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Effectiveness of Glecaprevir/Pibrentasvir for Hepatitis C: Real-World Experience and Clinical Features of Retreatment Cases

1
Department of Medicine, Division of Gastroenterology and Hepatology, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Consultation Centers for Hepatic Diseases, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Department of Gastroenterology, Japanese Red Cross Society Nagano Hospital, 22-1 Wakasato, Nagano, Nagano 380-0928, Japan
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Department of Gastroenterology, National Hospital Organization, Shinshu Ueda Medical Center, 27-21 Midorigaoka, Ueda, Nagano 386-8610, Japan
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Department of Gastroenterology, National Hospital Organization, Matsumoto Medical Center, 20-30 Muraimachiminami, Matsumoto, Nagano 399-8701, Japan
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Department of Internal Medicine, Nagano Prefectural Kiso Hospital, 6613-4 Fukushima, Kiso-town, Kiso, Nagano 397-8555, Japan
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Department of Gastroenterology, Ina Central Hospital, 1313-1 Koshiroukubo, Ina, Nagano 396-8555, Japan
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Department of Gastroenterology, Japanese Red Cross Society Suwa Hospital, 5-11-50 Kogandori, Suwa, Nagano 392-8510, Japan
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Department of Gastroenterology, Nagano Chuo Hospital, 1570 Tsuruga-Nishitsurugamachi, Nagano, Nagano 380-0814, Japan
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Department of Gastroenterology, Chikuma Central Hospital, 58 Kuiseshita, Chikuma, Nagano 387-0011, Japan
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Department of Gastroenterology, Japanese Red Cross Society Azumino Hospital, 5685 Toyoshina, Azumino, Nagano 399-8205, Japan
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Aki Naika Clinic, 236-1 Nozawa, Saku, Nagano 385-0053, Japan
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Kawanakajima Clinic, 1942-25 Kawanagajima-machi, Nagano, Nagano 381-2221, Japan
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Gibo Hepatology Clinic, 1-34-20 Muraimachiminami, Matsumoto, Nagano 399-0036, Japan
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Department of Gastroenterology, Kenwakai Hospital, 1936 Kanaenakadaira, Iida, Nagano 395-8522, Japan
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Kanebako Internal Medicine Clinic, 320-2 Kanebako, Nagano, Nagano 381-0007, Japan
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Nakano Gastroenterology Clinic, 4-13-5 Muraimachiminami, Matsumoto, Nagano 399-0036, Japan
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Gastroenterology Center, Aizawa Hospital, 2-5-1 Honjo, Matsumoto, Nagano 390-0814, Japan
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Department of Community Medicine Promotion, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Department of Life Innovation, Institute for Biomedical Sciences, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
*
Author to whom correspondence should be addressed.
Biomedicines 2020, 8(4), 74; https://doi.org/10.3390/biomedicines8040074
Received: 5 March 2020 / Revised: 30 March 2020 / Accepted: 1 April 2020 / Published: 3 April 2020
(This article belongs to the Section Therapeutic Strategies in Different Diseases)
Glecaprevir/pibrentasvir (G/P) are direct-acting antivirals (DAAs) that achieve a high sustained virological response (SVR) rate for hepatitis C virus (HCV) infection. We investigated G/P effectiveness for HCV patients based on real-world experience and the clinical features of retreatment cases. HCV patients (n = 182) were compared for clinical features and outcomes between first treatment (n = 159) and retreatment (n = 23) G/P groups. Overall, 77 patients (42.3%) were male, the median age was 68 years, and 86/66/1/4 cases had genotype 1/2/1 + 2/3, respectively. An SVR was achieved in 97.8% (178/182) of cases by intention-to-treat analysis and 99.4% (178/179) of cases by per-protocol analysis. There were no remarkable differences between the first treatment and retreatment groups for male (42.8% vs. 39.1%, p = 0.70), median age (68 vs. 68 years, p = 0.36), prior hepatocellular carcinoma (5.8% vs. 8.7%, p = 0.59), or the fibrosis markers AST-to-platelet ratio index (APRI) (0.5 vs. 0.5, p = 0.80) and fibrosis-4 (FIB-4) index (2.2 vs. 2.6, p = 0.59). The retreatment group had a significantly more frequent history of interferon treatment (12.3% vs. 52.2%, p < 0.01) and the Y93H mutation (25.0% vs. 64.7%, p = 0.02). The number of retreatment patients who had experienced 3, 2, and 1 DAA treatment failures was 1, 3, and 19, respectively, all of whom ultimately achieved an SVR by G/P treatment. In conclusion, G/P was effective and safe for both HCV first treatment and retreatment cases despite the retreatment group having specific resistance mutations for other prior DAAs. As G/P treatment failure has been reported for P32 deletions, clinicians should consider resistance mutations during DAA selection. View Full-Text
Keywords: chronic hepatitis C; hepatitis C virus; glecaprevir; pibrentasvir; retreatment chronic hepatitis C; hepatitis C virus; glecaprevir; pibrentasvir; retreatment
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Sugiura, A.; Joshita, S.; Yamashita, Y.; Yamazaki, T.; Fujimori, N.; Kimura, T.; Matsumoto, A.; Wada, S.; Mori, H.; Shibata, S.; Yoshizawa, K.; Morita, S.; Furuta, K.; Kamijo, A.; Iijima, A.; Kako, S.; Maruyama, A.; Kobayashi, M.; Komatsu, M.; Matsumura, M.; Miyabayashi, C.; Ichijo, T.; Takeuchi, A.; Koike, Y.; Gibo, Y.; Tsukadaira, T.; Inada, H.; Nakano, Y.; Usuda, S.; Kiyosawa, K.; Tanaka, E.; Umemura, T. Effectiveness of Glecaprevir/Pibrentasvir for Hepatitis C: Real-World Experience and Clinical Features of Retreatment Cases. Biomedicines 2020, 8, 74.

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