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Factors associated with treatment failure of direct‐acting antivirals for chronic hepatitis C: A real‐world nationwide hepatitis C virus registry programme in Taiwan
Author(s) -
Chen ChiYi,
Huang ChungFeng,
Cheng PinNan,
Tseng KuoChih,
Lo ChingChu,
Kuo HsingTao,
Huang YiHsiang,
Tai ChiMing,
Peng ChengYuan,
Bair MingJong,
Chen ChienHung,
Yeh MingLun,
Lin ChihLang,
Lin ChunYen,
Lee PeiLun,
Chong LeeWon,
Hung ChaoHung,
Huang JeeFu,
Yang ChiChieh,
Hu JuiTing,
Lin ChihWen,
Chen ChunTing,
Wang ChiaChi,
Su WeiWen,
Hsieh TsaiYuan,
Lin ChihLin,
Tsai WeiLun,
Lee TzongHsi,
Chen GueiYing,
Wang SzuJen,
Chang ChunChao,
Mo LeinRay,
Yang ShengShun,
Wu WenChih,
Huang ChiaSheng,
Hsiung ChouKwok,
Kao ChienNeng,
Tsai PeiChien,
Liu ChenHua,
Lee MeiHsuan,
Liu ChunJen,
Dai ChiaYen,
Kao JiaHorng,
Chuang WanLong,
Lin HanChieh,
Yu MingLung
Publication year - 2021
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.14849
Subject(s) - medicine , daclatasvir , sofosbuvir , hepatocellular carcinoma , ribavirin , simeprevir , odds ratio , hepatitis c virus , gastroenterology , hepatitis c , cirrhosis , confidence interval , virology , virus
Background/aims Direct‐acting antivirals (DAAs) are highly effective in treating chronic hepatitis C virus (HCV)‐infected patients. The real‐world treatment outcome in Taiwanese patients on a nationwide basis is elusive. Methods The Taiwan HCV Registry ( TACR) programme is a nationwide registry platform including 48 study sites, which is organized and supervised by the Taiwan Association for the Study of the Liver. The primary endpoint was sustained virological response (SVR12, undetectable HCV RNA 12 weeks after end‐of‐treatment). Results A total of 13 951 registered patients with SVR12 data available were analysed (mean age, 63.0 years; female, 55.9%; HCV genotype‐1 [GT1], 57.9%; cirrhosis, 38.4%; preexisting hepatocellular carcinoma [HCC], 10.6%; and hepatitis B virus coinfection, 7.7%). The overall SVR12 rate was 98.3%, with 98.7%, 98.0%, 98.4% and 97.4% in treatment‐naïve noncirrhotic, treatment‐naïve cirrhotic, treatment‐experienced noncirrhotic and treatment‐experienced cirrhotic patients, respectively. The SVR12 rate was > 95% across all subgroups except treatment‐experienced cirrhotic patients who received sofosbuvir/ribavirin (88.7%), treatment‐naïve noncirrhotic patients (94.8%) and treatment‐experienced cirrhotic (94.8%) patients who received daclatasvir/asunaprevir. The most important factor associated with treatment failure was DAA adherence < 60% ( adjusted odds ratio [aOR]/95% confidence interval [CI]: 117.1/52.4‐261.3, P < .001), followed by GT3/GT2 (aOR/CI: 5.78/2.25‐14.9, P = .0003 and aOR/CI: 1.55/1.05‐2.29, P = .03, compared with GT1), active hepatocellular carcinoma (aOR/CI: 4.29/2.57‐7.16, P < .001), the use of sofosbuvir/ribavirin (aOR/CI: 2.51/1.67‐3.77, P < .001) and daclatasvir/asunaprevir (aOR/CI: 3.29/1.94‐5.58, P < .001), decompensated liver cirrhosis (aOR/CI: 2.50/1.20‐5.22, P = .02) and high HCV viral loads (aOR/CI: 2.16/1.57‐2.97, P < .001). Conclusions DAAs are highly effective in treating Taiwanese HCV patients in the real‐world setting. Maintaining DAA adherence and selecting highly efficacious regimens are keys to ensure treatment success.