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Meunier L, Belkacemi M, Pageaux GP, Radenne S, Vallet-Pichard A, Houssel-Debry P, Duvoux C, Botta-Fridlund D, de Ledinghen V, Conti F, Anty R, Di Martino V, Debette-Gratien M, Leroy V, Gerster T, Lebray P, Alric L, Abergel A, Dumortier J, Besch C, Montialoux H, Samuel D, Duclos-Vallée JC, Coilly A. Patients Treated for HCV Infection and Listed for Liver Transplantation in a French Multicenter Study: What Happens at Five Years? Viruses 2022; 15:137. [PMID: 36680177 PMCID: PMC9865729 DOI: 10.3390/v15010137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/26/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Direct-acting antiviral (DAA) agents for the treatment of hepatitis C virus (HCV) infection have been proven safe and effective in cirrhotic patients awaiting liver transplantation (LT). However, in the long term, data remain minimal regarding the clinical impact of viral eradication on patients listed for decompensated cirrhosis or hepatocellular carcinoma (HCC). We aimed to elucidate the clinical outcomes of patients regarding delisting and the evolution of HCC during the long-term follow-up. METHODS An observational, multicenter, retrospective analysis was carried out on prospectively collected data from HCV-positive patients treated with an interferon-free regimen while awaiting LT in 18 French hospitals. RESULTS A total of 179 patients were included in the study. The indication for LT was HCC in 104 (58.1%) patients and cirrhosis in 75 (41.9%) patients. The sustained virological response was 84.4% and the treatment was well tolerated. At five years, among 75 patients with cirrhosis treated for HCV, 19 (25.3%) were delisted following improvement after treatment. Predictive factors for delisting highlighted an absence of ascites, MELD score ≤ 15, and Child-Pugh score ≤ 7. No patients with refractory ascites were delisted. Among patients with HCC, 82 (78.9%) were transplanted. The drop-out rate was low (6.7%) and few recurrences of HCC after LT were observed. CONCLUSIONS DAAs are safe and effective in patients awaiting LT for cirrhosis or HCC. A quarter of patients with cirrhosis can be delisted because of clinical improvement. Predictive factors for delisting, as a result of improvement, may assist prescribers, before initiating HCV infection therapy in the long-term perspective.
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Affiliation(s)
- Lucy Meunier
- Montpellier Saint Eloi University Hospital, 80 Avenue Augustin Fliche, 34090 Montpellier, France
| | | | - George Philippe Pageaux
- Montpellier Saint Eloi University Hospital, 80 Avenue Augustin Fliche, 34090 Montpellier, France
| | - Sylvie Radenne
- Croix-Rousse Hospital, Lyon University Hospital, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
| | - Anaïs Vallet-Pichard
- Cochin Hospital, Public Hospitals of Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | | | - Christophe Duvoux
- Henri-Mondor University Hospital, Public Hospitals of Paris, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Danielle Botta-Fridlund
- Marseille Public Hospital, Timone University Hospital, 264 Rue Saint Pierre, 13005 Marseille, France
| | - Victor de Ledinghen
- Hepatology and Liver Transplantation Unit, Haut-Lévêque Hospital, Bordeaux University Hospital, 33600 Pessac, France
| | - Filomena Conti
- Pitié-Salpêtrière University Hospital, Public Hospitals of Paris, 47-83 Boulevard de l’Hôpital, 75013 Paris, France
| | - Rodolphe Anty
- Archet 2 Hospital, Nice University Hospital, 151 Route de Saint-Antoine, 06200 Nice, France
| | - Vincent Di Martino
- Besançon Regional University Hospital, 3 Boulevard Alexandre Fleming, 25000 Besançon, France
| | | | - Vincent Leroy
- Service d’Hépato-Gastroentérologie, Pôle Digidune, CHU Grenoble Alpes, 38700 La Tronche, France
| | - Theophile Gerster
- Service d’Hépato-Gastroentérologie, Pôle Digidune, CHU Grenoble Alpes, 38700 La Tronche, France
| | - Pascal Lebray
- Pitié-Salpêtrière University Hospital, Public Hospitals of Paris, 47-83 Boulevard de l’Hôpital, 75013 Paris, France
| | - Laurent Alric
- Rangueil Hospital, Toulouse 3 University Hospital, 31000 Toulouse, France
| | - Armand Abergel
- Gabriel-Montpied Hospital, Clermont-Ferrand University Hospital, 58 Rue Montalembert, 63000 Clermont-Ferrand, France
| | - Jérôme Dumortier
- Edouard Herriot Hospital, Lyon University Hospital, 5 Place d’Arsonval, 69003 Lyon, France
