Dismal prognosis for cirrhotic patients with hepatitis C after initial failure of direct acting anti-virals, but salvage therapy may be life-saving

Figures & data

Table 1. Clinical and demographic data for all patients with primary DAA failure.

Variable	All patients, n = 288
Median age, years (IQR)	56 (47–61)
Females, n (%)	60 (21)
Previous treatment experience^a, n (%)	48 (17)
Median baseline liver elasticity (fibroscan), kPa (IQR)	9.3 (6.8–20.3)^b
Liver elasticity >20 kPa, indicating portal hypertension, n (%)	58 (25)^b
Baseline fibrosis stage
F0-1, n (%)	62 (22)
F2-3, n (%)	85 (30)
F4/cirrhosis, n (%)	100 (34)
Stage unknown n (%)	41 (14)
HCV genotype
1a, n (%)	114 (40)
1b, n (%)	15 (5)
1, no subtype n (%)	5 (2)
2, n, (%)	14 (5)
3, n, (%)	120 (42)
4, n, (%)	14 (5)

^aRefers to previous interferon-based treatment regimens.

^bMissing data n = 58.

Figure 1. Flow chart displaying the delay as well as death and drop-out rates during treatment and delay periods before and between salvage therapies for 288 patients with primary DAA failure.

Figure 2. Type of treatment given as first (A) and second (B) salvage treatment. ELV: elbasvir; GP: Glecaprevir/Pibrentasvir; GZP: grazoprevir; LDV: lepipasvir; R: ribavirin; SIM: simeprevir; SOF: sofosbuvir; VEL: velpatasvir; VOX: voxilaprevir.

Table 2. Outcome of first and second salvage treatments according to presence of baseline cirrhosis.

Treatment population	SVR N (%)	non-SVR N (%)	Total N
First salvage treatment
All patients	199 (85)	37 (15)	236^a
Patients with baseline cirrhosis	62 (78)	17 (22)	79^b
Patients without baseline cirrhosis	111 (90)	13 (10)	124^b
Second salvage treatment
All patients	13 (87)	2 (13)	15^cd
Patients with baseline cirrhosis	7 (87)	1 (13)	8^bcd
Patients without baseline cirrhosis	5 (83)	1 (17)	6^bcd

^a52 patients who were lost to follow-up or died waiting for first salvage treatment were excluded, see Figure 1.

^b41 patients with unknown fibrosis stage were excluded.

^cPatients who were lost to follow-up or died waiting for first or second salvage treatment were excluded, see Figure 1.

^dPatients who achieved SVR following first salvage treatment were excluded.

Figure 3. (A) Overall survival (days) following primary DAA failure in 55 patients with and 85 patients without baseline cirrhosis. (B) Event-free survival (days) following primary DAA failure in 55 patients with and 85 patients without baseline cirrhosis. Events were defined as either death, liver decompensation or HCC. (C) Overall survival (days) following primary DAA failure in 117 patients with and 13 patients without SVR after first salvage treatment. (D) Event-free survival (days) following primary DAA failure in 117 patients with and 13 patients without SVR after first salvage treatment. Events were defined as death, liver decompensation or HCC. * Log rank test.