Effectiveness of Glecaprevir/Pibrentasvir for Hepatitis C: Real-World Experience and Clinical Features of Retreatment Cases

Abstract

Glecaprevir/pibrentasvir (G/P) are direct-acting antivirals (DAAs) that achieve a high sustained virological response (SVR) rate for hepatitis C virus (HCV) infection. We investigated G/P effectiveness for HCV patients based on real-world experience and the clinical features of retreatment cases. HCV patients (n = 182) were compared for clinical features and outcomes between first treatment (n = 159) and retreatment (n = 23) G/P groups. Overall, 77 patients (42.3%) were male, the median age was 68 years, and 86/66/1/4 cases had genotype 1/2/1 + 2/3, respectively. An SVR was achieved in 97.8% (178/182) of cases by intention-to-treat analysis and 99.4% (178/179) of cases by per-protocol analysis. There were no remarkable differences between the first treatment and retreatment groups for male (42.8% vs. 39.1%, p = 0.70), median age (68 vs. 68 years, p = 0.36), prior hepatocellular carcinoma (5.8% vs. 8.7%, p = 0.59), or the fibrosis markers AST-to-platelet ratio index (APRI) (0.5 vs. 0.5, p = 0.80) and fibrosis-4 (FIB-4) index (2.2 vs. 2.6, p = 0.59). The retreatment group had a significantly more frequent history of interferon treatment (12.3% vs. 52.2%, p < 0.01) and the Y93H mutation (25.0% vs. 64.7%, p = 0.02). The number of retreatment patients who had experienced 3, 2, and 1 DAA treatment failures was 1, 3, and 19, respectively, all of whom ultimately achieved an SVR by G/P treatment. In conclusion, G/P was effective and safe for both HCV first treatment and retreatment cases despite the retreatment group having specific resistance mutations for other prior DAAs. As G/P treatment failure has been reported for P32 deletions, clinicians should consider resistance mutations during DAA selection.

Quantitative and qualitative lipid improvement with chronic hepatitis C virus eradication using direct‐acting antivirals

“…1 Direct-acting antivirals (DAAs) have revolutionized HCV therapy, with sustained virological response (SVR) rates of over 95% for the most common genotypes regardless of comorbidities. [2][3][4][5][6] The achievement of an SVR by DAAs in patients with chronic HCV infection also implies substantial improvements in liver histological findings, liver function, gastroesophageal varices grades, HCC complication risk, and more in the clinical setting. [7][8][9] HCV hijacks hepatic lipid pathways in multiple aspects of its life cycle, starting with attachment of the HCV particle to lowdensity lipoprotein (LDL) and high-density lipoprotein (HDL) receptors of scavenger receptor class B type 1 and ensuing expression regulation, [10][11][12] all of which suggest a close association between HCV infection and serum lipid levels.…”

“…Chronic hepatitis C virus (HCV) infection remains a global health concern due to its risk of progression to advanced fibrosis, cirrhosis, and hepatocellular carcinoma (HCC) 1 . Direct‐acting antivirals (DAAs) have revolutionized HCV therapy, with sustained virological response (SVR) rates of over 95% for the most common genotypes regardless of comorbidities 2–6 . The achievement of an SVR by DAAs in patients with chronic HCV infection also implies substantial improvements in liver histological findings, liver function, gastroesophageal varices grades, HCC complication risk, and more in the clinical setting 7–9 …”

aMAP score prediction of hepatocellular carcinoma occurrence and incidence‐free rate after a sustained virologic response in chronic hepatitis C

“…Interferon‐based regimens were used for HCV eradication from the 1990s to the early 2010s and could achieve SVR rates of 40%–80% 5,6 . Afterwards, well‐tolerated, all‐oral, pan‐genotypic DAAs revolutionized chronic HCV treatment, with high SVR rates of over 95% regardless of prior HCC or decompensated cirrhosis 7–9 . Achievement of SVR by such regimens has been shown to improve liver fibrosis and decrease HCC incidence 10–14 .…”

Protocol: Prospective observational study aiming for micro-elimination of hepatitis C virus in Nagawa town: The Nagawa Project

“…Chronic infection leads to liver cirrhosis and eventually to hepatocellular carcinoma (HCC) [ 1 ], and remains the primary cause of liver cirrhosis and cancer in Japan [ 2 ]. However, advances in such therapeutic agents as direct acting antivirals (DAAs), with sustained virological response (SVR) rates of over 95% [ 3 , 4 ], have reached a stage where it is possible to eliminate HCV entirely.…”