Real-world effectiveness of glecaprevir/pibrentasvir and ledipasvir/sofosbuvir for mixed genotype hepatitis C infection:a multicenter pooled analysis in Taiwan.

Data on direct-acting antiviral agent (DAA) treatment for mixed genotype hepatitis C virus (HCV) infection are scant. This studyexamined the effectiveness of glecaprevir/pibrentasvir(GLE/PIB)and ledipasvir/sofosbuvir (LDV/SOF) for mixed HCV genotype infection in a real-world setting in Taiwan.We analyzed the data from allpatients with mixed HCV genotype infectionstreated withGLE/PIBor LDV/SOFfrom 2017 to 2019in three Chang Gung Memorial Hospitals inTaiwan.The primary treatment outcome was sustained virologic response 12 weeks after treatment cessation (SVR12). Adverse events (AEs) were also evaluated.A total of 5190HCV patients received DAA treatment during this time period. Among them,116 patients (2.2%) had mixed infections of any 2 or 3 genotypes of 1a, 1b, 2, 3, and 6. Fifty four patients received GLE/PIB and 62 received LDV/SOF. SVR12 rates for LDV/SOF versus GLE/PIB therapy were 96.6% (56/58) versus 100% (51/51) by the per-protocol analysis and 90.3% (56/62) versus 94.4% (51/54) by the evaluable population analysis. Two patients with 1b+6 and 1b+2 genotype infections in the LDV/SOFgroup had relapse. Evaluating the GLE/PIB versus LDV/SOF groups for the most common AEs revealedpruritus (16.7% vs 4.8%), abdominal discomfort (5.6% vs 8%), and fatigue (5.6% vs 4.8%). One patient with AE-related treatmentdiscontinuationpresented with liver decompensation after 4-week GLE/PIB therapy. DAA-related significant laboratory abnormalities occurred intwo patients with>3x elevated bilirubin level in the GLE/PIB group.GLE/PIB and LDV/SOF arewell toleratedand achieve high SVR12 ratesforpatientswith mixed HCV genotype infection.