Los Angeles—Direct-acting antivirals (DAAs) are touted as a virtual cure for hepatitis C, but a new study suggests the therapy works better in some groups than others.

The report in Pharmacology Research & Perspectives discusses how, in a large ethnically diverse patient population at a Veterans’ Affairs community medical center, cure rates for chronic hepatitis C were lower for African-American patients than white patients.

The study, led by David Geffen School of Medicine at UCLA researchers, found that the difference persisted even when optimal therapies were provided.

“In the era of direct-acting antivirals (DAAs), HCV cure has become the goal, as defined by sustained virological response 12 weeks (SVR12) after completion of therapy,” study authors write, adding that, historically, African-Americans have had lower SVR12 rates compared with whites when interferon was the standard therapy.

That had been attributed to the high prevalence of non-CC interleukin 28B (IL28B) type, the researchers explain, although they point out that differences in response because of race or ethnicity are less clear with DAAs.

The study team sought to evaluate the predictors of SVR12 in a diverse, single-center Veterans Affairs population. To do that, they conducted a retrospective study of patients undergoing HCV therapy with DAAs from 2014 to 2016 at the VA Greater Los Angeles Healthcare System with 1,068 patients; included was an equal percentage, 37.5%, of whites and African-Americans, with 83.9% of patients overall having genotype 1.

Results in the adjusted models indicate that race/ethnicity and the presence of fibrosis were statistically significant predictors of non-SVR. In fact, the researchers report that African-Americans had 57% lower odds for reaching SVR12 compared with whites.

Also a significant predicter of non-SVR was advanced fibrosis, with an adjusted odds ratio of 0.40.

“In a single-center VA population on DAAs, African-Americans were less likely than white people to reach SVR12 when adjusting for covariates,” study authors conclude.

They add that although their study demonstrates the importance of racial/ethnic differences in chronic hepatitis C, specific causes of the differences remain unclear and should be explored further in prospective studies where drug levels and patient genetics are factored in.
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