Optimization of direct anti-viral agent treatment schedule: Focus on HCV genotype 3

for the ITAL-C consortium

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

Background and aim: Direct antiviral agents (DAAs) have led to high sustained virological responses (SVR) in hepatitis C virus (HCV) patients. However, genotype 3 patients respond to treatment in a suboptimal way. This study aims to identify which of the several treatment schedules recommended for genotype 3 would constitute the best option. Methods: Twenty-four Italian centers were involved in this real-life study of HCV genotype 3 patients treated with DAAs. To expand the number of cases, we conducted a systematic review of the literature on the outcome of genotype 3 patients treated with DAAs. Results: A total of 233 patients with HCV genotype 3 were enrolled. Cirrhotic patients accounted for 83.7%. Overall, the SVR12 rate was achieved by 205 patients (88.0%); the SVR rates were 78.8% after sofosbuvir/ribavirin, 92.5% after sofosbuvir/daclatasvir ± ribavirin, and 100% after sofosbuvir/ledipasvir (seven patients). No difference in rate of SVR was observed in cirrhotic and non-cirrhotic patients (92.2 vs 94.4) using a combination regimen of NS5A and NS5B inhibitors. The systematic review of the literature provided data of 3311 patients: The mean weighted SVR12 rate was 84.4% (CI: 80.4–87.8); the rates varied from 79.0% (CI: 70.9–85.3) with sofosbuvir/ribavirin, to 83.7% (CI: 66.2–93.1) with sofosbuvir/ledispavir, and to 88.2% (CI: 83.3–91.7) with sofosbuvir/daclatasvir. Conclusions: Our results reinforce the concept that patients with HCV genotype 3 should no longer be considered difficult-to-treat individuals. The optimal therapeutic regimen for these patients appears to be the combination sofosbuvir/daclatasvir, administered for 12 weeks without the use of RBV in non-cirrhotic patients. In cirrhotics the meta-analytic approach suggests extending therapy to 24 weeks.

Original languageEnglish
Pages (from-to)225-237
Number of pages13
JournalUnited European Gastroenterology Journal
Volume6
Issue number2
DOIs
Publication statusPublished - Mar 1 2018

Fingerprint

Hepacivirus
Appointments and Schedules
Genotype
Ribavirin
Therapeutics
Antiviral Agents
Sofosbuvir

Keywords

  • cirrhosis
  • direct antiviral agent
  • genotype 3
  • HCV
  • meta-analysis

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

Cite this

Optimization of direct anti-viral agent treatment schedule : Focus on HCV genotype 3. / for the ITAL-C consortium.

In: United European Gastroenterology Journal, Vol. 6, No. 2, 01.03.2018, p. 225-237.

Research output: Contribution to journalReview article

@article{b1056cc8eba541b8a27920de8e7ffbd0,
title = "Optimization of direct anti-viral agent treatment schedule: Focus on HCV genotype 3",
abstract = "Background and aim: Direct antiviral agents (DAAs) have led to high sustained virological responses (SVR) in hepatitis C virus (HCV) patients. However, genotype 3 patients respond to treatment in a suboptimal way. This study aims to identify which of the several treatment schedules recommended for genotype 3 would constitute the best option. Methods: Twenty-four Italian centers were involved in this real-life study of HCV genotype 3 patients treated with DAAs. To expand the number of cases, we conducted a systematic review of the literature on the outcome of genotype 3 patients treated with DAAs. Results: A total of 233 patients with HCV genotype 3 were enrolled. Cirrhotic patients accounted for 83.7{\%}. Overall, the SVR12 rate was achieved by 205 patients (88.0{\%}); the SVR rates were 78.8{\%} after sofosbuvir/ribavirin, 92.5{\%} after sofosbuvir/daclatasvir ± ribavirin, and 100{\%} after sofosbuvir/ledipasvir (seven patients). No difference in rate of SVR was observed in cirrhotic and non-cirrhotic patients (92.2 vs 94.4) using a combination regimen of NS5A and NS5B inhibitors. The systematic review of the literature provided data of 3311 patients: The mean weighted SVR12 rate was 84.4{\%} (CI: 80.4–87.8); the rates varied from 79.0{\%} (CI: 70.9–85.3) with sofosbuvir/ribavirin, to 83.7{\%} (CI: 66.2–93.1) with sofosbuvir/ledispavir, and to 88.2{\%} (CI: 83.3–91.7) with sofosbuvir/daclatasvir. Conclusions: Our results reinforce the concept that patients with HCV genotype 3 should no longer be considered difficult-to-treat individuals. The optimal therapeutic regimen for these patients appears to be the combination sofosbuvir/daclatasvir, administered for 12 weeks without the use of RBV in non-cirrhotic patients. In cirrhotics the meta-analytic approach suggests extending therapy to 24 weeks.",
keywords = "cirrhosis, direct antiviral agent, genotype 3, HCV, meta-analysis",
author = "{for the ITAL-C consortium} and Filomena Morisco and Rocco Granata and Silvia Camera and Antonio Ippolito and Michele Milella and Fabio Conti and Chiara Masetti and Antonella Smedile and Paolo Tundo and Teresa Santantonio and Valvano, {Maria Rosa} and Antonio Termite and Pietro Gatti and Vincenzo Messina and Angelo Iacobellis and Marta Librandi and Nicola Caporaso and Angelo Andriulli",
year = "2018",
month = "3",
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doi = "10.1177/2050640617717158",
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TY - JOUR

