Use of glecaprevir and pibrentasvir as rescue therapy in patients with resistance to direct-acting antiviral agents

Introduction and Objective

Hepatitis C virus infection is one of the main causes of chronic liver disease. Treatment with direct-acting antivirals (DAAs) has shown high efficacy in achieving sustained viral response with a low risk of relapse. There are no specific algorithms for treatment in patients with resistance to DAAs). Treatment with Sofosbuvir, velpatasvir and voxilaprevir is suggested for 12 weeks with a sustained viral response of 95%, except in moderate/severe liver disease. There is a combination of sofosbuvir plus NS3 protease inhibitor and an NS5A with favorable results.

Materials and Methods

65-year-old female, positive smoker, occasional alcoholism. Car accident and transfusion in 1992. Surgeries: hysterectomy and cholecystectomy. Chronic: DM2, irritable bowel syndrome, hypothyroidism under treatment, anxiety disorder treated with venlafaxine and clonazepam. In 2010 Hepatitis C was detected, and he received peginterferon and ribavirin without response. Triple therapy (peginterferon, boceprevir and ribavirin) was used with partial response; he presented relapse. In 2015 she received daclastavir, sofosbuvir and ribavirin with no response. Viral load in 2017 and result of resistance Genotype 1a: polymorphism Q80K (resistance to Simeprevir), mutation V36M (resistance to Boceprevir, Simeprevir, telaprevir and possibly Asunaprevir, Grazoprevir and Paritaprevir), mutation L31V (resistance to Daclatasvir, Elbasvir, Ledipasvir, OmbitaSvir), received Sofosbuvir Velpatasvir 12 weeks post-treatment undetectable viral load, at 24 months detectable viral load, Glecaprevir biprentasvir was indicated for 16 weeks with a sustained viral response; elastography 6.8 kPa, discharge due to healing. The trial was approved by the research ethics committee, and informed consent was obtained.

Conclusions

According to the evidence, there are treatment schemes suggested internationally. However, their availability is not the same in our country, so according to the results obtained in this patient, this rescue scheme with Glecaprevir Biprentasvir is suggested for 18 weeks if there is no response to Sofosbuvir/velpatasvir, and no availability of other DAAs.

Funding

The resources used in this study were from the hospital without any additional financing

Declaration of interest

The authors declare no potential conflicts of interest.