Optimal efficacy of interferon-free HCV retreatment after protease inhibitor failure in real life

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.

doi:10.1016/j.cmi.2017.04.005

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 âGRT-guidedâ regimens (N = 18); B) with âAASLD/EASL recommended, not GRT-guidedâ regimens (N = 72); C) with ânot recommended, not GRT-guidedâ regimens (N = 31). Overall SVR rate was 91%, but all 18 patients treated with âGRT-guidedâ regimens reached SVR (100%), despite heterogeneity in treatment duration, use of PI and ribavirin, versus 68/72 patients (94.4%) receiving âAASLD/EASL recommended, not GRT-guidedâ regimens. SVR was strongly reduced (77.4%) among the 31 patients who received a ânot recommended, not GRT-guided regimenâ (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.

Optimal efficacy of interferon-free HCV retreatment after protease inhibitor failure in real life

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.

2017-01-01

Abstract

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 âGRT-guidedâ regimens (N = 18); B) with âAASLD/EASL recommended, not GRT-guidedâ regimens (N = 72); C) with ânot recommended, not GRT-guidedâ regimens (N = 31). Overall SVR rate was 91%, but all 18 patients treated with âGRT-guidedâ regimens reached SVR (100%), despite heterogeneity in treatment duration, use of PI and ribavirin, versus 68/72 patients (94.4%) receiving âAASLD/EASL recommended, not GRT-guidedâ regimens. SVR was strongly reduced (77.4%) among the 31 patients who received a ânot recommended, not GRT-guided regimenâ (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.