San Francisco—The remarkable efficacy of direct acting antivirals in HCV clinical trials has made identifying the patients who will experience treatment failure especially important. Data obtained from Trio Health’s disease management program provide some surprising answers. The analysis was reported here recently by NH Afdhal and colleagues in Late Breaking abstract 17 (LB-17) at the 2015 annual meeting of the AASLD. You can find the entire abstract here.
An analysis of records from 1225 patients with genotype 1 hepatitis C infections who received direct acting antivirals between October 2014 and March 2015 indicate that male patients with cirrhosis, thrombocytopenia and prior treatment failure prove the most difficult to treat.
Figure 1. A rendering of the genotype 1 hepatitis C virus.
Also among this group, 29 patients suffered virologic failure. Males comprised 80% of treatment failures and 58% of those who achieve sustained virologic response (SVR). Patients with cirrhosis accounted for 60% of failed treatments and 40% of patients achieving SVR. Also, among patients for whom treatment had failed, 41% had platelet counts of <100,000/mL compared with 10% of those who responded successfully.
Of the 90 patients with HIV coinfection, 100% attained SVR as did all 40 of the post-transplant patients. Age, race, treatment site, genotype subtype and viral load were not associated with treatment failure.
Overall, 97% (1190/1225) of patients achieved SVR. Patients received one of 3 12-week courses of therapy: ledipasvir/sofosbuvir, ombitasvir/paritaprevir/ritonavir and dasabuvir or simeprevir and sofosbuvir.
Patients who received ribavirin in addition to any of the 3 direct-acting antiviral therapies were included with those who did not. Almost 95% of patients received the ledipasvir/sofosbuvir combination, which had a 97% SVR rate. Of the 39 patients who received ombitasvir/paritaprevir/ritonavir and dasabuvir, 95% achieved SVR and of the 27 on simeprevir and sofosbuvir, 93% achieved SVR.
