Author information

¹Department of Infectious Diseases, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.

²Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA.

³Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan.

⁴Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung.

⁵Hepatitis Research Center, College of Medicine and Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung.

⁶Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.

⁷Gastroenterology & Hepatology, Changi General Hospital, Singhealth, Singapore.

⁸Singhealth Duke-NUS Medicine Academic Clinical Program, Singapore.

⁹Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Japan.

¹⁰Department of Internal Medicine, Hanyang University, College of Medicine, Seoul, Korea.

¹¹Hanyang Institute of Bioscience and Biotechnology, Hanyang University, Seoul, Korea.

¹²Department of Hepatology, The Third People's Hospital of Kunming City, Kunming, Yunnan, China.

¹³Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.

¹⁴Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.

¹⁵Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung.

¹⁶Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.

¹⁷Division of Gastroenterology and Hepatology, Nippon Medical School, Tokyo, Japan.

¹⁸Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan.

¹⁹Department of Transfusion Medicine and Department of Hepatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.

²⁰San Jose Gastroenterology, San Jose, CA, USA.

²¹Gastroenterology & Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.

²²Division of Gastroenterology and Hepatology, University of Washington, Seattle, WA, USA.

²³Department of Gastroenterology, Good Gang-An Hospital, Busan, Korea.

²⁴Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan.

²⁵Liver Center, Saga University Hospital, Saga, Japan.

²⁶Division of Metabolism and Endocrinology, Saga University Faculty of Medicine, Saga, Japan.

²⁷Division of Gastroenterology and Hepatology, Shinmatsudo Central General Hospital, Chiba, Japan.

²⁸2nd Department of Internal Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan.

²⁹Locomedical General Institute, Locomedical Eguchi Hospital, Saga, Japan.

³⁰Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.

³¹Affiliated Traditional Chinese Medicine Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.

³²Department of Gastroenterology and Hepatology, The Second People's Hospital of Tianjin, Tianjin, China.

³³Department of Infectious Diseases, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, Henan, China.

³⁴Department of Gastroenterology and Hepatology, The Third Central Hospital of Tianjin, Tianjin, China.

³⁵Department of Medicine, The University of Hong Kong, Hong Kong, China.

³⁶Department of Hepatology, Zhejiang Provincial People's Hospital Affiliated to Zhejiang University, Hangzhou, Zhejiang, China.

³⁷Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

³⁸Center of liver diseases, Beijing Ditan Hospital Affiliated to Capital Medical University, Beijing, China.

³⁹Division of Gastroenterology and Hepatology, National University Hospital, Singapore.

⁴⁰Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

⁴¹Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.

⁴²State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.

⁴³Digestive Health Associates of Texas, Dallas, TX, USA.

⁴⁴Taihaku Avenue Clinic, Fukuoka, Japan.

⁴⁵Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.

⁴⁶Department of Internal Medicine, Haradoi Hospital, Fukuoka, Japan.

⁴⁷Hepatology Clinic, Kajiwara Clinic, Kitakyushu, Japan.

⁴⁸Department of Internal Medicine, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Korea.

⁴⁹Department of Medicine, Kyushu Central Hospital, Fukuoka, Japan.

⁵⁰Department of Internal Medicine, Chihaya Hospital, Fukuoka, Japan.

⁵¹Department of Internal Medicine, Hanyang University, College of Medicine, Guri Hospital, Guri, Korea.

⁵²Division of Hepatology, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.

⁵³Departments of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea.

⁵⁴Department of Medicine, Kitakyushu Municipal Medical Center, Fukuoka, Japan.

⁵⁵Department of Medicine, Fukuoka City Hospital, Fukuoka, Japan.

⁵⁶Department of Hepatology, Steel Memorial Yawata Hospital, Kitakyushu, Japan.

⁵⁷Center for Liver Disease, National Hospital Organization Kokura Medical Center, Kitakyushu, Japan.

⁵⁸Department of Medicine, Hamanomachi Hospital, Fukuoka, Japan.

⁵⁹Division of Gastoroentelorogy, Nippon Medcal School Chiba Hokusoh Hospital, Chiba, Japan.

⁶⁰Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan.

⁶¹Department of Hepatology, Kagawa Prefectural Central Hospital, Kagawa, Japan.

⁶²Department of Hepatology, The First Hospital of Jilin University, Changchun, Jilin, China.

⁶³Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.

⁶⁴Department of Hepatology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan.

⁶⁵Liver Diseases Group, Vall d'Hebron Research Institute, Barcelona, Spain.

⁶⁶Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.

⁶⁷Liver Unit, Department of Internal Medicine, Hospital Universitari Valle d'Hebron and Universitat Autònoma de Barcelona, Barcelona, Spain.

⁶⁸State Key Laboratory of Liver Research, The University of Hong Kong, Hong Kong, China.

⁶⁹Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Ji'nan, Shandong, China.

⁷⁰Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.

⁷¹Kyushu General Internal Medicine Center, Haradoi Hospital, Fukuoka, Japan.

⁷²School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-sen University, Kaohsiung.

⁷³Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA.

Abstract

Background and aims: As practice patterns and hepatitis C virus (HCV) genotypes (GT) vary geographically, a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HCV elimination goal. This study aimed to assess the effectiveness and tolerability of DAA treatment in routine clinical practice in a multinational cohort for patients infected with all HCV GTs, focusing on GT3 and GT6.

Methods: We analyzed the sustained virological response (SVR12) of 15,849 chronic hepatitis C patients from 39 Real-World Evidence from the Asia Liver Consortium for HCV clinical sites in Asia Pacific, North America, and Europe between 07/01/2014-07/01/2021.

Results: The mean age was 62±13 years, with 49.6% male. The demographic breakdown was 91.1% Asian (52.9% Japanese, 25.7% Chinese/Taiwanese, 5.4% Korean, 3.3% Malaysian, and 2.9% Vietnamese), 6.4% White, 1.3% Hispanic/Latino, and 1% Black/African-American. Additionally, 34.8% had cirrhosis, 8.6% had hepatocellular carcinoma (HCC), and 24.9% were treatment-experienced (20.7% with interferon, 4.3% with direct-acting antivirals). The largest group was GT1 (10,246 [64.6%]), followed by GT2 (3,686 [23.2%]), GT3 (1,151 [7.2%]), GT6 (457 [2.8%]), GT4 (47 [0.3%]), GT5 (1 [0.006%]), and untyped GTs (261 [1.6%]). The overall SVR12 was 96.9%, with rates over 95% for GT1/2/3/6 but 91.5% for GT4. SVR12 for GT3 was 95.1% overall, 98.2% for GT3a, and 94.0% for GT3b. SVR12 was 98.3% overall for GT6, lower for patients with cirrhosis and treatment-experienced (TE) (93.8%) but ≥97.5% for treatment-naive patients regardless of cirrhosis status. On multivariable analysis, advanced age, prior treatment failure, cirrhosis, active HCC, and GT3/4 were independent predictors of lower SVR12, while being Asian was a significant predictor of achieving SVR12.

Conclusions: In this diverse multinational real-world cohort of patients with various GTs, the overall cure rate was 96.9%, despite large numbers of patients with cirrhosis, HCC, TE, and GT3/6. SVR12 for GT3/6 with cirrhosis and TE was lower but still excellent (>91%).