Blacks, Hispanics with Hepatitis C More Likely to Fail Treatment with Direct-Acting Antiviral Agents

Blacks, Hispanics with Hepatitis C More Likely to Fail Treatment with Direct-Acting Antiviral Agents

Within the U.S. Veterans Affairs’ healthcare system, black and Hispanic patients with hepatitis C are more likely to fail treatment with direct-acting antiviral (DAAs) drugs, than patients who are white, a new study shows.

The study with that finding, “The association between race/ethnicity and the effectiveness of direct antiviral agents for hepatitis C virus infection,” was published in the journal Hepatology.

“Different racial and ethnic groups in the United States are known to have different responses to traditional, interferon-based HCV [hepatitis C virus] regimens,” researchers said in a press release. “It is not yet clear whether the effectiveness of DAAs varies between racial and ethnic groups.”

To investigate the association between race/ethnicity and effectiveness of new DAA regimens in the Veterans Affairs healthcare system nationally, George Ioannou and colleagues from the Division of Gastroenterology/Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, analyzed data from 21,095 HCV–infected patients. Of those, 11,029 patients were white, 6,171 were black, 1,187 were Hispanic, 348 were Asian/Pacific Islander/American Indian/Alaska Native, and 2,360 patients with no race or ethnicity defined.

All patients started antiviral treatment with DAAs during the 18-month period from January 2014 to June 2015.

DAA treatments included Sovaldi (sofosbuvir, Gilead), Olysio (simeprevir, Janssen) plus sofosbuvir, ledipasvir/sofosbuvir, or Viekira Pak (paritaprevir/ombitasvir/ritonavir/dasabuvir, AbbVie).

Overall, the sustained virological responses (SVR; defined as the absence of detectable HCV RNA in the blood for at least 24 weeks after treatment discontinuation) were found to be similar between the groups —  89.8% in white, 89.8% in black, 86.0% in Hispanic, and 90.7% in Asian/Pacific Islander/American Indian/Alaska Native patients.

However, after adjusting the data for well-known negative predictors of SVR, such as cirrhosis, decompensated cirrhosis, and, most importantly, HCV genotype 2 or 3 infections, researchers found that black and Hispanic patients were less likely to achieve SVR compared to white patients, and this difference was not explained by treatment discontinuation.

In addition, the team found that black patients infected with HCV genotype 1 and receiving treatment for eight weeks with Harvoni (ledipasvir/sofosbuvir), were less likely to achieve SVR than white patients, but not when treated for 12 weeks. These results led the researchers to suggest that shorter Harvoni treatments should be avoided in patients from a black ethnic background.

“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.”

The researchers emphasized that further studies on DAAs should include populations from racial and ethnic minorities to ensure the detection of clinical disparities.

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