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巴西全国性调查:直接抗病毒药物治疗无应答的丙型肝炎患者的治疗结局。

National Brazilian survey on the outcomes of hepatitis c retreatment in patients non-responders to direct antiviral agents.

机构信息

Universidade Federal de São Paulo, Disciplina de Gastroenterologia, São Paulo, SP, Brazil.

Serviço Municipal de Infectologia de Caxias do Sul, Caxias do Sul, RS, Brazil.

出版信息

Braz J Infect Dis. 2022 Jul-Aug;26(4):102388. doi: 10.1016/j.bjid.2022.102388. Epub 2022 Jul 26.

Abstract

BACKGROUND AND AIMS

Treatment of hepatitis C with direct antiviral agents (DAA) is associated with almost 95% of sustained virological response. However, some patients need retreatment. In Brazil, it should be done according to the Ministry of Health guidelines, frequently updated to include newly available drugs. This study aimed to conduct a national survey about the characteristics and outcomes of retreatment of hepatitis C in previously non-responders to DAAs.

PATIENTS AND METHODS

Institutions from all over the country were invited to participate in a national registry for retreatment, including information about clinical and epidemiological characteristics of the patients, type and outcomes of retreatment regimens. Only patients previously treated with interferon-free regimens were included.

RESULTS

As previous treatments the distribution was: SOF/DCV (56%), SOF/SIM (22%), 3D (11%), SOF/LED (6%) and SOF/RBV (5%). For retreatment the most frequently used drugs were SOF/GP (46%), SOF/DCV (23%) and SOF/VEL (11%). From 159 patients retreated, 132/159 (83%) had complete information in the registry and among them only seven patients were non-responders (SVR of 94.6%). All retreatments were well tolerated, without any serious adverse events or interruptions.

CONCLUSION

The retreatment of patients previously non-responders to DAAs was associated with high rate of SVR in this sample of Brazilian patients. This finding allows us to conclude that the retreatment options available in the public health system in Brazil are effective and safe and are an important component of the strategy of elimination of hepatitis C in our country.

摘要

背景与目的

直接抗病毒药物(DAA)治疗丙型肝炎的持续病毒学应答率接近 95%。然而,一些患者需要再次治疗。在巴西,应根据卫生部的指南进行治疗,该指南经常更新,以纳入新的可用药物。本研究旨在对先前对 DAA 无应答的丙型肝炎患者进行再次治疗的特征和结果进行全国性调查。

患者与方法

邀请全国各地的机构参与国家再治疗登记处,包括患者临床和流行病学特征、再治疗方案类型和结果的信息。仅包括先前接受无干扰素方案治疗的患者。

结果

之前的治疗分布为:SOF/DCV(56%)、SOF/SIM(22%)、3D(11%)、SOF/LED(6%)和 SOF/RBV(5%)。对于再治疗,最常使用的药物是 SOF/GP(46%)、SOF/DCV(23%)和 SOF/VEL(11%)。在 159 名接受再治疗的患者中,132/159(83%)在登记处有完整的信息,其中只有 7 名患者无应答(SVR 为 94.6%)。所有再治疗均耐受良好,无严重不良事件或中断。

结论

在巴西,先前对 DAA 无应答的患者再次治疗与高 SVR 率相关。这一发现使我们能够得出结论,巴西公共卫生系统提供的再治疗方案是有效且安全的,是消除我国丙型肝炎战略的重要组成部分。

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