Treatment and re-treatment results of HCV patients in the DAA era

• Published in: PloS one 2020-05, Vol.15 (5), p.e0232773-e0232773
• Main Authors: Piecha, Felix, Gänßler, Jan-Michael, Ozga, Ann-Kathrin, Wehmeyer, Malte H, Dietz, Julia, Kluwe, Johannes, Laschtowitz, Alena, von Felden, Johann, Sterneck, Martina, Jordan, Sabine, Pischke, Sven, Lohse, Ansgar W, Schulze Zur Wiesch, Julian
• Format: Article
• Language: English
• Subjects: Analysis; Antiviral agents; Antiviral drugs; Biological response modifiers; Biology and Life Sciences; Care and treatment; Chronic infection; Comorbidity; Confidence intervals; Failure analysis; Health aspects; Hepatitis; Hepatitis C; Hepatitis C virus; HIV; Human immunodeficiency virus; Immunodeficiency; Infection; Infections; Interferon; Liver; Liver cancer; Liver cirrhosis; Liver transplantation; Liver transplants; Medicine; Medicine and Health Sciences; Organ transplant recipients; Patients; Regression analysis; Sofosbuvir; Statistical analysis; Telaprevir; Transplants & implants; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0232773

Re-treatment in patients with a chronic hepatitis C virus (HCV) infection and a previous failure to direct-acting antiviral (DAA) treatment remains a challenge. Therefore, we investigated the success rate of treatment and re-treatment regimens used at our center from October 2011 to March 2018. A retrospective analysis of DAA-based HCV therapies of 1096 patients was conducted. Factors associated with a virological relapse were identified by univariable and multivariable logistic regression, treatment success of the re-treatment regimens was evaluated by an analysis of sustained virological response (SVR) rates in patients with a documented follow-up 12 weeks after the end of treatment. Of 1096 patients treated with DAA-based regimens, 91 patients (8%) were lost to follow-up, 892 of the remaining 1005 patients (89%) achieved an SVR12. Most patients (65/113, 58%) who experienced a virological relapse received an interferon-based DAA regimen. SVR rates were comparable in special cohorts like liver transplant recipients (53/61, 87%) and people with a human immunodeficiency virus (HIV) coinfection (41/45, 91%). On multivariable analysis, interferon-based DAA therapy was associated with treatment failure (odds ratio 0.111, 95%-confidence interval 0.054-0.218) among others. One hundred seventeen patients with multiple DAA treatment courses were identified, of which 97 patients (83%) experienced a single relapse, but further relapses after two (18/117, 15%) or even three (2/117, 2%) treatment courses were also observed. Eighty-two of 96 (85%) re-treatment attempts with all-oral DAA regimens were successful after an initial treatment failure. Overall, DAA re-treatments were highly effective in this real-world cohort and only a minority of patients failed more than two treatment courses. Switching to-or addition of-a new drug class seem to be valid options for the re-treatment of patients especially after failure of an interferon-based regimen.