Triple therapy in treatment-experienced patients with HCV-cirrhosis in a multicentre cohort of the French Early Access Programme (ANRS CO20-CUPIC)-NCT01514890

Background & Aims: In phase III trials, the safety profile of triple therapy (pegylated interferon/ribavirin with boceprevir or telaprevir) seems to be similar in HCV treatment-experienced cirrhotic and non-cirrhotic patients, but few cirrhotics were included. We report the week 16 safety and efficacy analysis in a cohort of compensated cirrhotics treated in the French Early Access Programme. Methods: 674 genotype 1 patients, prospectively included, received 48 weeks of triple therapy. The analysis is restricted to 497 patients reaching week 16. Results: A high incidence of serious adverse events (40.0%), and of death and severe complications (severe infection or hepatic decompensation) (6.4%), and a difficult management of anaemia (erythropoietin and transfusion use in 50.7% and 12.1%) were observed. Independent predictors of anaemia <8 g/dl or blood transfusion were: female gender (OR 2.19, 95% CI 1.11-4.33, p = 0.024), no lead-in phase (OR 2.25, 95% CI 1.15-4.39, p = 0.018), age >= 65 years (OR 3.04, 95% CI 1.54-6.02, p = 0.0014), haemoglobin level (<= 12 g/dl for females, <= 13 g/dl for males) (OR 5.30, 95% CI 2.49-11.5, p = 0.0001). Death or severe complications were related to platelets count <= 100,000/mm(3) (OR 3.11, 95% CI 1.30-7.41, p = 0.0105) and albumin <35 g/dl (OR 6.33, 95% CI 2.66-15.07, p = 0.0001), with a risk of 44.1% in patients with both. However, the on-treatment virological response was high. Conclusions: The safety profile was poor and patients with platelet count <= 100,000/mm(3) and serum albumin <35 g/L should not be treated with the triple therapy. (c) 2013 Published by Elsevier B.V. on behalf of the European Association for the Study of the Liver.