01 Set Treatment with daclatasvir and sofosbuvir for 24 weeks without ribavirin in cirrhotic patients who failed first-generation protease inhibitors

Lucio Boglione

Optimal treatment of patients with chronic hepatitis C (CHC) who previously failed the triple therapy with first generation of protease inhibitors is not still defined. The combined use of sofosbuvir (SOF) and daclatasvir (DCV) seems to be promising due to higher genetic barrier, good tolerance and effectiveness, but no data in a real-life population were currently available.
In this study we described the good effectiveness of treatment with this drug combination in a real-life cohort of cirrhotic patients with genotype 1 who failed the triple therapy due to virological breakthrough. SOF (400mg daily) and DCV (60mg daily) without ribavirin (RBV) for 24 weeks were administered in 20 cirrhotic patients; 18 of them (90%) with Child-Pugh A, 11 (55%) with genotype 1a, 17 (85%) with more than 1 and 8 (40%) with more than 2 previous failed treatment; all patients had at baseline NS3 resistance associated variants (RAVs) related to triple therapy failure. RBV was not administered because of history of anemia in previous treatments. The overall observed sustained virological response (SVR) at 12 weeks was 100%, without any reported adverse events. The MELD score improved in 12 patients (60%).
In conclusion, treatment with SOF+DCV without RBV for 24 weeks is safety and effective in a difficult-to-treat population of cirrhotic patients who failed triple therapy with the first generation of protease inhibitors.