Retreatment for hepatitis C virus direct‐acting antiviral therapy virological failure in primary and tertiary settings: The REACH‐C cohort. Issue 8 (28th May 2022)

• Record Type: Journal Article
• Authors: Carson, Joanne M.; Hajarizadeh, Behzad; Hanson, Josh; O'Beirne, James; Iser, David; Read, Phillip; Balcomb, Anne; Davies, Jane; Doyle, Joseph S.; Yee, Jasmine; Martinello, Marianne; Marks, Philippa; Matthews, Gail V.; Dore, Gregory J.
• Other Names: Post Jeffery investigator.; Batey Robert investigator.; Smart John investigator.; Dawson Olivia investigator.; Hill Sonja investigator.; Douglas Mark investigator.; Montebello Mark investigator.; Collie Patricia investigator.; Hallinan Richard investigator.; Snelgar Gail investigator.; Baker David investigator.; Galhenage Sam investigator.; Soo Tuck Meng investigator.; Bopage Rohan investigator.; Faros John investigator.; Cooper Lucy investigator.; Nelson Renjy investigator.; Shaw David investigator.; Wilson Mark investigator.; Pratt William investigator.; Hinton Stephen investigator.; Wade Amanda investigator.; Van Gessel Helen investigator.; Davidson Leonie investigator.; Dibdin Miranda investigator.; Lucas Micaela investigator.; Ahmad Raghib investigator.; Smith Denise investigator.; Tan Khim investigator.; Roder Christine investigator.; Harney Brendan investigator.; Holdaway Susan investigator.; Walsh Jayde investigator.; Fox Penny investigator.; Mousavi Roshanak investigator.; Lam Wendy investigator.; Dahal Rupa Pudasaini investigator.; Habel Philip investigator.; Gilliver Rosie investigator.; Silins Edmund investigator.; Ackerman Jessica investigator.; Deacon Rachel investigator.; Hall Edmund investigator.; Everson Arlene investigator.; Stewart Jeffrey investigator.; Milner Margery investigator.; Ferguson Catherine investigator.; Tate‐Baker Jaclyn investigator.; Bradshaw Jane investigator.; Duncan Gai investigator.; Baluran Gilbert investigator.; Watson Belinda investigator.; Hey Camilla investigator.; Hickey Rebecca investigator.; Orme Clare investigator.; Miczkova Silvie investigator.;
• Is Part Of: Journal of viral hepatitis. Volume 29:Issue 8(2022)
• Page Start: 661
• Page End: 676
• Publication Date: 2022-05-28
• Subjects: direct‐acting antivirals -- HCV -- primary care -- retreatment -- virological failure; Hepatitis, Viral -- Periodicals; Hepatitis, Viral, Animal; Hepatitis, Viral, Human; 616.3623
• DOI: 10.1111/jvh.13705
• Languages: English
• ISSNs: 1352-0504

Abstract

Abstract: Virological failure occurs in a small proportion of people treated for hepatitis C virus (HCV) with direct‐acting antiviral (DAA) therapies. This study assessed retreatment for virological failure in a large real‐world cohort. REACH‐C is an Australian observational study ( n = 10, 843) evaluating treatment outcomes of sequential DAA initiations across 33 health services between March 2016 to June 2019. Virological failure retreatment data were collected until October 2020. Of 408 people with virological failure (81% male; median age 53; 38% cirrhosis; 56% genotype 3), 213 (54%) were retreated once; 15 were retreated twice. A range of genotype specific and pangenotypic DAAs were used to retreat virological failure in primary ( n = 56) and tertiary ( n = 157) settings. Following sofosbuvir/velpatasvir/voxilaprevir availability in 2019, the proportion retreated in primary care increased from 21% to 40% and median time to retreatment initiation declined from 294 to 152 days. Per protocol (PP) sustained virological response (SVR12) was similar for people retreated in primary and tertiary settings (80% vs 81%; p = 1.000). In regression analysis, sofosbuvir/velpatasvir/voxilaprevir (vs. other regimens) significantly decreased likelihood of second virological failure (PP SVR12 88% vs. 77%; adjusted odds ratio [AOR] 0.29; 95%CI 0.11–0.81); cirrhosis increased likelihood (PP SVR12 69% vs. 91%; AOR 4.26; 95%CI 1.64–11.09). Indigenous Australians had lower likelihood of retreatment initiation (AOR 0.36; 95%CI 0.15–0.81). Treatment setting and prescriber type were not associated with retreatment initiation or outcome. Virological failure can be effectively retreated in primary care. Expanded access to simplified retreatment regimens through decentralized models may increase retreatment uptake and reduce HCV‐related mortality.