Retreatment of chronic hepatitis C virus genotype-4 patients after non-structural protein 5A inhibitors' failure: efficacy and safety of different regimens

• Published in: European journal of gastroenterology & hepatology Vol. 32; no. 3; pp. 440 - 446
• Main Authors: El-Khayat, Hisham, Kamal, Enas M., Mahmoud, Hani, Gomaa, Ahmed, Ebeid, Bassel, Sameh, Yehia, Hasseb, Alaa, El Raziky, Maissa, El Serafy, Magdy, Doss, Wahid, Esmat, Gamal, Fouad, Yasser, Attia, Dina
• Format: Journal Article
• Language: English
• Published: England Wolters Kluwer Health, Inc. All rights reserved 01-03-2020; Copyright Wolters Kluwer Health, Inc. All rights reserved
• ISSN: 0954-691X; 1473-5687
• DOI: 10.1097/MEG.0000000000001581

BACKGROUND:Nonstructural protein 5A (NS5A) is an important regimen for the treatment of chronic hepatitis C virus (HCV) genotype-4 infected patients. Retreatments for NS5A virologic failure are limited. The aim of this study is to provide real-life data regarding the effectiveness and safety of retreatment with different regimens after NS5A regimen virologic failure in GT4 patients.
PATIENTS AND METHODS:A total of 524 HCV patients (mean age 48 ± 11 years, 71% males), with virologic failure to sofosbuvir+daclatasvir, n = 450 and sofosbuvir/ledipasvir, n = 74 were included in this study. Patients were retreated with sofosbuvir + ombitasvir/paritaprevir/ritonavir + ribavirin, n = 278 and sofosbuvir + simeprevir + daclatasvir + ribavirin, n = 246. Response was evaluated 12 weeks after the end of treatment (SVR12).
RESULTS:Overall, SVR12 was 95.2% [95% confidence interval (CI) 93.3%–97.1%]. In sofosbuvir + ombitasvir/paritaprevir/ritonavir + ribavirin and sofosbuvir + simeprevir + daclatasvir + ribavirin, SVR12s were 94.9% (95% CI 92.5%–97.4%) and 95.5% (95% CI 92.8%–98%), respectively. In liver cirrhosis patients, SVR12s were 96.4% (95% CI 90.7%–100%) and 98% (95% CI 94.9%–100%), respectively. Relapse in the sofosbuvir + ombitasvir/paritaprevir/ritonavir + ribavirin was n = 14 patients, and n = 11 patients in sofosbuvir + simeprevir + daclatasvir + ribavirin. Three patients developed hepatic encephalopathy, haematemesis, lower limb oedema, and one patient died in the SOF + OBV/PTV/RTV + RIB. In the sofosbuvir + simeprevir + daclatasvir + ribavirin, three patients developed hepatocellular carcinoma and one patient died. No treatment discontinuation due to anaemia.
CONCLUSION:Salvage treatment for NS5A-treatment failure is effective and well tolerated in genotype-4 patients, in both noncirrhotic and compensated cirrhotic groups.