Theme: Clinical Research Year: 2018
Opioid substitution treatment (OST) programmes not only have a high HCV-prevalence, but
also allow for Directly observed therapy (DOT), making them an ideal setting for HCVtreatment. The aim of our study was to describe feasibility, outcome and uptake of HCVtreatment in OST patients in Switzerland in the IFN-based and IFN-free Directly-acting agent
(DAA) era of HCV-treatment.
Between 2014 and 04/2018, the Swiss Association for the Medical Management in
Substance Users (SAMMSU)-Cohort has enrolled 704 opioid substitution patients in eight
centres throughout Switzerland. Data on 305 HCV-treatments was collected retrospectively
at baseline and prospectively by yearly follow-up.
Of the total of 305 HCV-treatments, 153 were classified as IFN-based (including regimens
containing boceprevir, telaprevir or sofosbuvir) and 152 as IFN-free. Until 2012, all HCVtreatments were IFN-based. From 2016 onwards, all were IFN-free. Median treatment
duration decreased from 45.3 weeks in HIV-positives and 25.9 weeks in HIV-negatives to 12
weeks for both. The proportion with pre-term stop (mainly toxicity-driven) decreased from
17.6% (27/153) to 0% (0/152) and adherence problems from 9.2% (14/153) to 2.6% (4/152).
Sustained virological response (SVR) increased from 58.7% (88/150) to 95.7% (112/117),
with no significant difference between HIV-positive and –negative patients. In the IFN-based
era (even after the introduction of the first HCV-protease inhibitors in 2011), maximal 16
patients were treated per year. This number increased to 46/year in 2016 and 54/year in
2017 with IFN-free DAA-treatment.
In the IFN-free DAA era with better tolerable drugs and 50-75% shorter treatment, adherence
problems have become rare and pre-term stops virtually non-existent. SVR went up to ≥95%
irrespective of HIV-status. So far, treatment-uptake has increased threefold. Omission of
reimbursement restrictions (≥F2-fibrosis until 05/2017; prescription only by
gastroenterologists/infectious disease specialists until now) has the potential of further
Disclosure of Interest Statement:
SAMMSU is financed by Infodrog (on behalf of Swiss Federal Office of Public Health),
Pharma industries (BMS, Abbvie, Gilead, Merck, Roche), SSAM (Swiss Society for Addiction
Medicine), SEVHep (Swiss Experts in Viral Hepatitis), Inselspital Bern, Kantonsspital St.
Gallen, Kantonsspital Aarau, Arud Zentren für Suchtmedizin, Zfs Zentrum für Suchtmedizin
Basel, Universitätsspital Zürich