In real-world practice, direct-acting antivirals (DAAs) work well in treating hepatitis C virus (HCV) among those with advanced liver disease. However, as seen in clinical trials, cure rates are not as high as for those with less damaged livers. Also, the treatment success rate is particularly low for people with genotype 3 of hep C and advanced liver disease.

Publishing their findings in Alimentary Pharmacology & Therapy, researchers in the HCV-TARGET consortium, which includes 39 academic and 13 community health centers in the United States, Germany, Israel and Canada, analyzed data on 240 people with advanced liver disease who started hep C treatment between December 2013 and October 2014.

The members of the study cohort all had a MELD score of at least 10, indicating significant liver damage. The investigators ultimately analyzed data on the 220 individuals who completed 12 weeks of posttreatment follow-up.

A total of 103 of the participants received Sovaldi (sofosbuvir) and Olysio (simeprevir); 32 received Sovaldi, Olysio and ribavirin; and 85 received Sovaldi and ribavirin.

The respective rates of a sustained virologic response 12 weeks after completing therapy (SVR12, considered a cure) with each of the aforementioned regimens were as follows for those with: a MELD score between 10 and 15, 73 percent, 67 percent and 50 percent; a MELD score of at least 16 (indicating more severe liver disease), 75 percent, 80 percent and 55 percent; genotype 1 (including both genotype 1a and 1b), 74 percent, 66 percent and 54 percent; genotype 1a, 64 percent, 70 percent and 56 percent; and genotype 1b, 84 percent, 50 percent and 44 percent. Among those with genotype 1 who had not been treated before, the respective cure rates were 76 percent, 56 percent and 60 percent; among those with genotype 1 who had been treated before, the respective cure rates were 72 percent, 70 percent and 50 percent.

Among those with genotype 2, the one person treated with Sovaldi, Olysio and ribavirin was cured, as were 72 percent of the 25 people who received Sovaldi and ribavirin. Just 35 percent of the 31 people with genotype 3, all of whom received Sovaldi and ribavirin, were cured.

The study authors concluded: “All-oral therapies are effective among patients with advanced liver disease with high levels of success in [genotype 2] and [genotype 1b], and may serve to reduce the severity of liver disease after SVR. Treatment for [genotype 3] patients remains an unmet need.”

To read the study abstract, click here.