Effectiveness of Glecaprevir/Pibrentasvir for Hepatitis C: Real-World Experience and Clinical Features of Retreatment Cases

• Published in: Biomedicines 2020-04, Vol.8 (4), p.74
• Main Authors: Sugiura, Ayumi, Joshita, Satoru, Yamashita, Yuki, Yamazaki, Tomoo, Fujimori, Naoyuki, Kimura, Takefumi, Matsumoto, Akihiro, Wada, Shuichi, Mori, Hiromitsu, Shibata, Soichiro, Yoshizawa, Kaname, Morita, Susumu, Furuta, Kiyoshi, Kamijo, Atsushi, Iijima, Akihiro, Kako, Satoko, Maruyama, Atsushi, Kobayashi, Masakazu, Komatsu, Michiharu, Matsumura, Makiko, Miyabayashi, Chiharu, Ichijo, Tetsuya, Takeuchi, Aki, Koike, Yuriko, Gibo, Yukio, Tsukadaira, Toshihisa, Inada, Hiroyuki, Nakano, Yoshiyuki, Usuda, Seiichi, Kiyosawa, Kendo, Tanaka, Eiji, Umemura, Takeji
• Format: Article
• Language: English
• Subjects: Age; Antiviral agents; chronic hepatitis C; Failure; Fibrosis; Genomes; Genotype & phenotype; Genotypes; glecaprevir; Hepatitis; Hepatitis C; hepatitis C virus; Hepatocellular carcinoma; Interferon; Laboratories; Liver cirrhosis; Mutation; Patients; pibrentasvir; retreatment; Statistical analysis
• ISSN: 2227-9059; 2227-9059
• DOI: 10.3390/biomedicines8040074

Glecaprevir/pibrentasvir (G/P) are direct-acting antivirals (DAAs) that achieve a high sustained virological response (SVR) rate for hepatitis C virus (HCV) infection. We investigated G/P effectiveness for HCV patients based on real-world experience and the clinical features of retreatment cases. HCV patients (n = 182) were compared for clinical features and outcomes between first treatment (n = 159) and retreatment (n = 23) G/P groups. Overall, 77 patients (42.3%) were male, the median age was 68 years, and 86/66/1/4 cases had genotype 1/2/1+2/3, respectively. An SVR was achieved in 97.8% (178/182) of cases by intention-to-treat analysis and 99.4% (178/179) of cases by per-protocol analysis. There were no remarkable differences between the first treatment and retreatment groups for male (42.8% vs. 39.1%, p = 0.70), median age (68 vs. 68 years, p = 0.36), prior hepatocellular carcinoma (5.8% vs. 8.7%, p = 0.59), or the fibrosis markers AST-to-platelet ratio index (APRI) (0.5 vs. 0.5, p = 0.80) and fibrosis-4 (FIB-4) index (2.2 vs. 2.6, p = 0.59). The retreatment group had a significantly more frequent history of interferon treatment (12.3% vs. 52.2%, p < 0.01) and the Y93H mutation (25.0% vs. 64.7%, p = 0.02). The number of retreatment patients who had experienced 3, 2, and 1 DAA treatment failures was 1, 3, and 19, respectively, all of whom ultimately achieved an SVR by G/P treatment. In conclusion, G/P was effective and safe for both HCV first treatment and retreatment cases despite the retreatment group having specific resistance mutations for other prior DAAs. As G/P treatment failure has been reported for P32 deletions, clinicians should consider resistance mutations during DAA selection.