| | - Camille Besch
- Hautepierre Hospital, Strasbourg University Hospital, 1 Avenue Molière, 67200 Strasbourg, France
| | - Helene Montialoux
- Rouen University Hospital, 37 Boulevard Gambetta, 76000 Rouen, France
| | - Didier Samuel
- Paul-Brousse Hospital, Public Hospsitals of Paris, 12 Avenue Paul Vaillant Couturier, FHU Hépatinov, 94800 Villejuif, France
| | - Jean-Charles Duclos-Vallée
- Paul-Brousse Hospital, Public Hospsitals of Paris, 12 Avenue Paul Vaillant Couturier, FHU Hépatinov, 94800 Villejuif, France
| | - Audrey Coilly
- Paul-Brousse Hospital, Public Hospsitals of Paris, 12 Avenue Paul Vaillant Couturier, FHU Hépatinov, 94800 Villejuif, France
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2
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Pereira GH, Peixoto HR, Giusti ML, Souza ML, Victor LB, Fernandes F, Perez RM, Villela-Nogueira CA. Long-term survival and clinical outcomes following direct-acting antiviral (DAA) treatment in HCV decompensated cirrhosis in Brazil: a real-world study. Braz J Infect Dis 2022; 26:102697. [PMID: 36037847 PMCID: PMC9485045 DOI: 10.1016/j.bjid.2022.102697] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/13/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction The outcomes regarding portal hypertension-related complications and infections after HCV cure in decompensated cirrhosis are scarcely reported. We aimed to identify the predictors of survival and to evaluate the frequency of decompensation events of cirrhosis, including hepatocellular carcinoma (HCC), portal hypertension complications and infections in a cohort of decompensated cirrhotic with sustained virological response (SVR) in a real-world scenario. Patients and methods This was a prospective study in consecutive HCV-infected patients with decompensated cirrhosis who achieved SVR after direct-acting antiviral (DAA) treatment. At baseline, clinical and laboratory data were recorded. Patients were followed until development of outcomes regarding further decompensation, death, or liver transplant. A Cox-regression analysis was performed and survival curves were constructed using the Kaplan Mayer method. Results One hundred and thirty patients (age 60 ± 9 years, 64% female, 70% genotype 1) were included and followed-up through three years. SVR was associated with a lower prevalence of ascites and an improvement in Child-Pugh and MELD scores. One and three-year probability of transplant-free survival was 93% and 66%, respectively. Variables related to three-years survival were MELD < 11 (HR 1.24, 95% CI 1.13-1.37) and absence of ascites (HR 2.03, 95% CI 0.99-4.13) after the end of treatment (91% versus 37% in patients with ascites and a higher MELD, p < 0.001). Conclusions Decompensated cirrhotics with SVR and a low MELD without ascites have an excellent long-term prognosis. On the contrary, those with higher MELD and ascites have a low probability of survival even in the short term and might be evaluated for liver transplantation.
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Affiliation(s)
- Gustavo H Pereira
- Hospital Federal de Bonsucesso, Serviço de Gastroenterologia e Hepatologia, Rio de Janeiro, RJ, Brazil; Universidade Estácio de Sá, Faculdade de Medicina, Rio de Janeiro, RJ, Brazil
| | - Helena R Peixoto
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, RJ, Brazil
| | - Mariana L Giusti
- Universidade Estácio de Sá, Faculdade de Medicina, Rio de Janeiro, RJ, Brazil
| | - Mariana L Souza
- Universidade Estácio de Sá, Faculdade de Medicina, Rio de Janeiro, RJ, Brazil
| | - Livia B Victor
- Hospital Federal de Bonsucesso, Serviço de Gastroenterologia e Hepatologia, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro, Programa de Pós-Graduação em Clínica Médica, Rio de Janeiro, RJ, Brazil
| | - Flávia Fernandes
- Hospital Federal de Bonsucesso, Serviço de Gastroenterologia e Hepatologia, Rio de Janeiro, RJ, Brazil; Universidade Estácio de Sá, Faculdade de Medicina, Rio de Janeiro, RJ, Brazil
| | - Renata M Perez
- D'Or Research Institute, Rio de Janeiro, RJ, Brazil; Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Serviço de Hepatologia, Rio de Janeiro, RJ, Brazil
| | - Cristiane A Villela-Nogueira
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Hospital Universitário Clementino Fraga Filho, Serviço de Hepatologia, Rio de Janeiro, RJ, Brazil.
