Changes in characteristics of patients with hepatitis C virus-related cirrhosis from the beginning of the interferon-free era

Abstract

BACKGROUND Nearly 290000 patients with chronic hepatitis C die annually from the most severe complications of the disease. One of them is liver cirrhosis, which occurs in about 20% of patients chronically infected with the hepatitis C virus (HCV). Direct-acting antivirals (DAAs), which replaced interferon (IFN)-based regimens, significantly improved the prognosis of this group of patients, increasing HCV eradication rates and tolerability of therapy. Our study is the first to assess changes in patient profile, effectiveness, and safety in the HCV-infected cirrhotic population in the IFN-free era. AIM To document changes in patient characteristics and treatment regimens along with their effectiveness and safety profile over the years. METHODS The studied patients were selected from 14801 chronically HCV-infected individuals who started IFN-free therapy between July 2015 and December 2021 in 22 Polish hepatology centers. The retrospective analysis was conducted in real-world clinical practice based on the EpiTer-2 multicenter database. The measure of treatment effectiveness was the percentage of sustained virologic response (SVR) calculated after excluding patients lost to follow-up. Safety data collected during therapy and the 12-wk post-treatment period included information on adverse events, including serious ones, deaths, and treatment course. RESULTS The studied population ( n = 3577) was balanced in terms of gender in 2015-2017, while the following years showed the dominance of men. The decline in the median age from 60 in 2015-2016 to 57 years in 2021 was accompanied by a decrease in the percentage of patients with comorbidities and comedications. Treatment-experienced patients dominated in 2015-2016, while treatment-naive individuals gained an advantage in 2017 and reached 93.2% in 2021. Genotype (GT)-specific options were more prevalent in treatment in 2015-2018 and were supplanted by pangenotypic combinations in subsequent years. The effectiveness of the therapy was comparable regardless of the period analyzed, and patients achieved an overall response rate of 95%, with an SVR range of 72.9%-100% for the different therapeutic regimens. Male gender, GT3 infection, and prior treatment failure were identified as independent negative predictors of therapeutic success. CONCLUSION We have documented changes in the profile of HCV-infected cirrhotic patients over the years of accessibility to changing DAA regimens, confirming the high effectiveness of IFN-free therapy in all analyzed periods.

Direct-Acting Antivirals Remain Cost-Effective Treatments for Chronic Hepatitis C in Australia Despite Changes to the Treated Population and the Availability of Retreatment: The Glecaprevir/Pibrentasvir (Maviret®) Example

“…Since the initial availability of DAAs, the demographic and disease characteristics of treated patients were substantially different to those undergoing antiviral treatment in Australia in 2022 (Table 2 ). This evolution of patient demographics is consistent with changes amongst HCV populations prescribed DAAs globally, demonstrating the relevance of this research in other countries [ 10 – 12 ]. Many patients with a primary diagnosis of HCV-related cirrhosis have now been treated [ 13 ], and thus most patients being presently treated have mild/moderate fibrosis at treatment initiation.…”

Gene-Editing and RNA Interference in Treating Hepatitis B: A Review

“…This may be similar to the era of interferon treatments in hepatitis C, which, apart from tolerance issues, were challenging due to their regime. The field was revolutionized with the subsequent introduction of direct-acting antivirals that are available orally [153,154]. Obviously, there are several differences between the hepatitis C virus and HBV, a major one being the ability of the latter to form cccDNA, preventing a similar treatment approach.…”