T1 - Optimization of direct anti-viral agent treatment schedule

T2 - Focus on HCV genotype 3

AU - for the ITAL-C consortium

AU - Morisco, Filomena

AU - Granata, Rocco

AU - Camera, Silvia

AU - Ippolito, Antonio

AU - Milella, Michele

AU - Conti, Fabio

AU - Masetti, Chiara

AU - Smedile, Antonella

AU - Tundo, Paolo

AU - Santantonio, Teresa

AU - Valvano, Maria Rosa

AU - Termite, Antonio

AU - Gatti, Pietro

AU - Messina, Vincenzo

AU - Iacobellis, Angelo

AU - Librandi, Marta

AU - Caporaso, Nicola

AU - Andriulli, Angelo

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background and aim: Direct antiviral agents (DAAs) have led to high sustained virological responses (SVR) in hepatitis C virus (HCV) patients. However, genotype 3 patients respond to treatment in a suboptimal way. This study aims to identify which of the several treatment schedules recommended for genotype 3 would constitute the best option. Methods: Twenty-four Italian centers were involved in this real-life study of HCV genotype 3 patients treated with DAAs. To expand the number of cases, we conducted a systematic review of the literature on the outcome of genotype 3 patients treated with DAAs. Results: A total of 233 patients with HCV genotype 3 were enrolled. Cirrhotic patients accounted for 83.7%. Overall, the SVR12 rate was achieved by 205 patients (88.0%); the SVR rates were 78.8% after sofosbuvir/ribavirin, 92.5% after sofosbuvir/daclatasvir ± ribavirin, and 100% after sofosbuvir/ledipasvir (seven patients). No difference in rate of SVR was observed in cirrhotic and non-cirrhotic patients (92.2 vs 94.4) using a combination regimen of NS5A and NS5B inhibitors. The systematic review of the literature provided data of 3311 patients: The mean weighted SVR12 rate was 84.4% (CI: 80.4–87.8); the rates varied from 79.0% (CI: 70.9–85.3) with sofosbuvir/ribavirin, to 83.7% (CI: 66.2–93.1) with sofosbuvir/ledispavir, and to 88.2% (CI: 83.3–91.7) with sofosbuvir/daclatasvir. Conclusions: Our results reinforce the concept that patients with HCV genotype 3 should no longer be considered difficult-to-treat individuals. The optimal therapeutic regimen for these patients appears to be the combination sofosbuvir/daclatasvir, administered for 12 weeks without the use of RBV in non-cirrhotic patients. In cirrhotics the meta-analytic approach suggests extending therapy to 24 weeks.

AB - Background and aim: Direct antiviral agents (DAAs) have led to high sustained virological responses (SVR) in hepatitis C virus (HCV) patients. However, genotype 3 patients respond to treatment in a suboptimal way. This study aims to identify which of the several treatment schedules recommended for genotype 3 would constitute the best option. Methods: Twenty-four Italian centers were involved in this real-life study of HCV genotype 3 patients treated with DAAs. To expand the number of cases, we conducted a systematic review of the literature on the outcome of genotype 3 patients treated with DAAs. Results: A total of 233 patients with HCV genotype 3 were enrolled. Cirrhotic patients accounted for 83.7%. Overall, the SVR12 rate was achieved by 205 patients (88.0%); the SVR rates were 78.8% after sofosbuvir/ribavirin, 92.5% after sofosbuvir/daclatasvir ± ribavirin, and 100% after sofosbuvir/ledipasvir (seven patients). No difference in rate of SVR was observed in cirrhotic and non-cirrhotic patients (92.2 vs 94.4) using a combination regimen of NS5A and NS5B inhibitors. The systematic review of the literature provided data of 3311 patients: The mean weighted SVR12 rate was 84.4% (CI: 80.4–87.8); the rates varied from 79.0% (CI: 70.9–85.3) with sofosbuvir/ribavirin, to 83.7% (CI: 66.2–93.1) with sofosbuvir/ledispavir, and to 88.2% (CI: 83.3–91.7) with sofosbuvir/daclatasvir. Conclusions: Our results reinforce the concept that patients with HCV genotype 3 should no longer be considered difficult-to-treat individuals. The optimal therapeutic regimen for these patients appears to be the combination sofosbuvir/daclatasvir, administered for 12 weeks without the use of RBV in non-cirrhotic patients. In cirrhotics the meta-analytic approach suggests extending therapy to 24 weeks.

KW - cirrhosis

KW - direct antiviral agent

KW - genotype 3

KW - HCV

KW - meta-analysis

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