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All-oral DAA regimens safe, effective in treating PWID
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All-oral direct-acting antiviral regimens delivered within a multidisciplinary care model are safe and effective in treating hepatitis C virus infection in people who inject drugs, according study findings published in Open Forum Infectious Diseases.
In a retrospective cohort study, Arshia Alimohammadi, BSc, of the Vancouver Infectious Diseases Centre, and colleagues assessed 291 patients with HCV who were treated at the clinic between March 2014 and December 2017. The mean age of the patients was 54 years, 88% were people who inject drugs (PWID) and 20% were treatment-experienced. The study’s primary outcome was the achievement of SVR at 12 or more weeks after the completion of HCV therapy.
By the end of December 2017, 62 patients remained on treatment and 229 were eligible for evaluation of SVR by intention-to-treat (ITT) analysis, Alimohammadi and colleagues said. Of the patients still on treatment, 45 were taking sofosbuvir-based therapies, one was on glecaprevir/pibrentsavir, and 15 were taking elbasvir/grazoprevir. Between the start and end of treatment, four patients were suspected lost to follow-up (LTFU) and two patients ceased treatment due to comorbid psychiatric conditions, the researchers reported.
Approximately 90% of the ITT population — 93% of the modified ITT population that excluded patients LTFU — achieved SVR, according to Alimohammadi and colleagues. The per-protocol SVR rate was 96%. No confirmed cases of reinfection were identified. There was a 6% prevalence of loss to follow-up.
The rates of SVR in the ITT population varied by treatment regimen from 87% to 94% but were not significantly different, the researchers said. Of seven reported relapses, three were with paritaprevir/ritonavir/ombitasavir plus dasabuvir, three were with sofosbuvir/ledipasvir and one was with sofosbuvir/velpatisvir.
In a stratified ITT SVR rates, the researchers found that active PWID had a significantly lower likelihood of achieving SVR (P = .0185). Patients who had previously undergone HCV treatment were significantly more likely to achieve SVR (P = .0317). Additional analysis of the active PWID patients showed that those who injected in the previous 6 months attained an SVR rate of 84%.
“HCV treatment delivered to PWID within a multidisciplinary program of care to address medical, social, psychological and addiction-related aspects of care leads to very high SVR rates and very low rates of LTFU, irrespective of the DAA regimen that is prescribed,” Alimohammadi and colleagues concluded. “Approaches such as ours will be essential to the achievement of the goals of the World Health Organization to eliminate HCV as a public health concern by 2030.”-by Jennifer Byrne
Disclosure: Alimohammadi reports receiving travel grants from AbbVie and Merck & Company. Please see the study for all other authors’ relevant financial disclosures.
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