Black, Hispanic HCV patients more likely to fail DAA therapy
Black and Hispanic patients with hepatitis C virus infection were less likely to achieve sustained virologic response with direct-acting antiviral agents compared with white patients within the U.S. Veterans Affairs health care system, according to recent study results.
Further, black patients with HCV genotype 1 infection who were treated with Harvoni (ledipasvir/sofosbuvir, Gilead) monotherapy were significantly less likely to achieve SVR compared with white patients when treated for 8 weeks, but not 12 weeks, leading investigators to suggest that these short ledipasvir/sofosbuvir regimens be avoided in black patients.
“Different racial and ethnic groups in the United States are known to have different responses to traditional, interferon-based HCV regimens,” researchers wrote. “It is not yet clear whether the effectiveness of DAAs varies between racial and ethnic groups.”
To evaluate the relationship between race or ethnicity and the effectiveness of DAAs, investigators identified 21,095 HCV patients within the VA health system who were treated with DAAs from January 2014 through June 2015, and reviewed their electronic medical records.
Overall, 52% of the patients were white, 29% were black, 6% were Hispanic, 2% were Asian, Pacific Islander, American Indian or Alaska Native, and 11% had unknown racial or ethnic background.
DAA treatments included Sovaldi (sofosbuvir, Gilead), Olysio (simeprevir, Janssen) plus sofosbuvir, ledipasvir/sofosbuvir, or Viekira Pak (paritaprevir/ombitasvir/ritonavir/dasabuvir, AbbVie).
SVR rates were similar among groups, but slightly lower among Hispanics: 89.8% (95% CI, 89.2-90.4) of whites, 89.8% (95% CI, 89-90.6) of blacks, 86% (95% CI, 83.7-88) of Hispanics, and 90.7% (95% CI, 87-93.5) of Asians, Pacific Islanders, American Indians and Alaska Natives achieved SVR.
However, multivariable logistic regression models adjusting for baseline characteristics — including “important negative predictors of SVR, such as cirrhosis, decompensated cirrhosis, and, most importantly, HCV genotype 2 or 3 infection [which] were less common in black patients” — showed black patients (adjusted OR = 0.77; P < .001) and Hispanic patients (aOR = 0.76; P = .007) had lower odds of SVR compared with white patients, and this difference was not explained by early treatment discontinuation, the investigators wrote.
Moreover, SVR rates were similar among patients with HCV genotype 1 who received 8 and 12 weeks of ledipasvir/sofosbuvir, except for black patients, who had slightly lower SVR rates with 8 weeks of treatment vs. 12 weeks (92% vs. 95.2%). Multivariate analysis showed black race was associated with reduced odds of SVR with 8 weeks of treatment (aOR = 0.56; 95% CI, 0.36-0.88) but not 12 weeks.
“Our results demonstrate that DAA-based regimens are highly effective for treatment of chronic HCV among all race and ethnicity groups in real-world practice,” the researchers concluded. “Although black race and Hispanic ethnicity are still associated with lower likelihood of SVR in multivariate analysis, DAAs hold promise in closing the SVR gap between different race/ethnicity groups,” and future studies should include racial and ethnic minorities to ensure detection of clinical differences, they added. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.