Resistance-guided retreatment of hepatitis C virus (HCV) infection in conjunction with an interpreted report allows for the achievement of high sustained virologic response (SVR) rates with old treatment regimens where access to the new direct-acting antiviral (DAA) combination regimens is limited, according to prospective multicenter cohort study results published in the Journal of Hepatology.

Hepatitis C virus (HCV) infection can be cured with available antiviral agents, but a low percentage of patients are not cured. A high number of patients may need retreatment worldwide. Although highly effective combinations of antivirals are available for retreatment, they may not be available in resource-limited settings. In Spain, researchers sought to characterize why SVR was not achieved in a real-world cohort of patients after their first interferon-free DAA regimen. They studied 342 patients experiencing virologic nonresponse after treatment with sofosbuvir/ledipasvir±ribavirin (54%), sofosbuvir/daclatasvir±ribavirin (23%), or paritaprevir-ritonavir/ombitasvir±dasabuvir±ribavirin (20%). After receiving a comprehensive resistance interpretation report, 186 patients were retreated. They found that an SVR at 12 weeks after treatment completion (SVR12) was achieved in 88.1% of patients not responsive to d treatment with sofosbuvir/ledipasvir±ribavirin, 83.3% of patients not responsive to treatment  with sofosbuvir/daclatasvir±ribavirin, and 93.7% of patients not responsive to treatment with paritaprevir-ritonavir/ombitasvir±dasabuvir±ribavirin.

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“In conclusion, we have shown that resistance findings in conjunction with an interpreted report allow achieving SVR rates close to 90%,” stated the investigators. They added that, “We believe that our data may be of special relevance for those countries where new drug combinations are still not available, and may allow treating patients at a lower cost, avoiding drug-drug interaction and preserving the three-drug combination regimen.”

Reference
Belén Pérez A, Chueca N, García-Deltoro M, et al; GEHEP-004 Cohort. High efficacy of resistance-guided retreatment of HCV patients failing NS5A inhibitors in real world [published online July 4, 2019]. J Hepatol. doi:10.1016/j.jhep.2019.06.022