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3
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Rumph DM, Straley CM, Kolberg JL, Jacob DA. Impact of proton pump inhibitors on sustained virologic response in veterans treated with sofosbuvir/velpatasvir for chronic hepatitis C virus: A retrospective cohort study. Pharmacotherapy 2022; 42:397-404. [DOI: 10.1002/phar.2682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/21/2022] [Accepted: 03/15/2022] [Indexed: 12/09/2022]
Affiliation(s)
- Danielle M. Rumph
- Battle Creek Veterans Affairs Medical Center Battle Creek Michigan USA
| | - Craig M. Straley
- Battle Creek Veterans Affairs Medical Center Battle Creek Michigan USA
- College of Pharmacy Ferris State University Big Rapids Michigan USA
| | - Jenny L. Kolberg
- Battle Creek Veterans Affairs Medical Center Battle Creek Michigan USA
| | - David A. Jacob
- Pharmacy Service Veterans Integrated Service Network 17 Arlington Texas USA
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4
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Barbosa WF, Andrade VG, Braz AMM, Winckler FC, Barbosa LR, Golim MDA, Silveira LVDA, Simões RP, Silva GF. Cirrhosis regression after SVR with indirect methods of fibrosis analysis: How far is it real? Clin Exp Med 2021; 22:269-275. [PMID: 34347205 DOI: 10.1007/s10238-021-00749-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/22/2021] [Indexed: 12/01/2022]
Abstract
Hepatitis C virus has infected over 71 million people worldwide, and it is the main cause of cirrhosis in the western world. Currently, the treatment involves direct-acting antiviral agents (DAAs) and its main goal is to achieve sustained virologic response (SVR). The aim of this study was to evaluate the impact of SVR using DAAs in the improvement of liver fibrosis using scores evaluation by indirect method, liver function, and inflammation indirect biomarkers. Patients with cirrhosis with SVR after treatment (n = 104) were evaluated using liver function scores, indirect fibrosis methods, alpha-fetoprotein, and ferritin at t-base and t-SVR. Statistically significant positive results in all parameters were observed: 54 patients were classified as 5 in the CP score in t-base, and 77 in t-SVR; a significant decrease was observed in MELD score, alpha-fetoprotein, ferritin, APRI, FIB-4 and liver stiffness in liver elastography. We did not observe difference in the liver function scores between regressors and non-regressors of liver stiffness, as well as in indirect inflammation biomarkers. The measurements of fibrosis using the indirect methods have significantly decreased in patients with cirrhosis treated who achieved SVR associated with decreased indirect inflammation biomarkers and improved liver function scores.
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Affiliation(s)
- Walnei Fernandes Barbosa
- Department of Clinical Medicine, Botucatu Medical School, São Paulo State University (UNESP), Av. Prof. Mário Rubens Guimarães Montenegro, s/n - UNESP, Botucatu, São Paulo, Brazil
| | - Vanessa Gutierrez Andrade
- Department of Clinical Medicine, Botucatu Medical School, São Paulo State University (UNESP), Av. Prof. Mário Rubens Guimarães Montenegro, s/n - UNESP, Botucatu, São Paulo, Brazil
| | - Aline Márcia Marques Braz
- Department of Clinical Medicine, Botucatu Medical School, São Paulo State University (UNESP), Av. Prof. Mário Rubens Guimarães Montenegro, s/n - UNESP, Botucatu, São Paulo, Brazil
| | - Fernanda Cristina Winckler
- Department of Clinical Medicine, Botucatu Medical School, São Paulo State University (UNESP), Av. Prof. Mário Rubens Guimarães Montenegro, s/n - UNESP, Botucatu, São Paulo, Brazil
| | - Livia Roma Barbosa
- Undergraduate Course in Medicine, Taubaté Medical School - UNITAU, Taubaté, São Paulo, Brazil
| | - Márjorie de Assis Golim
- Graduate Program in Research and Development (Medical Biotechnology), Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Liciana Vaz de Arruda Silveira
- Department of Bioestatistics, Institute of Biosciences of Botucatu, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Rafael Plana Simões
- Graduate Program in Research and Development (Medical Biotechnology), Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.,Department of Biotechnology and Bioprocess Engineering, Faculty of Agronomic Sciences, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Giovanni Faria Silva
- Department of Clinical Medicine, Botucatu Medical School, São Paulo State University (UNESP), Av. Prof. Mário Rubens Guimarães Montenegro, s/n - UNESP, Botucatu, São Paulo, Brazil. .,Graduate Program in Research and Development (Medical Biotechnology), Botucatu Medical School, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil.
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5
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Elbasvir/Grazoprevir in People With Hepatitis C Genotype 1 Infection and Child-Pugh Class B Cirrhosis: The C-SALT Study. Clin Transl Gastroenterol 2020; 10:e00007. [PMID: 30939489 PMCID: PMC6493687 DOI: 10.14309/ctg.0000000000000007] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Treatment options are limited for people infected with hepatitis C virus (HCV) with decompensated liver disease. The C-SALT study assessed elbasvir (EBR) plus grazoprevir (GZR) in individuals with HCV genotype 1 infection and Child-Pugh class B (CP-B) cirrhosis.
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6
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Laursen TL, Sandahl TD, Kazankov K, George J, Grønbæk H. Liver-related effects of chronic hepatitis C antiviral treatment. World J Gastroenterol 2020; 26:2931-2947. [PMID: 32587440 PMCID: PMC7304101 DOI: 10.3748/wjg.v26.i22.2931] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/26/2020] [Accepted: 05/29/2020] [Indexed: 02/06/2023] Open
Abstract
More than five years ago, the treatment of hepatitis C virus infection was revolutionized with the introduction of all-oral direct-acting antiviral (DAA) drugs. They proved highly efficient in curing patients with chronic hepatitis C (CHC), including patients with cirrhosis. The new DAA treatments were alleged to induce significant improvements in clinical outcome and prognosis, but the exact cause of the expected benefit was unclear. Further, little was known about how the underlying liver disease would be affected during and after viral clearance. In this review, we describe and discuss the liver-related effects of the new treatments in regards to both pathophysiological aspects, such as macrophage activation, and the time-dependent effects of therapy, with specific emphasis on inflammation, structural liver changes, and liver function, as these factors are all related to morbidity and mortality in CHC patients. It seems clear that antiviral therapy, especially the achievement of a sustained virologic response has several beneficial effects on liver-related parameters in CHC patients with advanced liver fibrosis or cirrhosis. There seems to be a time-dependent effect of DAA therapy with viral clearance and the resolution of liver inflammation followed by more discrete changes in structural liver lesions. These improvements lead to favorable effects on liver function, followed by an improvement in cognitive dysfunction and portal hypertension. Overall, the data provide knowledge on the several beneficial effects of DAA therapy on liver-related parameters in CHC patients suggesting short- and long-term improvements in the underlying disease with the promise of an improved long-term prognosis.
