High efficacy of resistance-guided retreatment of HCV patients failing NS5A inhibitors in the real world

Abstract Background & Aims Most hepatitis C virus (HCV)-infected patients failing NS5A inhibitors develop resistance-associated substitutions (RASs). Here we report the use of resistance-guided retreatment of patients who failed prior NS5A inhibitor-containing regimens in the GEHEP-004 cohort. T...

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Autores: Pérez, Ana Belén, Chueca, Natalia, García Deltoro, Miguel, Martínez Sapiña, Ana María, Lara Pérez, María MAgdalena, García Bujalance, Silvia, Aldámiz Echevarría, Teresa, Vera Méndez, Francisco Jesús, Pineda, Juan Antonio, Casado, Marta, Pascasio, Juan Manuel, Salmerón, Javier, Alados Arboledas, Juan Carlos, Poyato, Antonio, Téllez, Francisco, Rivero Juárez, Antonio, Merino, Dolores, Vivancos Gallego, María Jesús, Rosales Zábal, José Miguel, García, Federico
Tipo de recurso: artículo
Fecha de publicación:2019
País:España
Institución:Universidad Católica San Antonio de Murcia (UCAM)
Repositorio:RIUCAM. Repositorio Institucional de la Universidad Católica San Antonio de Murcia
OAI Identifier:oai:repositorio.ucam.edu:10952/9058
Acceso en línea:http://hdl.handle.net/10952/9058
Access Level:acceso abierto
Palabra clave:HCV
RASs
Treatment failure
Resistance testing
Resistance-associated substitution
Direct-acting antivirals
Ribavirin
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spelling High efficacy of resistance-guided retreatment of HCV patients failing NS5A inhibitors in the real worldPérez, Ana BelénChueca, NataliaGarcía Deltoro, MiguelMartínez Sapiña, Ana MaríaLara Pérez, María MAgdalenaGarcía Bujalance, SilviaAldámiz Echevarría, TeresaVera Méndez, Francisco JesúsPineda, Juan AntonioCasado, MartaPascasio, Juan ManuelSalmerón, JavierAlados Arboledas, Juan CarlosPoyato, AntonioTéllez, FranciscoRivero Juárez, AntonioMerino, DoloresVivancos Gallego, María JesúsRosales Zábal, José MiguelGarcía, FedericoHCVRASsTreatment failureResistance testingResistance-associated substitutionDirect-acting antiviralsRibavirinAbstract Background & Aims Most hepatitis C virus (HCV)-infected patients failing NS5A inhibitors develop resistance-associated substitutions (RASs). Here we report the use of resistance-guided retreatment of patients who failed prior NS5A inhibitor-containing regimens in the GEHEP-004 cohort. This is the largest direct-acting antiviral (DAA)-resistance cohort study conducted in Spain. We aim to provide indications on how to use resistance information in settings where sofosbuvir/velpatasvir/voxilaprevir may not be available. Methods GEHEP-004 is a prospective multicenter cohort enrolling HCV-infected patients treated with interferon (IFN)-free DAA regimens. Prior to retreatment, population-based sequencing of HCV NS3, NS5A and NS5B genes was performed. After receiving a comprehensive resistance interpretation report, the retreatment regimen was chosen and the sustained virological response (SVR) at 12 weeks after treatment completion (SVR12) was recorded. Results A total of 342 patients experiencing virological failure after treatment with sofosbuvir/ledipasvir±ribavirin (54%), sofosbuvir/daclatasvir±ribavirin (23%), or paritaprevir-ritonavir/ombitasvir±dasabuvir±ribavirin (20%) were studied. After a resistance report, 186 patients were retreated. An SVR12 was achieved for 88.1% of the patients who failed after sofosbuvir/ledipasvir±ribavirin, 83.3% of the patients who failed after sofosbuvir/daclatasvir±ribavirin, 93.7% of the patients who failed after paritaprevir-ritonavir+ombitasvir±dasabuvir±ribavirin. Conclusions In our study, we show how resistance-guided retreatment in conjunction with an interpreted report allows patients to achieve SVR rates close to 90%. We hypothesize that SVR rates may even be improved if resistance data are discussed between experienced virologists and treating clinicians. We believe that our data may be relevant for countries where the access to new DAA combination regimens is limited.MedicinaMedicina2019info:eu-repo/semantics/articlehttp://hdl.handle.net/10952/9058reponame:RIUCAM. Repositorio Institucional de la Universidad Católica San Antonio de Murciainstname:Universidad Católica San Antonio de Murcia (UCAM)Inglésinfo:eu-repo/semantics/openAccessoai:repositorio.ucam.edu:10952/90582026-06-07T18:35:21Z
dc.title.none.fl_str_mv High efficacy of resistance-guided retreatment of HCV patients failing NS5A inhibitors in the real world
title High efficacy of resistance-guided retreatment of HCV patients failing NS5A inhibitors in the real world
spellingShingle High efficacy of resistance-guided retreatment of HCV patients failing NS5A inhibitors in the real world
Pérez, Ana Belén
HCV
RASs
Treatment failure
Resistance testing
Resistance-associated substitution
Direct-acting antivirals
Ribavirin
title_short High efficacy of resistance-guided retreatment of HCV patients failing NS5A inhibitors in the real world
