Monjur Ahmed*, Raja Koteswar Dhanekula, Charles Kistler, Amy Javia and Divya Chalikonda
Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital, USAFulltext PDF
Background: DAA failure was seen in a small percentage of Hepatitis C (HCV) infected patients in clinical trials. The incidence of this DAA failure against HCV infection may vary in clinical practice. Those patients who had initial DAA failure are generally managed with an alternate regimen of DAA or by addition of ribavirin for a longer duration. Aims: To find out the incidence of DAA failure in clinical practice and also to define the associated clinical characteristics and DAA regimen used in those patients. Methods: Retrospective, single center study conducted at a tertiary care center utilizing an Electronic Medical Record (EMR) of all patients treated with DAAs for HCV infection at our institution. We analyzed the database for patients who did not achieve Sustained Virological Response at 24 weeks (SVR24) between October 2014 and July 2017. The DAA failure rate, viral genotypes and related host factors were evaluated in this group. Patients were excluded if full treatment course of DAA was not completed. Results: Total 1686 patients received treatment of HCV infection with DAA during the study period, 53 patients (3.14%) of them did not achieve SVR24. 9 of the 53 patients (16.9%) were excluded due to an incomplete course, leaving 44 cases for review. 56.8% of patients were treatment naïve, and 43.2% were treatment-experienced to prior antiviral therapy. DAA failure was most commonly seen in the Ribavirin (RBV)/Sofosbuvir (SOF) group (40.9%), males (81.8%), cirrhotics (63.6%), and in patients who received proton pump inhibitor therapy (27.3%). Conclusion: DAA failure rate in the treatment of hepatitis C was low (3.14%) in our study. The DAA failure group had varying clinical and viral characteristics. PPI therapy should be avoided with certain DAA therapy. In case of DAA failure, different DAA regimen should be used or ribavirin should be added to the existing one for a longer duration. A better understanding of patients’ clinical characteristics and viral resistance may guide future treatment algorithms.
Direct acting anti-virals (DAA) for hepatitis C; DAA failure; Treatment of hepatitis C; HCV infection
Ahmed M, Koteswar Dhanekula R, Kistler C, Javia A, Chalikonda D. Hepatitis C Treatment Failure with Direct Acting Antiviral Therapy: Demographics and Clinical Management. Ann Clin Hepatol. 2019; 3(1): 1011..