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Affiliation(s)
- Tea L Laursen
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Thomas D Sandahl
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Konstantin Kazankov
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital, Sydney NSW 2145, Australia
- University of Sydney, Sydney NSW 2145, Australia
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark
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7
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Rutledge SM, Zheng H, Li DK, Chung RT. No evidence for higher rates of hepatocellular carcinoma after direct-acting antiviral treatment: a meta-analysis. ACTA ACUST UNITED AC 2019; 5. [PMID: 31453368 PMCID: PMC6709867 DOI: 10.20517/2394-5079.2019.19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aim: Hepatitis C virus (HCV) is the leading cause of hepatocellular carcinoma (HCC) in the United States. Achieving sustained viral response with interferon (IFN) treatment reduces the risk from 3%-5% to 0.5%-1% annually. Several studies reported unexpectedly high rates of HCC after treatment with direct-acting antivirals (DAAs). The aim of our study was to compare HCC rates in DAA-, IFN-treated and untreated populations. Methods: A literature search was conducted using ScienceDirect, Ovid®, Web of Science and MEDLINE through January 2019. Studies were included if they measured rates of de novo or recurrent HCC (following curative treatment) in HCV-infected persons. We included 138 studies (n = 177,512). Simple pooling of data and meta-analysis were performed, using the random effects method. Results: Mean age was higher in the DAA-treated vs. IFN-treated group (58.4 years vs. 52.6 years; P = 0.0073), as were diabetes prevalence (34.5% vs. 11.7%; P ≤ 0.001) and incident cirrhosis (47.8% vs. 34.2%, P = 0.0017). The incidence rate of de novo HCC was 2.01/100 person-years (py) (95%CI: 1.38, 2.67) in the DAA group and 1.45/100py (95%CI: 0.98, 1.94) in the IFN-treated group. HCC recurred at 16.76/100py (95%CI: 10.75, 22.91) in the DAA-treated group vs. 20.04/100py (95%CI: 2.58, 45.21) after IFN. After adjusting for factors such as age and cirrhosis, the hazard ratio was 0.58 (95%CI: 0.20, 1.07) for HCC occurrence and 0.59 (95%CI: 0.24, 1.03) for HCC recurrence after DAA treatment compared to IFN-based treatment. Conclusion: We did not find evidence for increased rates of HCC in DAA-treated compared with IFN-treated patients. Compared to those treated with IFN, older patients with additional risk factors for HCC were treated with DAAs. This imbalance appears to explain the higher numerical incidence of HCC among DAA-treated patients.
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Affiliation(s)
- Stephanie M Rutledge
- Department of Medicine, Massachusetts General Hospital, Gastroenterology Unit/Warren 10, Boston, MA02114, USA.,Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Hui Zheng
- Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Darrick K Li
- Department of Medicine, Massachusetts General Hospital, Gastroenterology Unit/Warren 10, Boston, MA02114, USA.,Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Raymond T Chung
- Department of Medicine, Massachusetts General Hospital, Gastroenterology Unit/Warren 10, Boston, MA02114, USA.,Liver Center, Gastrointestinal Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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8
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Equivalent Outcomes With Retransplantation and Primary Liver Transplantation in the Direct-acting Antiviral Era. Transplantation 2019; 103:1168-1174. [DOI: 10.1097/tp.0000000000002460] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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9
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Al-Judaibi B, Thomas B, Wong P, Benmassaoud A, Chen JH, Dokus MK, Hussaini T, Bilodeau M, Burak KW, Marotta P, Yoshida EM. Sofosbuvir-Based Therapy in the Pre-Liver Transplant Setting: The Canadian National Experience. Ann Hepatol 2019; 17:437-443. [PMID: 29735784 DOI: 10.5604/01.3001.0011.7388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Sofosbuvir (SOF)-based regimen has been shown to have high efficacy even in patients with decompensated cirrhosis. Treated patients may experience various degrees of hepatic recovery ranging from stabilization of liver function, to removal from liver transplant wait lists. The frequency of these occurrences in larger transplant eligible patient populations is unknown. The aim of this study was to assess the efficacy of SOF-based therapy in HCV infected transplant eligible patients and to evaluate short term changes in liver function and the effect on their liver transplant status. MATERIAL AND METHODS A retrospective multicenter Canadian study of liver transplant candidates with advanced HCV cirrhosis treated with SOF-based therapy. Outcomes included sustained virologic response (SVR), and liver transplant status. RESULTS 105 liver transplant candidates with advanced liver disease due to HCV were evaluated. The overall SVR was 83.8%. Hepatocellular carcinoma was diagnosed in 39 (37.1%) prior to transplant evaluation. In short term follow-up, 14 (13.3%) remained active on the list at the time of SVR12, 22 (20.9%) patients underwent liver transplantation, 7 (6.6%) patients were deactivated due to clinical improvement, 3 patients were delisted, and 10 deaths were reported. CONCLUSIONS SOF-based therapy for patients progressing to liver transplantation leads to high SVR rates, short term stability in liver function, and deactivation from the transplant list .
