Characteristics of patients with Chronic Hepatitis C who have failed past treatment or who have never been treated: How much room left for Interferon?

Background/aims: According to current guidelines on management of Chronic Hepatitis C (CHC), both interferon (IFN)-containing and IFN-free treatment combinations may be offered to patients, depending on viral genotype, previous treatment and contraindications to IFN. The past two decades of treatment have selected a large population of patients ineligible to IFN. Our aim is to characterize the current CHC population in order to best drive resource allocation. Patients and methods: we retrospectively retrieved the characteristics and outcomes of a cohort of 801 consecutive CHC outpatients followed-up at two tertiary Centers in Northern Italy. Baseline characteristics of never treated and treated CHC patients were compared by means of Chi-Square test for categorical and t-test for continuous variables. Results: fifty-three percent (426 out of 801) of patients had previously received treatment. Among them, 103 (24%) had achieved SVR; 323 (76%) had failed, of whom 74 (23%) did not complete and 249 (77%) did not respond to treatment. Adverse events were the main cause of treatment withdrawal (90%). Forty-seven percent (n = 375) of all participants had never received any treatment, mostly because of contraindications (27% overall, hematologic 11%, psychiatric 24%, cardiovascular 15%, autoimmune 7%, others 43%), advanced age (27%), personal choice (15%) or no fibrosis (10%). Never treated patients differed significantly (p < 0.01) from treated ones by age (61 vs 56 years) and gender (male 49 vs 65%). Six-hundred and ninety-eight patients (323 failed plus 375 never treated) are awaiting new antiviral therapy, of which 442 (63%) are candidate to all-oral combinations because of contraindications or past intolerance to IFN, while the remaining 256 (37%) may still receive an IFN-containing regimen. Conclusions: 37% of the CHC patients being followed in our clinics may receive IFN-containing protocols with newer DAAs, while about the two thirds of these patients are obligated c