Clinical evaluation of some sofosbuvir-based regimens for the treatment of hepatitis c in private healthcare sector in Egypt

Hepatitis C Virus has been a universal rising problem and the leading cause of liver cirrhosis and its related complications principally hepatic decompensation and hepatocellular carcinoma. The annual prevalence is estimated at 3-4 million subjects. Egypt is considered among the highest endemic seropositive areas globally having more than 5% related to the adult inhabitants. In Egypt, hepatitis C virus, genotype 4 is responsible for about 90% of the cases. In addition to their efficacy, DAA therapies target to significantly cut the cumulative total economic burden of HCV. The previous established and published studies related to new treatment regimens for hepatitis C virus in Egypt focused mainly on governmental hospitals / institutes, and nearly none focused on the private sector. This is a retrospective observational study focused on efficacy and safety evaluation of sofosbuvir (SOF) + ribavirin (RBV), SOF + daclatasvir (DCV), and SOF + daclatasvir (DCV) + RBV compared with SOF + pegylated interferon alfa (pegIFN) + RBV in the treatment of naive non-cirrhotic patients infected with hepatitis C virus in Egypt. The population in this study were 200 Egyptian patients, diagnosed with chronic hepatitis C genotype 4 who were non-cirrhotic, not diagnosed with hepatocellular carcinoma (HCC), and didn't have a liver transplant or co-infections. Those patients received treatment in private hospitals and clinics between 2014 and 2017. Results of this study showed that treatment with DAAs was associated with dramatic increase in SVR12 rate. The achieved SVR12 rates in this study were 91.7% for SOF + pegIFN + RBV, 75% for SOF + RBV, 96% for SOF + RBV + DCV, and 94% for SOF + DCV. Among the studied baseline patient characteristics, the viral load was found to be a significant independent predictor of the expected SVR12 rate. Safety assessment revealed that the most common side effect in this study were anaemia and thrombocytopenia. Anaemia was found to be significantly associated with regimens containing RBV and the initial haemoglobin level, while thrombocytopenia was found to be associated with the initial patient platelets count and pegINF containing regimen.