Published online Dec 7, 2022. doi: 10.3748/wjg.v28.i45.6380
Peer-review started: August 26, 2022
First decision: September 25, 2022
Revised: October 1, 2022
Accepted: November 19, 2022
Article in press: November 19, 2022
Published online: December 7, 2022
Processing time: 97 Days and 17.9 Hours
The revolution in treatment of patients with chronic hepatitis C virus (HCV) infection dates back to the introduction of direct-acting antivirals (DAAs). The increase in efficacy was most pronounced in patients infected with genotype (GT) 1b, as this was the most poorly responsive population to treatment during the interferon era.
To identify the most effective interferon-free therapy for GT1b-infected patients and to determine positive and negative predictors of virological response.
This real-world retrospective analysis included patients chronically infected with GT1b HCV whose data were obtained from the multicenter observational EpiTer-2 database. Treatment effectiveness was evaluated for each therapeutic regimen as the percentage of sustained virological responses (SVR). Assessment of the safety was based on the evaluation of the course of therapy, the occurrence of adverse events including serious ones, deaths during treatment and in the post 12-wk follow-up period.
The studied population consisted of 11385 patients with a mean age of 53 ± 14.8 years and a female predominance (53.4%). The majority of them were treatment-naïve (74.6%) and patients with cirrhosis accounted for 24.3%. Of the DAA regimens used, 76.9% were GT-specific with ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin being the most used option (32.4%). A total of 10903 patients responded to treatment resulting in a 98.1% in the per-protocol analysis after excluding 273 patients without SVR data. The effectiveness of all regimens exceeded 90% and the highest SVR of 98.9% was achieved in patients treated with a combination of glecaprevir/pibrentasvir. Logistic regression analyses showed that the virologic response was independently associated with female sex [odds ratio (OR) = 1.67], absence of decompensated cirrhosis at baseline (OR = 2.42) and higher baseline platelets (OR = 1.004 per 1000/μL increase), while the presence of human immunodeficiency virus (HIV) coinfection significantly decreased the odds of response (OR = 0.39). About 95%-100% of patients completed therapy irrespective of the drug regimen. At least one adverse effect occurred in 10.9%-36.3% and most of them were mild. No treatment related deaths have been reported.
We documented very high effectiveness and a good safety profile across all DAA regimens. Positive predictors of SVR were female sex, absence of decompensated cirrhosis at baseline and higher platelet count while HIV coinfection reduced the effectiveness.
Core Tip: Our real-world analysis focused on a population of patients chronically infected with the genotype 1b of hepatitis C virus. In the interferon era, this was considered to be difficult to treat due to low cure rates. Although we documented the very good effectiveness of all interferon-free regimens, we have shown that in what is now described as the easiest to treat population, the chance of response to antiviral treatment is reduced by coinfection with human immunodeficiency virus, while female sex, absence of decompensated cirrhosis and higher platelets count at baseline, increase the chances of a cure.