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Real-life experience of chronic hepatitis C treatment in Switzerland: a retrospective analysis
Eleni Moschouri1, Gloria Salemme2, Adriana Baserga3
11Division of Gastroenterology and Hepatology, Lausanne University Hospital and University of Lausanne. elenimoschouri@gmail.com.
Insights
Direct-acting antivirals (DAAs) have improved chronic hepatitis C treatment success rates in Switzerland. Newer DAA generations and factors like genotype 1 are linked to higher sustained virological response (SVR) rates.
Area of Science:
- Hepatology
- Virology
- Pharmacotherapy
Background:
- Direct-acting antivirals (DAAs) have transformed chronic hepatitis C management.
- Analysis of DAA treatment outcomes and failure predictors in Switzerland is crucial.
Purpose of the Study:
- To analyze the utilization of different direct-acting antiviral (DAA) generations over time in Switzerland.
- To identify factors associated with treatment failure in patients with chronic hepatitis C.
Main Methods:
- Retrospective cohort study including 3088 patients treated with DAAs between 2015-2019.
- Data collected from eight Swiss referral centers within the Swiss Association for the Study of the Liver and Swiss Hepatitis C Cohort Study.
- Multivariable analysis to determine predictors of sustained virological response (SVR) and treatment failure.
Main Results:
- Overall sustained virological response (SVR) rate was 96.2%, increasing over time.
- Treatment failure rate decreased from 8.3% in 2015 to 2.5% in 2019.
- Factors associated with SVR included female sex, latest DAA generation, Caucasian origin, and genotype 1; factors associated with failure included active hepatocellular carcinoma (HCC), genotype 3, and increased liver stiffness.
Conclusions:
- SVR rates for chronic hepatitis C have increased, particularly with newer pangenotypic DAA regimens.
- Active hepatocellular carcinoma (HCC), genotype 3, and elevated liver stiffness are significant predictors of DAA treatment failure.
Background And Aim:
Direct-acting antivirals (DAAs) have revolutionised the management of chronic hepatitis C. We analysed the use of different generations of DAAs over time in Switzerland and investigated factors predictive of treatment failure.
Methods:
This retrospective study was conducted within the framework of the Swiss Association for the Study of the Liver and the Swiss Hepatitis C Cohort Study; it included all patients with chronic hepatitis C treated with DAAs between January 2015 and December 2019 at eight Swiss referral centres.
Results:
A total of 3088 patients were included; 57.3% were male, and the median age was 54 years. Liver cirrhosis was present in 23.9% of the cohort, 87.8% of whom were compensated. The overall sustained virological response (SVR) rate (defined as undetectable HCV RNA at week 12 after the first course of DAA-based treatment) was 96.2%, with an increase over time. The rate of treatment failure dropped from 8.3% in 2015 to 2.5% in 2019. Multivariable analysis revealed that female sex, the use of the latest generation of pangenotypic DAA regimens, Caucasian origin, and genotype (gt) 1 were associated with SVR, whereas the presence of active hepatocellular carcinoma (HCC), gt 3, and increasing liver stiffness were associated with treatment failure. Notably, the presence of active HCC during treatment increased the risk of DAA failure by a factor of almost thirteen.
Conclusions:
SVR rates increased over time, and the highest success rates were identified after the introduction of the latest generation of pangenotypic DAA regimens. Active HCC, gt 3 and increasing liver stiffness were associated with DAA failure.
