Hepatitis C re-treatment with first line direct acting antiviral drugs

Abstract

Background and Aim: Sofosbuvir (S) in combination with daclatasvir [D], ledipasvir, or velpatasvir [V] cures hepatitis C virus (HCV) viremia in 90-95% patients. We reportour experience of HCV retreatment using them in patients who had relapsed after their use. Methods: Study included adults who had relapsed after a single complete course of sofosbuvir containing first-lineanti-HCV treatment with or without pegylated-interferonor ribavirin (R). The retreatment was tailored, according to the prior regimen to which the participants hadrelapsed, and was designed on principles of using the first-line anti-HCV drugs, 24 weeks of treatment, addition of ribavirin, and swapping between pangenotypic and genotype- specific regimens. Treatment outcome were categorized as successful (SVR12) or relapse (HCV RNA negative at the end of treatment but not achieved SVR12). Results: Fourteen patients (11 males; 9 cirrhosis; all genotype 3) who relapsed to prior anti-HCV treatment (4 SD24,4 SD12, 2 SV12, 1 SDR24, 1 SDR12, 1 SR24, 1 SPR12) were included. On retreatment (4 SDR24, 10 SVR24), all the participants achieved RVR4 and ETR whereas 9 (75%) achievedSVR12. Two among three, in whom retreatment failed,achieved SVR12 after second course of sofosbuvir/velpatas-vir/ribavirin for 24 weeks. Overall, 13/14 (93%) patients achieved SVR12 following retreatment with the first-line DAAs available in the country. Conclusions: In conclusion, if newer DAAs are not available, HCV retreatment may be considered with the use of first-line DAAs for 24 weeks with ribavirin, and swapping between pangenotypic and genotype-specific regimen(NCT03483987).