Author/Authors :
Zarwbska-Michaluk, Dorota Department of Infectious Diseases - Voivodship Hospital and Jan Kochanowski University, Kielce, Poland , BuczyNska, Iwona Department of Infectious Diseases and Hepatology - Wrocław Medical University, Wrocław, Poland , Simon, Krzysztof Department of Infectious Diseases and Hepatology - Wrocław Medical University, Wrocław, Poland , Tudrujek-Zdunek, Magdalena Department of Infectious Diseases and Hepatology - Medical University of Lublin, Lublin, Poland , Janczewska, Ewa Department of Basic Medical Sciences - School of Public Health in Bytom - Medical University of Silesia, Katowice, Poland , Dybowska, Dorota Department of Infectious Diseases and Hepatology - Faculty of Medicine - Collegium Medicum Bydgoszcz - Nicolaus Copernicus University Torun, Poland , Sitko, Marek Department of Infectious and Tropical Diseases - Jagiellonian University Collegium Medicum - Krakow, Poland , Dobracka, Beata MED-FIX Medical Center - Wrocław, Poland , Jaroszewicz, Jerzy Department of Infectious Diseases - Medical University of Silesia in Katowice, Bytom, Poland , Pabjan, PaweB Department of Infectious Diseases - Voivodship Hospital and Jan Kochanowski University, Kielce, Poland , KlapaczyNski, Jakub Department of Internal Medicine and Hepatology - Central Clinical Hospital of the Ministry of Internal Afairs and Administration, Warsaw, Poland , Laurans, Aukasz Multidisciplinary Regional Hospital in Gorzow Wielkopolski - Gorzow Wielkopolski, Poland , Mazur, WBodzimierz Clinical Department of Infectious Diseases - Specialist Hospital in Chorzow - Medical University of Silesia, Katowice, Poland , Socha, Aukasz Department of Infectious Diseases - Hepatology and Liver Transplantation - Pomeranian Medical University - Szczecin, Poland , Tronina, Olga Department of Transplantation Medicine Nephrology and Internal Diseases - Medical University of Warsaw, Warsaw, Poland , Parczewski, MiBosz Department of Infectious - Tropical Diseases and Acquired Immunodefciency - Pomeranian Medical University, Szczecin, Poland , Flisiak, Robert Department of Infectious Diseases - Voivodship Hospital and Jan Kochanowski University, Kielce, Poland
Abstract :
Background and Aim
The development of interferon- (IFN-) free regimens substantially improved efficacy of treatment for HCV, but despite excellent effectiveness the failures still occur. The aim of our study was to evaluate the efficacy of retreatment with genotype specific direct acting antivirals- (DAA-) based regimens in nonresponders to previous IFN-free therapy.
Materials and Methods
Analysed population consisted of 31 nonresponders to IFN-free regimen, which received second IFN-free rescue therapy, selected from 6228 patients included in a national database EpiTer-2.
Results
Age and gender distribution were similar, whereas proportion of genotype 1b was slightly higher and genotype 4 lower in the whole population compared to studied one. Patients included in the study demonstrated much more advanced fibrosis. Primary therapy was discontinued in 12 patients, which were recognized as failures due to nonvirologic reason, whereas virologic reason of therapeutic failure was recognized in 19 patients which completed therapy. Overall sustained virologic response (SVR) rate was 81% and 86% in intent-to-treat (ITT) and modified ITT analysis, respectively (74% and 78% in virologic failures, 92% and 100% in nonvirologic failures). Resistance-associated substitutions (RAS) testing was carried out in 8 patients from the group of completed primary therapy and three of them had potential risk for failure of rescue therapy due to NS5A association, while two of them achieved SVR.
Conclusions
We demonstrated moderate effectiveness of genotype specific rescue therapy in failures due to virologic reason and high in those who discontinued primary therapy. Therefore rescue therapy with genotype specific regimens should be considered always if more potent regimens are not available.
