Stanislas Pol1,2, Lucia Parlati1. 1. Hepatology Department, Université Paris Descartes, Cochin hospital, APHP, Paris, France. 2. INSERM U1223 and Center for Translational Science, Institut Pasteur, Paris, France.
Abstract
BACKGROUND & AIMS: The recommended combination of pangenotypic direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) associates the co-formulation of 2 or 3 second-generation DAAs. In the so-called "special populations" defined as patients with chronic kidney disease (CKD), HCV/HIV co-infection, HCV/HBV co-infection and an unsuccessful previous DAA regimen, these combinations have a high antiviral potency (sustained virologic response (SVR) > 95%), fair tolerance and a reduced pill burden. METHODS: We have taken into account the scientific evidence on the treatment of "special populations", in particular from the RUBY 1-2 trials, EXPEDITION 2-4 study, C-WORTHY trial, ASTRAL 5, POLARIS 1-4 studies, MAGELLAN 1 and REVENGE study. RESULTS: CKD and HCV/HIV co-infection are not predictors of a non-viral response. The glecaprevir/pibentrasvir (Maviret) combination appears to be the first-line therapy for CKD patients while the sofosbuvir/vlpatasvir/voxaliprevir (Sovesi) combination is the first-line option for DAAs failures. Both are effective in patients with HIV-or HBV-HCV co-infection and should be chosen according to the potential drug-drug interaction profile. CONCLUSIONS: The notion of "special populations" is no longer pertinent with pangenotypic DAAs combinations. International guidelines recommend treating all infected patients and the next challenge is not the therapeutic choice, but to improve the limitations for screening and access to care in HCV infection.
BACKGROUND & AIMS: The recommended combination of pangenotypic direct-acting antivirals (DAAs) for the treatment of hepatitis C virus (HCV) associates the co-formulation of 2 or 3 second-generation DAAs. In the so-called "special populations" defined as patients with chronic kidney disease (CKD), HCV/HIV co-infection, HCV/HBV co-infection and an unsuccessful previous DAA regimen, these combinations have a high antiviral potency (sustained virologic response (SVR) > 95%), fair tolerance and a reduced pill burden. METHODS: We have taken into account the scientific evidence on the treatment of "special populations", in particular from the RUBY 1-2 trials, EXPEDITION 2-4 study, C-WORTHY trial, ASTRAL 5, POLARIS 1-4 studies, MAGELLAN 1 and REVENGE study. RESULTS:CKD and HCV/HIV co-infection are not predictors of a non-viral response. The glecaprevir/pibentrasvir (Maviret) combination appears to be the first-line therapy for CKDpatients while the sofosbuvir/vlpatasvir/voxaliprevir (Sovesi) combination is the first-line option for DAAs failures. Both are effective in patients with HIV-or HBV-HCV co-infection and should be chosen according to the potential drug-drug interaction profile. CONCLUSIONS: The notion of "special populations" is no longer pertinent with pangenotypic DAAs combinations. International guidelines recommend treating all infectedpatients and the next challenge is not the therapeutic choice, but to improve the limitations for screening and access to care in HCV infection.
Authors: Alessandra Mangia; Francesco Scaglione; Pierluigi Toniutto; Mario Pirisi; Nicola Coppola; Giovanni Di Perri; Gema Alvarez Nieto; Stefano Calabrese; Candido Hernandez; Valentina Perrone; Luca Degli Esposti; Stefano Fagiuoli Journal: Int J Environ Res Public Health Date: 2021-07-03 Impact factor: 3.390
Authors: Carmine Rossi; Jim Young; Valérie Martel-Laferrière; Sharon Walmsley; Curtis Cooper; Alexander Wong; M John Gill; Marina B Klein Journal: Open Forum Infect Dis Date: 2019-02-13 Impact factor: 3.835