Investigators noted the majority of patients (n = 62; 63.9%) discontinued treatment after 4 weeks. Of the 35 patients who discontinued treatment before 4 weeks, 12 stopped therapy within 2 weeks. Regardless of the type of treatment used, the most common reason for discontinuing therapy was hepatic decompensation (20.6%) or the patient's personal decision (18.6%), and less frequently, increased transaminase activity, cardiovascular or gastrointestinal symptoms, and anemia.1
What You Need to Know
Patients who discontinued direct-acting antiviral (DAA) therapy early for hepatitis C still achieved a sustained virologic response (SVR) in 78% of cases.
Patients who discontinued therapy were generally older, more likely to have liver cirrhosis, and often stopped due to hepatic decompensation or personal decisions.
The study suggests that early discontinuation of DAA therapy may not hinder the overall goal of eliminating hepatitis C as a public health threat, especially in patients with favorable baseline characteristics, like a low viral load.
Investigators pointed out patients who discontinued treatment were significantly older, more frequently therapy-experienced, and more likely to have cirrhosis, a history of decompensation, and a Child-Pugh B or C classification than those who completed treatment. Additionally, patients who discontinued therapy before the 4th week were significantly more likely to receive pan-genotypic drugs whereas those who discontinued therapy after 4 weeks were more often treated with genotype-specific therapy.1
SVR was achieved by 76 (78.4%) patients who discontinued treatment. Specifically, SVR was achieved by 93.5% of patients who discontinued treatment after 4 weeks, 60.9% of those who discontinued treatment at weeks 3 or 4, and 33.3% of those who discontinued treatment before the end of the second week.1
Investigators noted the SVR rate was significantly reduced in patients who discontinued therapy before the end of week 4 compared to those who discontinued it later or completed the therapy as planned, regardless of whether they were treated with pan-genotypic or genotype-specific therapy.1
In both pan-genotypic and genotype-specific patients, the SVR rate was significantly lower in patients who discontinued therapy before the end of week 4 compared to those who discontinued it later or completed the therapy as planned. While patients on pan-genotypic therapy who discontinued treatment after 4 weeks had the same chance of achieving SVR as those who completed therapy as planned, investigators pointed out patients discontinuing genotype-specific therapy after 4 weeks had a significantly lower chance of therapeutic success.1
Closer examination of the 4 patients who achieved SVR despite ≤ 2 weeks of treatment revealed elimination of HCV infection was not hindered by male gender, severe liver disease, or overweight, all of which are generally recognized as factors worsening prognosis. Of note, none of these 4 patients had a baseline viral load exceeding 400,000 IU/mL.1
Investigators acknowledged multiple limitations to these findings, including the retrospective, observational nature of the study introducing the potential for missing data and bias as well as the low discontinuation rate resulting from high patient adherence to the therapeutic program.1
“Despite discontinuation of therapy after week 4, the chances of SVR are high. Very early discontinuation does not preclude therapeutic success, especially in patients with low baseline viral load,” investigators concluded.1
References
1.Flisiak R, Zarębska-Michaluk D, Janczewska E, et al. Sustained Virological Response After Early Discontinuation of Hepatitis C Treatment. Journal of Viral Hepatitis. https://doi.org/10.1111/jvh.13991
3.World Health Organization. Hepatitis C. Newsroom. April 9, 2024. Accessed August 12, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-c
