Optimal efficacy of interferon-free HCV retreatment after protease inhibitor failure in real life
- Creators
- Cento, V.
- Barbaliscia, S.
- Lenci, I.
- Ruggiero, T.
- Magni, C. F.
- Paolucci, S.
- Babudieri, S.
- Siciliano, M.
- Pasquazzi, C.
- Ciancio, A.
- Perno, C. F.
- Ceccherini-silberstein, F.
- Micheli, V.
- Troshina, Y.
- Biliotti, E.
- Milana, M.
- Melis, M.
- Teti, E.
- Lambiase, L.
- Menzaghi, B.
- Nicolini, L
- Marenco, S.
- Di Maio, V. C.
- Aragri, M.
- Pecchioli, A.
- Bertoli, A.
- Sarrecchia, C.
- Macera, M.
- Coppola, N.
- Puoti, M.
- Romagnoli, D.
- Pellicelli, A.
- Bonora, S.
- Novati, S.
- Baldanti, F.
- Ghisetti, V.
- Andreoni, M.
- Taliani, G.
- Rizzardini, G.
- Angelico, M.
- Others:
- Cento, V.
- Barbaliscia, S.
- Lenci, I.
- Ruggiero, T.
- Magni, C. F.
- Paolucci, S.
- Babudieri, S.
- Siciliano, M.
- Pasquazzi, C.
- Ciancio, A.
- Perno, C. F.
- Ceccherini-silberstein, F.
- Micheli, V.
- Troshina, Y.
- Biliotti, E.
- Milana, M.
- Melis, M.
- Teti, E.
- Lambiase, L.
- Menzaghi, B.
- Nicolini, L
- Marenco, S.
- Di Maio, V. C.
- Aragri, M.
- Pecchioli, A.
- Bertoli, A.
- Sarrecchia, C.
- Macera, M.
- Coppola, N.
- Puoti, M.
- Romagnoli, D.
- Pellicelli, A.
- Bonora, S.
- Novati, S.
- Baldanti, F.
- Ghisetti, V.
- Andreoni, M.
- Taliani, G.
- Rizzardini, G.
- Angelico, M.
Description
Objectives First-generation protease-inhibitors (PIs) have suboptimal efficacy in GT-1 patients with advanced liver disease, and patients experiencing treatment failure may require urgent retreatment. Our objective was to analyse the real-life efficacy of interferon (IFN)-free retreatment after PI-failure, and the role of genotypic-resistance-testing (GRT) in guiding retreatment choice. Methods In this multi-centre observational study, patients retreated with IFN-free regimens after first-generation PI-failure (telaprevir-boceprevir-simeprevir) were included. Sustained-virological-response (SVR) was evaluated at week 12 of follow-up. GRT was performed by population-sequencing. Results After PI-failure, 121 patients (cirrhotic = 86.8%) were retreated following three different strategies: A) with 'GRT-guided' regimens (N = 18); B) with 'AASLD/EASL recommended, not GRT-guided' regimens (N = 72); C) with 'not recommended, not GRT-guided' regimens (N = 31). Overall SVR rate was 91%, but all 18 patients treated with 'GRT-guided' regimens reached SVR (100%), despite heterogeneity in treatment duration, use of PI and ribavirin, versus 68/72 patients (94.4%) receiving 'AASLD/EASL recommended, not GRT-guided' regimens. SVR was strongly reduced (77.4%) among the 31 patients who received a 'not recommended, not GRT-guided regimen' (p <0.01). Among 37 patients retreated with a PI, SVR rate was 89.2% (33/37). Four GT-1a cirrhotic patients failed an option (C) simeprevir-containing treatment; three out of four had a baseline R155K NS3-RAS. All seven patients treated with paritaprevir-containing regimens reached SVR, regardless of treatment duration and performance of a baseline-GRT. Conclusion Retreatment of PI-experienced patients can induce maximal SVR rates in real life. Baseline-GRT could help to optimize retreatment strategy, allowing PIs to be reconsidered when chosen after a RASs evaluation.
Additional details
- URL
- http://hdl.handle.net/11567/882929
- URN
- urn:oai:iris.unige.it:11567/882929
- Origin repository
- UNIGE