Background & Aims: In the direct-acting antiviral era, treatment of genotype-3 HCV (HCV-GT3) is still challenging. Real-life comparisons between recommended regimens, sofosbuvir (SOF)+daclatasvir (DAC), SOF/velpatasvir (VEL), glecaprevir/pibrentasvir (GLE/PIB), are scarce. We aimed at filling this data gap. Methods: Sustained virological response 12 weeks after treatment completion (SVR12) was assessed for all HCV-GT3 patients consecutively treated within the Lombardia web-based Navigatore HCV-Network; differences in SVR12 across regimens were evaluated by logistic regression. Results: Of the 2082 subjects with HCV-GT3, 1544 were evaluable for comparisons between regimens: SOF + DAC (1023, 66.2%), SOF/VEL (369, 23.9%), GLE/PIB (152, 9.8%). Patients treated with former regimens were more frequently male, cirrhotic, HIV-positive, pretreated, used ribavirin in their regimen, and had lower baseline HCV-RNA. SVR12 was similar across groups: 94.8% in SOF + DAC, 97.6% in SOF/VEL, 96.7% in GLE/PIB (P =.065). At univariate analysis, SVR12 was associated with female gender (97.9% vs 94.8%, P =.007) and lower median pretreatment Log10HCV-RNA (5.87 vs 6.20, P =.001). At multivariate logistic regression analysis, treatment with SOF/VEL was associated with a higher likelihood of SVR12 than SOF + DAC, but only in the absence of ribavirin (98% vs 90.3%). Female gender and lower pretreatment HCV-RNA were independently associated with SVR12. Conclusions: In a large real-life setting of HCV-GT3-infected patients with a high proportion of cirrhosis, the success rate was remarkable. The slight advantage of SOF/VEL on SOF + DAC was significant only without ribavirin. The current prescription shift towards novel regimens (ie SOF/VEL and GLE/PIB) in easier-to-treat patients allows ribavirin-free and shorter schedules without mining SVR12 in this <> genotype.

Comparison of three therapeutic regimens for genotype-3 hepatitis C virus infection in a large real-life multicentre cohort / A. Soria, M. Fava, D.P. Bernasconi, G. Lapadula, E. Colella, M.G. Valsecchi, G.M. Migliorino, R. D'Ambrosio, S. Landonio, M. Schiavini, A. Spinetti, C. Carriero, E. Degasperi, G. Cologni, F. Gatti, P. Vigano, H. Hasson, C. Uberti-Foppa, L. Pasulo, C. Baiguera, R. Rossotti, M. Vinci, M. Puoti, A. Giorgini, B. Menzaghi, A. Lombardi, A. Pan, A. Aghemo, P.A. Grossi, R. Boldizzoni, S. Colombo, M. Vigano, M.G. Rumi, P. Del Poggio, L. Valenti, O. Giglio, A. De Bona, A. d'Arminio Monforte, A. Colombo, O. Spinelli, M.G. Pigozzi, C. Molteni, P. Bonfanti, N. Terreni, P. Perini, A. Capretti, D. Bella, C. Liani, S. Polo, G. Aimo, L. Pagnucco, S. Bhoori, R. Centenaro, M. Graffeo, A. Ciaccio, E. Dionigi, S. Lazzaroni, I. Carderi, M. Di Marco, G. Rizzardini, F. Noventa, P. Lampertico, S. Fagiuoli. - In: LIVER INTERNATIONAL. - ISSN 1478-3223. - 40:4(2020 Apr), pp. 769-777. [10.1111/liv.14386]

Comparison of three therapeutic regimens for genotype-3 hepatitis C virus infection in a large real-life multicentre cohort

Lapadula G.;Valsecchi M. G.;Carriero C.;Degasperi E.;Pasulo L.;Baiguera C.;Menzaghi B.;Lombardi A.;Aghemo A.;Rumi M. G.;Valenti L.;De Bona A.;d'Arminio Monforte A.;Bonfanti P.;Perini P.;Capretti A.;Ciaccio A.;Lampertico P.;
2020-04

Abstract

Background & Aims: In the direct-acting antiviral era, treatment of genotype-3 HCV (HCV-GT3) is still challenging. Real-life comparisons between recommended regimens, sofosbuvir (SOF)+daclatasvir (DAC), SOF/velpatasvir (VEL), glecaprevir/pibrentasvir (GLE/PIB), are scarce. We aimed at filling this data gap. Methods: Sustained virological response 12 weeks after treatment completion (SVR12) was assessed for all HCV-GT3 patients consecutively treated within the Lombardia web-based Navigatore HCV-Network; differences in SVR12 across regimens were evaluated by logistic regression. Results: Of the 2082 subjects with HCV-GT3, 1544 were evaluable for comparisons between regimens: SOF + DAC (1023, 66.2%), SOF/VEL (369, 23.9%), GLE/PIB (152, 9.8%). Patients treated with former regimens were more frequently male, cirrhotic, HIV-positive, pretreated, used ribavirin in their regimen, and had lower baseline HCV-RNA. SVR12 was similar across groups: 94.8% in SOF + DAC, 97.6% in SOF/VEL, 96.7% in GLE/PIB (P =.065). At univariate analysis, SVR12 was associated with female gender (97.9% vs 94.8%, P =.007) and lower median pretreatment Log10HCV-RNA (5.87 vs 6.20, P =.001). At multivariate logistic regression analysis, treatment with SOF/VEL was associated with a higher likelihood of SVR12 than SOF + DAC, but only in the absence of ribavirin (98% vs 90.3%). Female gender and lower pretreatment HCV-RNA were independently associated with SVR12. Conclusions: In a large real-life setting of HCV-GT3-infected patients with a high proportion of cirrhosis, the success rate was remarkable. The slight advantage of SOF/VEL on SOF + DAC was significant only without ribavirin. The current prescription shift towards novel regimens (ie SOF/VEL and GLE/PIB) in easier-to-treat patients allows ribavirin-free and shorter schedules without mining SVR12 in this <> genotype.
daclatasvir; genotype 3; glecaprevir; Hepatitis C; pibrentasvir; ribavirin; sofosbuvir; sustained virological response; velpatasvir
Settore MED/09 - Medicina Interna
feb-2020
LIVER INTERNATIONAL
Article (author)
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2434/727191
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