1 St. Josefs-Hospital, Wiesbaden.
2 Universitätsklinikum Schleswig-Holstein (UKSH), Campus Kiel, Kiel.
3 Center for HIV and Hepatogastroenterology, Düsseldorf.
4 Hepatologische Praxis, Hannover.
5 ifi-Institut für interdisziplinäre Medizin, Hamburg.
6 Praxis City Ost, Berlin.
7 Internistische Arztpraxis, Berlin.
8 Universitätsklinikum Würzburg, Würzburg.
9 Universitätsklinkium Heidelberg, Heidelberg.
10 Universitätsklinikum Frankfurt, Frankfurt am Main.
11 MVZ Dres. Eisenbach, Simon, Schwarz GbR, Leverkusen.
12 Leberstiftungs-GmbH Deutschland, Hannover.
13 St. Josef-Hospital, Katholisches Klinikum Oberhausen, Oberhausen.
14 Universitätsklinikum Essen, Universität Duisburg-Essen, Essen.
15 Medizinische Hochschule Hannover, Hannover.
BACKGROUND: Virologic failure to approved combinations of direct antiviral agents (DAA) in patients with chronic hepatitis C virus (HCV) infection is rare. Mostly it involves difficult to treat patients with advanced liver disease and prior interferon-experience. Before approval of VOX/VEL/SOF, a restricted number of patients received rescue treatment, and the choice of DAA combinations for re-treatment were selected on an individual basis. In the present analysis, patient characteristics and rescue-regimens after virologic failure mainly based on first generation DAAs are described.
PATIENTS AND METHODS: Data were obtained from the German Hepatitis C-Registry (DHC-R), which is a national multicenter real-world cohort currently including about 16?500 patients recruited by more than 250 centers. The present analysis is based on 6683 patients who initiated a DAA therapy and for whom follow-up data (per-protocol analysis) were available.
RESULTS: Among the patients, 188 (2.8?%) experienced a virologic relapse. Compared to SVR-patients, relapse patients were significantly more often male (77.7?% versus 56.9?%, respectively, p?
CONCLUSIONS: Patients with failure with DAA combination therapies are a difficult but urgent to treat population with the frequent presence of cirrhosis and prior treatment failure with interferon-based therapies. Rescue therapy with inclusion of a new DAA class leads to high SVR rates, but multiple targeted therapy with VOX/VEL/SOF seems to be most effective.