Ribavirin facilitates early viral kinetics in chronic hepatitis C patients receiving daclatasvir/asunaprevir.

BACKGROUND/AIMS: Ribavirin (RBV) remains crucial in difficult-to-cure chronic hepatitis C (CHC) patients receiving directly-acting antivirals (DAAs). The current study aimed to address whether RBV enhanced early viral kinetics in patients with DAAs.

METHODS: Hepatitis C virus (HCV) genotype-1b patients were allocated to daclatasvir/asunaprevir +weight-based ribavirin (1000-1200 mg/day) for 12-24 weeks. HCV RNA levels were compared at day 1, week 1, week 2, and week 4 of treatment.

RESULTS: The sustained virological response rate was 100 % (67/67) and 96.7 % (59/61) in the RBV and non-RBV group, respectively. The HCV RNA levels at treatment week 2 (W2) were significantly lower in the RBV group than in the non-RBV group (0.42±0.81 log IU/mL vs. 0.79±1.03 log IU/mL, P=0.04). Among the intermediate responders who remained to have detectable RNA after W1 of treatment, patients with ribavirin had a significantly higher rate of undetectable HCV RNA (71.4 % vs. 36.0 %, P=0.003) and lower HCV RNA level at W2 (0.55±0.89 log IU/mL vs. 1.32±1.04 log IU/mL, P=0.001). A more significant magnitude of HCV RNA reduction was also noted from baseline to day 1 (3.15±0.38 log IU/mL vs. 2.80±0.70 log IU/mL, P=0.009) and W1 to W2 (1.40±0.65 log IU/mL vs. 0.88±0.78 log IU/mL, P=0.007) in the RBV group compared to the non-RBV group among the intermediate responders. Logistic regression analysis revealed that adding RBV independently predicted undetectable HCV RNA at W2 (OR/CI:4.74/1.54-14.57, P=0.007) in the intermediate responders.

CONCLUSIONS: Adding RBV to DAAs improved early viral kinetic, in particular, for intermediate responders.