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Affiliation(s)
- Bandar Al-Judaibi
- Department of Medicine, Division of Gastroenterology, Schulich School of Medicine and Dentistry at the University of Western Ontario, London, Canada
| | - Benson Thomas
- Department of Medicine, Division of Gastroenterology, Schulich School of Medicine and Dentistry at the University of Western Ontario, London, Canada
| | - Philip Wong
- Department of Medicine, Division of Gastroenterology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | - Amine Benmassaoud
- Department of Medicine, Division of Gastroenterology, McGill University Health Centre, Royal Victoria Hospital, Montreal, Canada
| | - Jo-Hua Chen
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - M Katherine Dokus
- Department of Medicine, Division of Gastroenterology, University of Rochester, Rochester, New York, United States of America
| | - Trana Hussaini
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Marc Bilodeau
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, Canada
| | - Kelly W Burak
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Calgary, Alberta, Canada
| | - Paul Marotta
- Department of Medicine, Division of Gastroenterology, Schulich School of Medicine and Dentistry at the University of Western Ontario, London, Canada
| | - Eric M Yoshida
- Department of Medicine, Division of Gastroenterology, University of British Columbia, Vancouver, Canada
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Laurain A, Metivier S, Haour G, Larrey D, Dorival C, Hezode C, Zoulim F, Marcellin P, Bourliere M, Zarski JP, Thabut D, Alric L, Ganne-Carrie N, Cales P, Bronowicki JP, Riachi G, Geist C, Causse X, Abergel A, Chazouilleres O, Mathurin P, Guyader D, Samuel D, Tran A, Loustaud-Ratti V, Petrov-Sanchez V, Diallo A, Luzivika-Nzinga C, Fontaine H, Carrat F, Pol S. Safety and efficacy of the combination simeprevir-sofosbuvir in HCV genotype 1- and 4-mono-infected patients from the French ANRS CO22 hepather cohort. BMC Infect Dis 2019; 19:300. [PMID: 30940090 PMCID: PMC6446259 DOI: 10.1186/s12879-019-3923-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 03/19/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although real-life results of sofosbuvir/simeprevir have been extensively reported from the United States, data from other geographical areas are limited. In the French observational cohort, ANRS CO22 HEPATHER, 9432 patients were given the new oral antivirals from December 2013 to June 30, 2018. We report the results of sofosbuvir/simeprevir in genotypes 1- and 4-infected patients. METHODS Demographics and history of liver disease were collected at entry in the cohort. Clinical, adverse events, and virological data were collected throughout treatment and post-treatment follow-up. The choice of treatment duration or addition of ribavirin was left up to the physician. RESULTS Five hundred ninety-nine HCV (467 genotype 1 and 132 genotype 4) mono-infected, naïve for all oral-DAAs regimen patients were given sofosbuvir/simeprevir with (n = 63) or without ribavirin (n = 536) for 12 or 24 weeks; 56% had cirrhosis (4% decompensated) and 71% had prior treatment failure to interferon-based regimen. 7 patients (1.16%) were lost to follow-up. The overall SVR12 rate was 92.6%. The SVR12 was 90% in GT1a, 94.2% in GT1b and 91.6% in GT4 with no significant difference for genotype, treatment duration or ribavirin addition. Severity of liver disease was not associated with a lower SVR12 rate on multivariate analysis but was associated with a higher rate of severe side effects. Early treatment discontinuations were rare; no new safety signals were reported. CONCLUSION In this real life, observational, prospective cohort study, the 12-week sofosbuvir/simeprevir+/-ribavirin combination appears to be efficient and safe. TRIAL REGISTRATION Trial registration with ClinicalTrials.gov NCT01953458 .
