Open AccessManagement of patients with chronic hepatitis C failing repeated courses of interferon‐free direct acting antiviral combination therapy
Author(s) -
Kozbial Karin,
AlZoairy Ramona,
Gschwantler Michael,
Stauber Rudolf,
Hametner Stephanie,
Laferl Hermann,
Strasser Michael,
HayatKhayyati Avida,
Datz Christian,
Kramer Ludwig,
Schaefer Benedikt,
Maieron Andreas,
Graziadei Ivo,
Stättermayer Albert Friedrich,
Beinhardt Sandra,
Munda Petra,
Zoller Heinz,
Holzmann Heidemarie,
Aberle Stephan W.,
Trauner Michael,
Hofer Harald,
Ferenci Peter
Publication year - 2019
Publication title -
gastrohep
Language(s) - English
Resource type - Journals
ISSN - 1478-1239
DOI - 10.1002/ygh2.329
Subject(s) - medicine , cirrhosis , gastroenterology , hepatitis c virus , virus , immunology
Summary Background Only few chronic hepatitis C patients treated with interferon (IFN)‐free direct acting antiviral (DAA) combinations fail to clear the virus. Most patients can be cured by retreatment with another DAA combination; however, some still fail to eradicate the virus. So far, little is known about how to best retreat these patients. In this study we summarise our real world experience of re‐retreatments. Methods One hundred and two patients who completed a DAA‐retreatment after virological failure to an IFN‐free DAA therapy and reached at least follow‐up 12 were included in this study.Twenty‐one (20.6%) of them relapsed again after retreatment (mean age 50.0 ± 10.6, 18 male, three female, GT1a:8, GT1b:4, GT1c:1, GT3a:7; GT4:1; cirrhosis:15; resistance associated substitutions [RAS]: 17/19; relapse after:SOF/SMV:2; 3D ± RBV:4; SOF/DCV ± RBV:4; SOF/LDV ± RBV:6; SOF/VEL:3; SOF/VEL/VOX:1; EBV/GZV:1).Treatment duration and addition of RBV were at the discretion of the treating physician. These 21 patients were studied in detail. Results Seventeen of the 21 patients finished a third DAA therapy: 13 achieved SVR12, three relapsed again (cirrhosis:2; SOF/VEL/RBV:GT3a; SOF/LDV/RBV:GT1a; EBV/GZV/SOF/RBV:GT1b), one was lost to follow‐up. One (GT1a, cirrhosis) achieved SVR12 after the third retherapy with 24 weeks of 3D/SOF/RBV, and one (GT3a, cirrhosis) achieved SVR4 after 24 weeks of glecaprevir/pibrentasvir, but died shortly thereafter. Overall, 95 (93.1%) of 102 patients achieved SVR12 after one or more retreatments. Sex, cirrhosis, genotype, RAS or baseline viral load were not associated with retreatment failure. Conclusion Most patients with failure to a DAA therapy achieved SVR after retreatment with a different regimen; however, 13.7% of patients required multiple retreatments.