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Review
. 2019 Dec;25(4):360-365.
doi: 10.3350/cmh.2019.0022. Epub 2019 May 2.

Upcoming direct acting antivirals for hepatitis C patients with a prior treatment failure

Tommaso Lorenzo Parigi  1   2 , Maria Corina Plaz Torres  1 , Alessio Aghemo  1   2
Affiliations
Review

Upcoming direct acting antivirals for hepatitis C patients with a prior treatment failure

Tommaso Lorenzo Parigi et al. Clin Mol Hepatol. 2019 Dec.

Abstract

Despite the high efficacy of direct acting antivirals (DAAs) not all patients successfully clear hepatitis C virus infection, in fact, approximately 1-3% fail to reach a sustained virological response 12 weeks after end of treatment. DAA failures are characterized by advanced liver disease, specific genotypes/subtypes and resistance associated substitutions to the DAA class they have been treated with. Current European Association for the Study of the Liver guidelines recommend three therapeutic options for such patients. The first is a 12 week course of sofosbuvir (SOF), velpatasvir (VEL) and voxilaprevir (VOX), which has shown to be effective in 90-99% of patients and was granted A1 level recommendation. The second option, reserved for patients who have predictors of failure consists in 12 weeks regimen with glecaprevir (GLE) and pibrentasvir (PIB), effective in 90-97%. Finally, although not supported by published data, for especially difficult to treat patients there should theoretically be a benefit in prolonged combinations of SOF+GLE/PIB or SOF/VEL/VOX±ribavirin. This review presents the latest evidence from both clinical trials and real-life on such therapeutic strategies.

Keywords: Antivirals; Hepatitis C virus (HCV); Re-treatment; Sofosbuvir.

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Conflict of interest statement

Conflicts of Interest

TLP, MCPT have nothing to discolose.

AA has received research grants from Gilead and Abbvie, and is an advisor for MSD, Gilead, Abbvie and Intercept.

Figures

Figure 1.
Figure 1.
Sustained virological response (SVR) rates to sofosbuvir/velapatasvir/voxilaprevir in previous direct acting antiviral fauilures. Sofosbuvir/velpatasvir/voxilaprevir for the re-treatment of direct acting antiviral failures. SVR12, sustained virological response at week 12.
Figure 2.
Figure 2.
SVR rates following re-treatment of direct acting antiviral (DAA) failures with glecaprevir/pibrentasvir. Glecaprevir/pibrentasvir for the retreatment of DAA failures. SVR12, sustained virological response at week 12; w, weeks.
See this image and copyright information in PMC

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