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Affiliation(s)
- Anne Laurain
- Université Paris Descartes ; APHP, Unité d'Hépatologie, Hôpital Cochin ; INSERM U-818 et USM20, Institut Pasteur, Paris, France.
| | - Sophie Metivier
- Department of Hepatology and Gastroenterology, CHU Purpan, Toulouse, France
| | - Georges Haour
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, F75012, Paris, France
| | - Dominique Larrey
- Liver unit-IRB-INSERM1040, Hôpital Saint Eloi, Montpellier, France
| | - Céline Dorival
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, F75012, Paris, France
| | - Christophe Hezode
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, AP-HP, Université Paris-Est, INSERM U955, Créteil, France
| | - Fabien Zoulim
- Department of Hepatology, Hospices Civils de Lyon, INSERM U1052, Université de Lyon, Lyon, France
| | - Patrick Marcellin
- Department of Hepatology, Hôpital Beaujon, AP-HP, Université Paris-Diderot, INSERM CRB3, Clichy, France
| | - Marc Bourliere
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France
| | - Jean-Pierre Zarski
- Department of Hepatology and Gastroenterology, Centre Hospitalo-Universitaire, INSERM U823, Grenoble, France
| | - Dominique Thabut
- Department of Hepatology and Gastroenterology, Groupe Hospitalier Pitié-Salpétrière, AP-HP, Université Pierre et Marie Curie Paris 6, INSERM UMR-S938, Paris, France
| | - Laurent Alric
- Internal Medicine-Digestive Department CHU Purpan, UMR152, IRD, Toulouse 3 University, Toulouse, France
| | - Nathalie Ganne-Carrie
- Functional Genomics of Solid Tumors, Hepatology Unit, Hôpital Jean Verdier, Bondy, AP-HP, University Paris 13, Sorbonne Paris Cité, Bobigny; Inserm UMR-1162, F-93000, Paris, France
| | - Paul Cales
- Liver-Gastroenterology Department, CHU Angers, Angers, France
| | - Jean-Pierre Bronowicki
- Department of Hepatology and Gastroenterology, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, INSERM U954, Vandoeuvre-les-Nancy, France
| | - Ghassan Riachi
- Department of Hepatology and Gastroenterology, CHU Charles Nicolle, Rouen, France
| | - Claire Geist
- Department of Hepatology and Gastroenterology, Centre Hospitalier Régional, Metz, France
| | - Xavier Causse
- Department of Hepatology and Gastroenterology, CHR d'Orléans, Orléans, France
| | - Armand Abergel
- Department of Digestive and Hepatobiliary Diseases, Estaing University Hospital, Clermont-Ferrand, France.,UMR Auvergne University/CNRS 6284 ISIT (Image Sciences for Innovations Techniques), Clermont-Ferrand, France
| | - Olivier Chazouilleres
- Department of Hepatology, Hôpital Saint-Antoine, AP-HP, Université Pierre et Marie Curie Paris 6, Paris, France
| | - Philippe Mathurin
- Department of Hepatology and Gastroenterology, Centre Hospitalier Régional et Universitaire Claude Huriez, Lille, France
| | - Dominique Guyader
- Liver disease unit, CHU Rennes, Université de Rennes 1, INSERM U991, Rennes, France
| | - Didier Samuel
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, UMR-S785, Université Paris-Sud, INSERM U785, Villejuif, France
| | - Albert Tran
- Digestive Center, Centre Hospitalier Universitaire de Nice, INSERM U1065-8, Nice, France
| | - Véronique Loustaud-Ratti
- Department of Hepatology and Gastroenterology, CHU Limoges, U850 INSERM, Univ. Limoges, F-87000, Limoges, France
| | - Ventzislava Petrov-Sanchez
- ANRS (France Recherche Nord&sud Sida-hiv Hépatites), Unit for Basic and Clinical Research on Viral Hepatitis, Paris, France
| | - Alpha Diallo
- ANRS (France Recherche Nord&sud Sida-hiv Hépatites), Clinical Trial Safety and Public Health, Paris, France
| | - Clovis Luzivika-Nzinga
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, F75012, Paris, France
| | - Hélène Fontaine
- Université Paris Descartes ; APHP, Unité d'Hépatologie, Hôpital Cochin ; INSERM U-818 et USM20, Institut Pasteur, Paris, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, F75012, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint Antoine, Unité de Santé Publique, F-75012, Paris, France
| | - Stanislas Pol
- Université Paris Descartes ; APHP, Unité d'Hépatologie, Hôpital Cochin ; INSERM U-818 et USM20, Institut Pasteur, Paris, France.
