Table 3.
Summary of the Study Results for Each Direct-Acting Antiviral Agent Regimen for Hepatitis C Virus-Related Liver Cirrhosis Patients
| DAA regimens according to HCV genotypes | Main results for LC patients | Reference |
|---|---|---|
| Genotype 1 | ||
| Daclatasvir (60 mg) and asunaprevir (100 mg) | A regimen for genotype 1b-infected patients. For compensated LC patients, SVR12/24 rates were 83.5%–90.9%. In case of the presence of NS3/4A- or NS5A-resistant variants, SVR rates were low (37.8%–50.0% for all patients, including LC patients). The elevation of serum aminotransferase was an adverse event. | [19,20] |
| Daclatasvir (30 mg), asunaprevir (200 mg), and beclabuvir (75 mg) | A regimen for compensated LC patients with HCV genotype 1a or 1b infection. In the UNITY-2 study, SVR12 rates were 90.2%–96.0%. Even for patients with NS5A-resistant variants, the SVR12 rate was high (92.9%). | [22] |
| Sofosbuvir (400 mg) and ledipasvir (90 mg) | A regimen for both genotype 1a- and 1b-infected patients. For compensated LC patients, SVR12 rates were 81.8%–100%. In the SIRIUS trial focusing on compensated LC, SVR12 rates were 96.1%–97.4%; even for patients with NS5A-resistant variants, the SVR12 rate was high (91.7%). This regimen can be applied to decompensated LC patients, including candidates for liver transplantation. In the SOLAR-1 and SOLAR-2 trials, SVR12 rates were 96.0%–96.2% for compensated LC patients and 60.0%–88.9% for decompensated LC patients. Notably, a majority of decompensated LC patients had decreased CP scores. | [27–32] |
| Sofosbuvir (400 mg) and simeprevir (150 mg) | A regimen for both genotype 1a- and 1b-infected patients. For compensated LC patients, SVR12 rates were 85.7%–100%. Even for patients with NS3/4A-resistant variants, the SVR12 rate was high (91.7%). | [33] |
| Grazoprevir (100 mg) and elbasvir (50 mg) | A regimen for both genotype 1a- and 1b-infected patients. For compensated LC patients, SVR12 rates were 90.5%–97.7%. This regimen can be applied to decompensated LC patients. In the C-SALT study, the SVR12 rate was 90.0% for CP class B LC patients. Approximately two-thirds of the class B LC patients had a decreased CP score. Overall, SVR12 rates were 91.2%–100% for patients with NS3/4A-resistant variants and 75.0%–87.5% for those with NS5A-resistant variants. | [37,40] |
| Paritaprevir (150 mg)/ritonavir (100 mg), ombitasvir (25 mg), and dasabuvir (250 mg) | A regimen for compensated LC patients with HCV genotype 1a or 1b infection. In the TURQUOISE-II trial, SVR12 rates were 91.8%–95.9%. HCV genotype 1a and previous null response were negative predictors of SVR12. | [45] |
| Genotypes 2 and 3 | ||
| Sofosbuvir (400 mg) and RBV | A regimen for both genotype 2- and 3-infected patients. For patients with compensated LC and genotype 2 infection, SVR12 rates were 60.0%–94.1% with the 12-week regimen and 77.8% with the 16-week regimen. By contrast, for patients with compensated LC and genotype 3 infection, SVR12 rates were 19.2%–21.4% with the 12-week regimen and 60.9%–68.3% with the 16- or 24- week regimen, suggesting that extension of the antiviral therapy duration could improve the DAA efficacy for this genotype infection. No NS5B-resistant variants emerged. | [13,48,49] |
| Genotype 4 | ||
| Sofosbuvir (400 mg) and RBV | For Egyptian patients with compensated LC, SVR12 rates were 42.9% with the 12-week regimen and 100% with the 24-week regimen. No NS5B-resistant variants emerged. | [51] |
| Sofosbuvir (400 mg) and ledipasvir (90 mg) | In the SOLAR-2 trial, 11% of the patients had HCV genotype 4 infection. For non-LC and compensated LC patients, SVR12 rates were 90.9% with the 12-week regimen and 100% with the 24-week regimen; for decompensated LC patients, SVR12 rates were 57.1% with the 12-week regimen and 85.7% in the 24-week regimen. | [32] |
DAA, direct-acting antiviral agent; HCV, hepatitis C virus; LC, liver cirrhosis; SVR, sustained virological response; CP, Child-Pugh; RBV, ribavirin.