prior failure of direct-acting antivirals

Flisiak,

Zarębska-Michaluk,

Berak

et al. 2023

ceh

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Aim of the study Despite the excellent effectiveness of direct-acting antivirals (DAA) in the treatment of hepatitis C virus (HCV) infection, still a few percent of patients fail therapy. The study aimed to determine the effectiveness of triple vs double rescue treatment in such a population. Material and methods The study included all consecutive DAA-experienced patients retreated with pangenotypic options from the EpiTer-2 database, a retrospective national multicenter real-world project evaluating antiviral treatment in HCV-infected patients in 2015-2023. Results The studied population consisted of 269 patients, of whom 208 were treated with the double (P2) and 61 with the triple (P3) pangenotypic option. No statistically significant differences were found between these subpopulations, except a significantly more frequent history of liver transplantation in the P3 group (6.6% vs. 0.5%, p = 0.01). In the P2 group, two-thirds of patients were treated with velpatasvir/sofosbuvir, while in the P3 group the majority of patients received a combination of velpatasvir/sofosbuvir/voxilaprevir. Virological response at the end of therapy was comparable in both analyzed subpopulations, but the sustained virologic response (SVR) rate was significantly higher in triple retherapy, 98.3% vs. 88.7%, p = 0.02, calculated after exclusion of patients lost to follow-up. Lower SVR was achieved in genotype 3-infected men with cirrhosis, 88.9% and 80% in P3 and P2, respectively. Conclusions A comparison of double and triple pangenotypic retherapy in patients after failure of DAA therapy showed a higher sustained virological response in the triple option with a comparable response at the end of therapy. The factors reducing the chances of cure were cirrhosis, genotype 3 infection and male gender.

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Clinical characteristics and antiviral therapy in patients infected with hepatitis C virus in the interferon-free era

Cited by 5 publications

References 31 publications

Changes in characteristics of patients with hepatitis C virus-related cirrhosis from the beginning of the interferon-free era

Changes in characteristics of patients with hepatitis C virus-related cirrhosis from the beginning of the interferon-free era

Evaluation of the prevalence of HCV infections in patients with hemophilia treated in one hemophilia center in Poland

Pangenotypic triple versus double therapy in HCV-infected patients after prior failure of direct-acting antivirals

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