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Aqel B, Leise M, Vargas HE, Watt KD, Keaveny AP, Zhang N, Zhang N, Pungpapong S. Multicenter Experience using Ledipasvir/Sofosbuvir ± RBV to Treat HCV GT 1 Relapsers after Simeprevir and Sofosbuvir Treatment. Ann Hepatol 2018; 17:815-821. [PMID: 30145562 DOI: 10.5604/01.3001.0012.3142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND AIM Approximately 10%-15% of patients with hepatitis C genotype 1 (HCV GT1) experience virological relapse after all-oral antiviral regimen using simeprevir (SMV) and sofosbuvir (SOF). The efficacy and safety of treating such relapsers using ledipasvir/sofosbuvir (LDV/SOF) with/without ribavirin (RBV) has been limited. OBJECTIVE Report the virological response and safety of LDV/SOF with/without RBV for 12-24 weeks in treating HCV GT1 relapsers after SMV + SOF. MATERIAL AND METHODS Patients treated with standardized clinical protocol utilizing LDV/SOF with/without RBV at three transplant centers were retrospectively reviewed. RESULTS Forty-five patients (29% post-LT, 82% male, 13% non-white, 73% subtype 1a, 86% IL28B CT/TT, 78% F3-4) started LDV/SOF with/without RBV at a median of 22 weeks (range 7-55 weeks) after the last dose of SMV+SOF treatment. Thirty-seven patients received LDV/SOF for 24 weeks (24/37 patients with RBV) and eight patients received LDV/SOF for 12 weeks (5/8 patients with RBV). RBV dose was adjusted for renal function. Sixteen patients who were RBV-ineligible received LDV/SOF without RBV for 12 or 24 weeks. SVR 12 was achieved in 96% (43/45) of patients. Baseline viral load, RBV use, or GT1 subtype did not impact SVR 12. Minimal adverse events were reported in those without RBV; 45% of patients who received RBV developed significant anemia requiring RBV dose reduction and/or discontinuation. In LT recipients, minimal immunosuppression dose adjustments were required and no biopsy-proven acute rejection occurred. CONCLUSIONS Treatment with LDV/SOF with/without RBV for 12-24 weeks was very well tolerated and resulted in high SVR 12 rates (96%) in HCV GT1 relapsers to SMV + SOF treatment.
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Affiliation(s)
| | - Michael Leise
- Division of Gastroenterology and Hepatology, Mayo Clinic in Minnesota, USA
| | - Hugo E Vargas
- Division of Gastroenterology and Hepatology, Mayo Clinic in Arizona, USA
| | - Kymberly D Watt
- Division of Gastroenterology and Hepatology, Mayo Clinic in Minnesota, USA
| | | | - Nan Zhang
- Department of Health Science Research, Section of Biostatistics, Mayo Clinic in Arizona, USA
| | - Nan Zhang
- Department of Health Science Research, Section of Biostatistics, Mayo Clinic in Arizona, USA
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12
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Tam E, Luetkemeyer AF, Mantry PS, Satapathy SK, Ghali P, Kang M, Haubrich R, Shen X, Ni L, Camus G, Copans A, Rossaro L, Guyer B, Brown RS. Ledipasvir/sofosbuvir for treatment of hepatitis C virus in sofosbuvir-experienced, NS5A treatment-naïve patients: Findings from two randomized trials. Liver Int 2018; 38:1010-1021. [PMID: 29091342 PMCID: PMC5930158 DOI: 10.1111/liv.13616] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/21/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND & AIMS We report data from two similarly designed studies that evaluated the efficacy, safety, and optimal duration of ledipasvir/sofosbuvir (LDV/SOF) ± ribavirin (RBV) for retreatment of chronic hepatitis C virus (HCV) in individuals who failed to achieve sustained virological response (SVR) with prior SOF-based, non-NS5A inhibitor-containing regimens. METHODS The RESCUE study enrolled HCV mono-infected adults with genotype (GT) 1 or 4. Non-cirrhotic participants were randomized to 12 weeks of LDV/SOF or LDV/SOF + RBV. Compensated cirrhotic participants were randomized to LDV/SOF + RBV (12 weeks) or LDV/SOF (24 weeks). The AIDS Clinical Trials Group A5348 study randomized genotype 1 adults with HCV/HIV co-infection to LDV/SOF + RBV (12 weeks) or LDV/SOF (24 weeks). Both studies used SVR at 12 weeks post-treatment (SVR12) as the primary endpoint. RESULTS In the RESCUE study, 82 participants were randomized and treated, and all completed treatment. Overall, SVR12 was 88% (72/82); 81-100% in non-cirrhotic participants treated with LDV/SOF or LDV/SOF + RBV for 12 weeks and 80-92% in cirrhotic participants treated with LDV/SOF + RBV for 12 weeks or LDV/SOF for 24 weeks. Adverse events (AEs), mostly mild-to-moderate in severity, were experienced by 78% of participants, with headache and fatigue most frequently reported. One serious AE, not related to treatment, was observed. No premature discontinuations of study drug, or deaths occurred. In the A5348 study, seven participants were randomized (cirrhotic n = 1; GT1a n = 5) and all attained SVR12, with no serious AEs or premature discontinuations. CONCLUSIONS In this SOF-experienced, NS5A inhibitor-naïve population, which included participants with cirrhosis or HCV/HIV co-infection, high SVR12 rates were achieved.