title_full High efficacy of resistance-guided retreatment of HCV patients failing NS5A inhibitors in the real world
title_fullStr High efficacy of resistance-guided retreatment of HCV patients failing NS5A inhibitors in the real world
title_full_unstemmed High efficacy of resistance-guided retreatment of HCV patients failing NS5A inhibitors in the real world
title_sort High efficacy of resistance-guided retreatment of HCV patients failing NS5A inhibitors in the real world
dc.creator.none.fl_str_mv Pérez, Ana Belén
Chueca, Natalia
García Deltoro, Miguel
Martínez Sapiña, Ana María
Lara Pérez, María MAgdalena
García Bujalance, Silvia
Aldámiz Echevarría, Teresa
Vera Méndez, Francisco Jesús
Pineda, Juan Antonio
Casado, Marta
Pascasio, Juan Manuel
Salmerón, Javier
Alados Arboledas, Juan Carlos
Poyato, Antonio
Téllez, Francisco
Rivero Juárez, Antonio
Merino, Dolores
Vivancos Gallego, María Jesús
Rosales Zábal, José Miguel
García, Federico
author Pérez, Ana Belén
author_facet Pérez, Ana Belén
Chueca, Natalia
García Deltoro, Miguel
Martínez Sapiña, Ana María
Lara Pérez, María MAgdalena
García Bujalance, Silvia
Aldámiz Echevarría, Teresa
Vera Méndez, Francisco Jesús
Pineda, Juan Antonio
Casado, Marta
Pascasio, Juan Manuel
Salmerón, Javier
Alados Arboledas, Juan Carlos
Poyato, Antonio
Téllez, Francisco
Rivero Juárez, Antonio
Merino, Dolores
Vivancos Gallego, María Jesús
Rosales Zábal, José Miguel
García, Federico
author_role author
author2 Chueca, Natalia
García Deltoro, Miguel
Martínez Sapiña, Ana María
Lara Pérez, María MAgdalena
García Bujalance, Silvia
Aldámiz Echevarría, Teresa
Vera Méndez, Francisco Jesús
Pineda, Juan Antonio
Casado, Marta
Pascasio, Juan Manuel
Salmerón, Javier
Alados Arboledas, Juan Carlos
Poyato, Antonio
Téllez, Francisco
Rivero Juárez, Antonio
Merino, Dolores
Vivancos Gallego, María Jesús
Rosales Zábal, José Miguel
García, Federico
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv HCV
RASs
Treatment failure
Resistance testing
Resistance-associated substitution
Direct-acting antivirals
Ribavirin
topic HCV
RASs
Treatment failure
Resistance testing
Resistance-associated substitution
Direct-acting antivirals
Ribavirin
description Abstract Background & Aims Most hepatitis C virus (HCV)-infected patients failing NS5A inhibitors develop resistance-associated substitutions (RASs). Here we report the use of resistance-guided retreatment of patients who failed prior NS5A inhibitor-containing regimens in the GEHEP-004 cohort. This is the largest direct-acting antiviral (DAA)-resistance cohort study conducted in Spain. We aim to provide indications on how to use resistance information in settings where sofosbuvir/velpatasvir/voxilaprevir may not be available. Methods GEHEP-004 is a prospective multicenter cohort enrolling HCV-infected patients treated with interferon (IFN)-free DAA regimens. Prior to retreatment, population-based sequencing of HCV NS3, NS5A and NS5B genes was performed. After receiving a comprehensive resistance interpretation report, the retreatment regimen was chosen and the sustained virological response (SVR) at 12 weeks after treatment completion (SVR12) was recorded. Results A total of 342 patients experiencing virological failure after treatment with sofosbuvir/ledipasvir±ribavirin (54%), sofosbuvir/daclatasvir±ribavirin (23%), or paritaprevir-ritonavir/ombitasvir±dasabuvir±ribavirin (20%) were studied. After a resistance report, 186 patients were retreated. An SVR12 was achieved for 88.1% of the patients who failed after sofosbuvir/ledipasvir±ribavirin, 83.3% of the patients who failed after sofosbuvir/daclatasvir±ribavirin, 93.7% of the patients who failed after paritaprevir-ritonavir+ombitasvir±dasabuvir±ribavirin. Conclusions In our study, we show how resistance-guided retreatment in conjunction with an interpreted report allows patients to achieve SVR rates close to 90%. We hypothesize that SVR rates may even be improved if resistance data are discussed between experienced virologists and treating clinicians. We believe that our data may be relevant for countries where the access to new DAA combination regimens is limited.
publishDate 2019
dc.date.none.fl_str_mv 2019
dc.type.none.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/10952/9058
url http://hdl.handle.net/10952/9058
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.source.none.fl_str_mv reponame:RIUCAM. Repositorio Institucional de la Universidad Católica San Antonio de Murcia
instname:Universidad Católica San Antonio de Murcia (UCAM)
instname_str Universidad Católica San Antonio de Murcia (UCAM)
reponame_str RIUCAM. Repositorio Institucional de la Universidad Católica San Antonio de Murcia
collection RIUCAM. Repositorio Institucional de la Universidad Católica San Antonio de Murcia
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812455

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