Rescue Therapy after Failure of HCV Antiviral Treatment with Interferon-Free Regimens
Olga Tronina,
Michał Brzdęk,
Dorota Zarębska-Michaluk,
Dorota Dybowska,
Beata Lorenc,
Ewa Janczewska,
Włodzimierz Mazur,
Anna Parfieniuk-Kowerda,
Anna Piekarska,
Rafał Krygier,
Jakub Klapaczyński,
Hanna Berak,
Jerzy Jaroszewicz,
Aleksander Garlicki,
Krzysztof Tomasiewicz,
Jolanta Citko,
Robert Flisiak
Affiliations
Olga Tronina
Department of Transplantation Medicine, Nephrology, and Internal Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland
Michał Brzdęk
Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
Dorota Zarębska-Michaluk
Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
Dorota Dybowska
Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland
Beata Lorenc
Pomeranian Center of Infectious Diseases, Medical University of Gdańsk, 80-210 Gdańsk, Poland
Ewa Janczewska
Department of Basic Medical Sciences, School of Public Health in Bytom, Medical University of Silesia, 40-055 Katowice, Poland
Włodzimierz Mazur
Clinical Department of Infectious Diseases, Medical University of Silesia, 41-500 Chorzów, Poland
Anna Parfieniuk-Kowerda
Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-540 Białystok, Poland
Anna Piekarska
Department of Infectious Diseases and Hepatology, Medical University of Łódź, 90-419 Łódź, Poland
Rafał Krygier
Outpatients Hepatology Department, State University of Applied Sciences, 62-510 Konin, Poland
Jakub Klapaczyński
Department of Internal Medicine and Hepatology, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, 02-241 Warszawa, Poland
Hanna Berak
Outpatient Clinic, Hospital for Infectious Diseases, 02-091 Warsaw, Poland
Jerzy Jaroszewicz
Department of Infectious Diseases and Hepatology, Medical University of Silesia in Katowice, 41-902 Bytom, Poland
Aleksander Garlicki
Department of Infectious and Tropical Diseases, Jagiellonian University Collegium Medicum, 30-252 Kraków, Poland
Krzysztof Tomasiewicz
Department of Infectious Diseases, Medical University of Lublin, 20-059 Lublin, Poland
Jolanta Citko
Regional Hospital, 10-561 Olsztyn, Poland
Robert Flisiak
Department of Infectious Diseases and Hepatology, Medical University of Białystok, 15-540 Białystok, Poland
Direct-acting antivirals (DAA) regimens have provided hope for eliminating hepatitis C virus (HCV) infection. Patients following ineffective therapy with DAA, especially those previously treated with inhibitors of non-structural protein 5A (NS5A), remain a challenge. The study aimed to assess the effectiveness of DAA pangenotypic options in patients after failure of NS5A containing genotype-specific regimens. The analysis included 120 patients selected from the EpiTer-2 database with data on 15675 HCV-infected individuals treated with IFN-free therapies from 1 July 2015 to 30 June 2022 at 22 Polish hepatology centres. The majority of them were infected with genotype (GT) 1b (85.8%) and one-third was diagnosed with fibrosis F4. Among the rescue pangenotypic regimens, the most commonly used was the sofosbuvir/velpatasvir (SOF/VEL) ± ribavirin (RBV) combination. The sustained virologic response, which was a measure of treatment effectiveness, was achieved by 102 patients, resulting in cure rate of 90.3% in the per protocol analysis. All 11 non-responders were infected with GT1b, 7 were diagnosed with cirrhosis, and 9 were treated with SOF/VEL±RBV. We demonstrated the high effectiveness of the pangenotypic rescue options in patients after genotype specific NS5A-containing regimens failures, identifying cirrhosis as a negative prognostic factor of treatment effectiveness.
