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Rescue Therapy after Failure of HCV Antiviral Treatment with Interferon-Free Regimens

Olga Tronina1, Michał Brzdęk2, Dorota Zarębska-Michaluk2,3

  • 1Department of Transplantation Medicine, Nephrology, and Internal Diseases, Medical University of Warsaw, 02-091 Warsaw, Poland.

Viruses
|March 30, 2023
PubMed

Insights

Pangenotypic direct-acting antivirals (DAA) effectively treat hepatitis C virus (HCV) after prior treatment failure with genotype-specific regimens. Cirrhosis was identified as a negative prognostic factor for treatment success.

Area of Science:

  • Hepatology
  • Virology
  • Infectious Diseases

Background:

  • Direct-acting antivirals (DAA) offer hope for hepatitis C virus (HCV) elimination.
  • Treatment failure with DAA, particularly after non-structural protein 5A (NS5A) inhibitor regimens, presents a clinical challenge.

Purpose of the Study:

  • To evaluate the efficacy of pangenotypic DAA regimens in patients who previously failed genotype-specific NS5A-containing therapies.
  • To identify factors influencing treatment outcomes in this patient population.

Main Methods:

  • Retrospective analysis of 120 patients from the EpiTer-2 database treated with IFN-free therapies between July 2015 and June 2022.
  • Focus on patients with prior treatment failure on NS5A-containing regimens.
  • Assessment of sustained virologic response (SVR) as the primary endpoint.

Main Results:

  • A high cure rate of 90.3% (102/120 patients) was achieved with pangenotypic rescue regimens.
  • Sofosbuvir/velpatasvir (SOF/VEL) ± ribavirin (RBV) was the most frequently used rescue therapy.
  • Non-responders (11 patients) were predominantly infected with genotype 1b, had cirrhosis, and received SOF/VEL±RBV.

Conclusions:

  • Pangenotypic DAA rescue options demonstrate high effectiveness in patients with prior treatment failures on genotype-specific NS5A inhibitors.
  • Cirrhosis is a significant negative prognostic factor impacting treatment effectiveness.
  • These findings support the use of pangenotypic DAA for salvage therapy in difficult-to-treat HCV cases.
Keywords:
chronic hepatitis Cdirect-acting antiviralsinterferon-freepangenotypicrescue therapysustained virologic response

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