Hepatology Xagena

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Treatment failure in hepatitis C: personalisation of direct-acting antiviral treatment could help eradicate HCV from the body

Data has demonstrated that choosing a different combination of direct-acting antiviral ( DAA ) treatment for hepatitis C can eradicate the virus at four weeks in patients who had already failed on previous medication regimens.
The results suggest that with the amount of DAAs available, the right combinations must be chosen for the right patients in order to eradicate the virus from the body.

Between 130 and 150 million people globally have chronic hepatitis C virus ( HCV ) infection. It is estimated that 15 million people in the World Health Organization’s EU Region are living with hepatitis C, representing 2% of adults.
Direct-acting antivirals are the treatment of choice for HCV, and these medicines have been used to treat and cure almost all patients.

As a result of the emergence of resistance associated variants, the re-treatment of patients with HCV remains challenging.

The German study drew patients with failure to DAAs from a large European HCV DAA-resistance database made up of more than 3,500 patients.
Patients were included if they had received Interferon-free DAA regimens. Treatment combinations were specific to HCV genotype.

The study identified 310 patients with failure to direct-acting antivirals. Among patients with genotype 1 and 3, 90% and 39% had resistance associated variants ( RAVs ), respectively.

Re-treatment was started in 29% ( n=57/195 ) of patients with genotype 1; the majority of these patients had failed treatment with the combination of Simeprevir ( Olysio ) and Sofosbuvir ( Sovaldi ), and were re-treated with the combinations of ledipasvir and Sofosbuvir ( Harvoni ) or Paritaprevir, Ombitasvir, and Dasabuvir ( Viekira Pak ).
SVR12 was achieved in 90% of the re-treated patients with genotype 1.
In the genotype 3 group, 23% ( n=16/69 ) of patients were re-treated with Sofosbuvir, Daclatasvir ± Ribavirin. All of the re-treated patients with available follow-up data achieved SVR12. ( Xagena )

Source: The International Liver Congress, 2016