Pangenotypic triple versus double therapy in HCV-infected patients after prior failure of direct-acting antivirals

Robert Flisiak; Dorota Zarębska-Michaluk; Hanna Berak; Dorota Dybowska; Marek Sitko; Anna Parfieniuk-Kowerda; Justyna Janocha-Litwin; Ewa Janczewska; Anna Piekarska; Beata Lorenc; Włodzimierz Mazur; Krystyna Dobrowolska; Magdalena Tudrujek-Zdunek; Jakub Klapaczyński; Jerzy Jaroszewicz

doi:10.5114/ceh.2023.130935

eISSN: 2449-8238
ISSN: 2392-1099

Clinical and Experimental Hepatology

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abstract:

Original paper

Pangenotypic triple versus double therapy in HCV-infected patients after prior failure of direct-acting antivirals

Robert Flisiak

¹

,

Dorota Zarębska-Michaluk

²

,

Hanna Berak

³

,

Dorota Dybowska

⁴

,

Marek Sitko

⁵

,

Anna Parfieniuk-Kowerda

¹

,

Justyna Janocha-Litwin

⁶

,

Ewa Janczewska

⁷

,

Anna Piekarska

⁸

,

Beata Lorenc

⁹

,

Włodzimierz Mazur

¹⁰

,

Krystyna Dobrowolska

¹¹

,

Magdalena Tudrujek-Zdunek

¹²

,

Jakub Klapaczyński

¹³

,

Jerzy Jaroszewicz

¹⁴

Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland
Department of Infectious Diseases and Allergology, Jan Kochanowski University, Kielce, Poland
Outpatient Clinic, Hospital for Infectious Diseases in Warsaw, Warsaw, Poland
Department of Infectious Diseases and Hepatology, Faculty of Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
Department of Infectious and Tropical Diseases, Jagiellonian University, Kraków, Poland
Department of Infectious Diseases and Hepatology, Wrocław Medical University, Wrocław, Poland
Department of Basic Medical Sciences, School of Public Health in Bytom, Medical University of Silesia, Katowice, Poland
Department of Infectious Diseases and Hepatology, Medical University of Łódź, Poland
Pomeranian Center of Infectious Diseases, Medical University of Gdańsk, Gdańsk, Poland
Clinical Department of Infectious Diseases, Medical University of Silesia, Chorzów, Poland
Collegium Medicum, Jan Kochanowski University, Kielce, Poland
Department of Infectious Diseases, Medical University of Lublin, Lublin, Poland
Department of Internal Medicine and Hepatology, The National Institute of Medicine of the Ministry of Interior and Administration, Warsaw, Poland
Department of Infectious Diseases and Hepatology, Medical University of Silesia, Katowice, Poland

Clin Exp HEPATOL 2023; 9, 3: 193-201

DOI: https://doi.org/10.5114/ceh.2023.130935

Online publish date: 2023/09/03

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AMA

Flisiak R, Zarębska-Michaluk D, Berak H, et al. Pangenotypic triple versus double therapy in HCV-infected patients after prior failure of direct-acting antivirals. Clinical and Experimental Hepatology. 2023;9(3):193-201. doi:10.5114/ceh.2023.130935.

APA

Flisiak, R., Zarębska-Michaluk, D., Berak, H., Dybowska, D., Sitko, M.,  & Parfieniuk-Kowerda, A. et al. (2023). Pangenotypic triple versus double therapy in HCV-infected patients after prior failure of direct-acting antivirals. Clinical and Experimental Hepatology, 9(3), 193-201. https://doi.org/10.5114/ceh.2023.130935

Chicago

Flisiak, Robert, Dorota Zarębska-Michaluk, Hanna Berak, Dorota Dybowska, Marek Sitko, Anna Parfieniuk-Kowerda,  and Justyna Janocha-Litwin et al. 2023. "Pangenotypic triple versus double therapy in HCV-infected patients after prior failure of direct-acting antivirals". Clinical and Experimental Hepatology 9 (3): 193-201. doi:10.5114/ceh.2023.130935.

Harvard

Flisiak, R., Zarębska-Michaluk, D., Berak, H., Dybowska, D., Sitko, M., Parfieniuk-Kowerda, A., Janocha-Litwin, J., Janczewska, E., Piekarska, A., Lorenc, B., Mazur, W., Dobrowolska, K., Tudrujek-Zdunek, M., Klapaczyński, J.,  and Jaroszewicz, J. (2023). Pangenotypic triple versus double therapy in HCV-infected patients after prior failure of direct-acting antivirals. Clinical and Experimental Hepatology, 9(3), pp.193-201. https://doi.org/10.5114/ceh.2023.130935

MLA

Flisiak, Robert et al. "Pangenotypic triple versus double therapy in HCV-infected patients after prior failure of direct-acting antivirals." Clinical and Experimental Hepatology, vol. 9, no. 3, 2023, pp. 193-201. doi:10.5114/ceh.2023.130935.

Vancouver

Flisiak R, Zarębska-Michaluk D, Berak H, Dybowska D, Sitko M, Parfieniuk-Kowerda A et al. Pangenotypic triple versus double therapy in HCV-infected patients after prior failure of direct-acting antivirals. Clinical and Experimental Hepatology. 2023;9(3):193-201. doi:10.5114/ceh.2023.130935.

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Aim of the study:
Despite the excellent effectiveness of direct-acting antivirals (DAA) in the treatment of hepatitis C virus (HCV) infection, still a few percent of patients fail therapy. The study aimed to determine the effectiveness of triple vs double rescue treatment in such a population.

Material and methods:
The study included all consecutive DAA-experienced patients retreated with pangenotypic options from the EpiTer-2 database, a retrospective national multicenter real-world project evaluating antiviral treatment in HCV-infected patients in 2015-2023.

Results:
The studied population consisted of 269 patients, of whom 208 were treated with the double (P2) and 61 with the triple (P3) pangenotypic option. No statistically significant differences were found between these subpopulations, except a significantly more frequent history of liver transplantation in the P3 group (6.6% vs. 0.5%, p = 0.01). In the P2 group, two-thirds of patients were treated with velpatasvir/sofosbuvir, while in the P3 group the majority of patients received a combination of velpatasvir/sofosbuvir/voxilaprevir. Virological response at the end of therapy was comparable in both analyzed subpopulations, but the sustained virologic response (SVR) rate was significantly higher in triple retherapy, 98.3% vs. 88.7%, p = 0.02, calculated after exclusion of patients lost to follow-up. Lower SVR was achieved in genotype 3-infected men with cirrhosis, 88.9% and 80% in P3 and P2, respectively.

Conclusions:
A comparison of double and triple pangenotypic retherapy in patients after failure of DAA therapy showed a higher sustained virological response in the triple option with a comparable response at the end of therapy. The factors reducing the chances of cure were cirrhosis, genotype 3 infection and male gender.

keywords:

Pangenotypic triple versus double therapy in HCV-infected patients after prior failure of direct-acting antivirals

direct-acting antivirals, hepatitis C virus, retherapy, pangenotypic