Efficacy and safety of glecaprevir/pibrentasvir treatment in Koreans with chronic hepatitis C: A retrospective study

Chronic hepatitis C virus (HCV) infection is a major cause of chronic liver diseases such as liver cirrhosis (LC) and hepatocellular carcinoma (HCC). As estimated in 2015, approximately 71.1 million HCV infections have occurred in patients worldwide [1]. Chronic hepatitis C (CHC) treatment can reduce liver injury, thereby preventing liver fibrosis, reducing LC, preventing HCC, and reducing all-cause mortality [2], [3]. After direct-acting antiviral (DAA) treatment was introduced in 2015, CHC treatment dramatically improved the treatment rate and became the standard treatment compared to past interferon treatment [4], [5], [6]. Furthermore, pangenotype DAA treatment, such as glecaprevir/pibrentasvir (G/P), sofosbuvir/velpatasvir, and sofosbuvir/velpatasvir/voxilaprevir, has recently been recommended for the treatment of HCV infections by the international guidelines [7], [8].

G/P (Mavyret™, Abbvie Inc.) is a ribavirin-free CHC treatment regimen that combines two DAAs. Glecaprevir is a nonstructural (NS) protein 3/4A protease inhibitor, and pibrentasvir is an NS5A inhibitor. Each fixed-dose tablet, taken 3 times daily, contains 100 mg of glecaprevir and 40 mg of pibrentasvir. Depending on the presence of LC, prior CHC treatment history, and HCV genotype, the treatment period varies from 8 to 16 weeks [7]. However, several previous studies, including phase 2 and 3 studies, found that G/P regimens demonstrated excellent sustained virologic response at 12 weeks posttreatment (SVR 12) regardless of the HCV genotype [9], [10], [11], [12], [13], [14].

Before June 2018 in South Korea, DAA treatment for CHC involved selecting a combination of various drugs according to the patient’s genotype. Various CHC treatments are available, including drugs that treat genotype 1—such as asunaprevir/daclatasvir, elbasvir/grazoprevir, and sofosbuvir/ledipasvir—and those that treat genotype 2—such as sofosbuvir/daclatasvir and sofosbuvir/ledipasvir plus ribavirin [15]. After June 2018, the pangenotype DAA treatment drug G/P was first approved by the Korean National Health Insurance Service. Since the introduction of pangenotype CHC treatment, CHC has been treated more aggressively in Korea. Unfortunately, given its relatively recent introduction, there is little real-world data on G/P treatment in a population of Koreans with CHC. Thus, we examined the effectiveness and safety of G/P treatment in these patients.

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