Re-re-treatment of hepatitis C virus: Eight patients who relapsed twice after direct-acting-antiviral drugs

Background: Treatment failure with direct-acting antiviral (DAA) therapy is associated with worsening of liver disease especially in cirrhotic patients. Moreover, data on retreatment of HCV genotype 4 patients (G4) with DAA failure are still very limited, since they are under- represented in most clinical trials. Aims: To evaluate the efficacy of retreatment of Egyptian HCV G4 DAA failure patients based on the use of a new DAA class from currently available first- generation DAA regimens other than the patient had relapsed to. Methods: 29 Egyptian HCV G4 DAA failure patients were retreated by switch to a new DAA class from first- generation DAA regimens than the patient had relapsed to independent of RAS testing. 25 out of these 29 patients completed retreatment and 4 patients were lost for follow–up. Results: Among other risk factors, by logistic regression analysis, only older age, high CTP score and high base-line viral load were independent predictors of DAA failure among our cohort. Also SOF/RBV regimen was the most common prior DAA regimen associated with treatment failure (48.3%). All our DAA failure patients were cirrhotics that made prompt retreatment of them a rescue strategy to halt viral replication and disease progression. After retreatment, 22 (88%) of the 25 patients who completed retreatment achieved SVR12 and the remaining 3 (12%) failed. These 3 patients completed a second retreatment, one achieved SVR and the other 2 relapsed again (re-relapsers) Conclusion: The overall SVR rate (88%) demonstrated in this real –world study, clearly shows that, the retreatment policy of DAA failure patients by switch to – or addition of a new drug class independent of RAS testing is a good retreatment option, that may be of importance for many areas of the world with no or difficult access to RAS testing or second-generation rescue regimens.

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“…SVR N=402 Similar results were also reported by other relevant real -world studies but with few discrepancies [12,13].…”

Section: Svr12n=22supporting

confidence: 88%

Management of Hepatitis C Virus Genotype 4 Treatment Failure: A Real-World Single Center Experience

Sarhan

Khodeir

Gabr

2021

IJTDH

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“…It is possible that cirrhosis prevents even perfusion of the liver with antiviral drugs, creating pockets that have low drug concentrations where HCV can persist. [ 33 , 34 ]…”

Section: Discussionmentioning

confidence: 99%

Patients with chronic hepatitis C receiving sofosbuvir and ribavirin-based treatment, with or without interferon in Zhejiang, China

Chen

et al. 2018

Medicine

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Hepatitis C virus (HCV) is one of the most important virus as the cause of liver disease in China. The aim of the present study was to explore whether sofosbuvir and ribavirin-based treatment can cure patients with chronic hepatitis C in eastern China. We examined a cohort of HCV-monoinfected patients and 9 patients agreed to participate in our treatment and research. The patients were diagnosed with chronic hepatitis C with or without cirrhosis. Nine patients including 4 female and 5 male met the requirements for selection and were willing to participate in this experiment. Sofosbuvir and ribavirin-based treatment with or without interferon was given to the patients. Viral loads, cytokines, and chemokines were recorded during treatment and after treatment. After 2 weeks of sofosbuvir and ribavirin-based treatment, the viral load of patients decreased to limits of detection. Eight patients were cured. Patients had rapid virological response (RVR) with undetectable viral load at week 4 and sustained virological response (SVR). The interferon-inducible protein-10 (IP-10) decreased after the treatment. However, the patient with cirrhosis failed, as the virus reappeared during SVR4. At the same time, the IP-10 dramatically increased as the relapse of the HCV virus. In summary, the IP-10 has the potential to be the biomarker for the prognostic of HCV.

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Optimal efficacy of interferon-free HCV retreatment after protease inhibitor failure in real life

Cento

Barbaliscia

Lenci

et al. 2017

Clinical Microbiology and Infection

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Re-re-treatment of hepatitis C virus: Eight patients who relapsed twice after direct-acting-antiviral drugs

Abstract: This study identifies factors associated with SMV/SOF treatment failure and provides evidence that twleve weeks of SMV/SOF/RBV is insufficient in cirrhotics with high-titer genotype 1a HCV.

Cited by 5 publications

References 29 publications

Management of Hepatitis C Virus Genotype 4 Treatment Failure: A Real-World Single Center Experience

Management of Hepatitis C Virus Genotype 4 Treatment Failure: A Real-World Single Center Experience

Patients with chronic hepatitis C receiving sofosbuvir and ribavirin-based treatment, with or without interferon in Zhejiang, China

Optimal efficacy of interferon-free HCV retreatment after protease inhibitor failure in real life

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