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Affiliation(s)
| | - Anne F. Luetkemeyer
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Parvez S. Mantry
- The Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA
| | - Sanjaya K. Satapathy
- Methodist University Hospital Transplant Institute, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Peter Ghali
- McGill University Health Centre, Royal Victoria Hospital, Montreal, QC, Canada
| | - Minhee Kang
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Liyun Ni
- Gilead Sciences, Foster City, CA, USA
| | | | | | | | | | - Robert S. Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York City, NY, USA
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13
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El-Khayat H, Fouad Y, Mohamed HI, El-Amin H, Kamal EM, Maher M, Risk A. Sofosbuvir plus daclatasvir with or without ribavirin in 551 patients with hepatitis C-related cirrhosis, genotype 4. Aliment Pharmacol Ther 2018; 47:674-679. [PMID: 29314146 DOI: 10.1111/apt.14482] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 08/14/2017] [Accepted: 11/30/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Daclatasvir and Sofosbuvir combination therapy (SOF/DCV) has shown efficacy in patients with chronic hepatitis C in clinical trials. AIM To investigate the efficacy and safety of SOF/DCV for treatment of patients with hepatitis C-related liver cirrhosis genotype 4. METHODS Multicentre study involving 551 patients with liver cirrhosis genotype 4; 432 naïve patients and 119 treatment-experienced patients. All patients received SOF (400 mg) and DCV (60 mg) daily in addition to weight-based ribavirin (RBV) for 12 weeks and when RBV is contraindicated the treatment duration was extended to 24 weeks. RESULTS Sustained virological response at 12 weeks after end of treatment (SVR12) rate was 92% in naïve cirrhotic patients and 87% in previous treated patients (by ITT analysis). Virological failure was infrequent, occurring in 42 patients (8%) overall. Thirty-two (6%) were non responders; and 10 (2%) cases were relapsers, 31 patients (7%) were CTP-A and 11 (13.3%) patients were CTP-B (by ITT analysis). The most common adverse events were anaemia, fatigue, headache, pruritus. Serious side effects were recorded mainly in CTP-B cirrhotic patients including HCC and hepatic encephalopathy. CONCLUSIONS The SOF/DCV combination therapy has proven efficacy and safety in treating patients with hepatitis C-related liver cirrhosis genotype 4 in a large cohort of patients in the real world.
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Affiliation(s)
- H El-Khayat
- Gastroenterology and Endemic Medicine Department, Theodore Research Institute, Cairo, Egypt
| | - Y Fouad
- Gastroenterology and Endemic Medicine Department, Minia University, Minia, Egypt
| | - H I Mohamed
- Gastroenterology and Endemic Medicine Department, Minia University, Minia, Egypt
| | - H El-Amin
- Internal Medicine Department, Assuit University, Assuit, Egypt
| | - E M Kamal
- Gastroenterology and Endemic Medicine Department, Minia University, Minia, Egypt
| | - M Maher
- Gastroenterology and Endemic Medicine Department, Ain Shams University, Cairo, Egypt
| | - A Risk
- Rheumatology Department, Cairo University, Cairo, Egypt
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Pharmacokinetics, Efficacy, and Safety of Hepatitis C Virus Drugs in Patients with Liver and/or Renal Impairment. Drug Saf 2017; 39:589-611. [PMID: 27098247 PMCID: PMC4912979 DOI: 10.1007/s40264-016-0420-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hepatitis C virus (HCV)-infected patients often suffer from liver cirrhosis, which can be complicated by renal impairment. Therefore, in this review we describe the treatment possibilities in HCV patients with hepatic and renal impairment. Cirrhosis alters the structure of the liver, which affects drug-metabolizing enzymes and drug transporters. These modifications influence the plasma concentration of substrates of drugs metabolized/transported by these enzymes. The direct-acting antivirals (DAAs) are substrates of, for example, cytochrome P450 enzymes in the liver. Most DAAs are not studied in HCV-infected individuals with decompensated cirrhosis, and therefore awareness is needed when these patients are treated. Most DAAs are contraindicated in cirrhotic patients; however, patients with a Child-Pugh score of B or C can be treated safely with a normal dose sofosbuvir plus ledipasvir or daclatasvir, in combination with ribavirin. Patients with renal impairment (glomerular filtration rate [GFR] <90 mL/min) or who are dependent on dialysis often tolerate ribavirin treatment poorly, even after dose adjustments. However, most DAAs can be used at the normal dose because DAAs are not renally excreted. To date, grazoprevir plus elbasvir is the preferred DAA regimen in patients with renal impairment as data are pending for sofosbuvir patients with GFR <30 mL/min (as for ledipasvir and velpatasvir). However, sofosbuvir has been used in a small number of patients with severe renal impairment and, based on these trials, we recommend sofosbuvir 400 mg every day when no other DAA regimen is available. Ledipasvir and velpatasvir are not recommended in patients with severe renal impairment.
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Libânio D, Marinho RT. Impact of hepatitis C oral therapy in portal hypertension. World J Gastroenterol 2017; 23:4669-4674. [PMID: 28765688 PMCID: PMC5514632 DOI: 10.3748/wjg.v23.i26.4669] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/28/2017] [Accepted: 05/19/2017] [Indexed: 02/07/2023] Open
Abstract
Chronic hepatitis C is a leading cause of morbidity and mortality, mainly related to fibrosis/cirrhosis and portal hypertension. Direct antiviral agents are highly effective and safe and can now cure > 90% of the patients. Sustained viral response (SVR) after interferon-based regimens has been associated with improvement in liver function, fibrosis and portal hypertension in a significant proportion of patients, although a point of no return seems to exist from which viral elimination is no longer capable of preventing portal hypertension progression and liver decompensation. Indeed, although SVR is associated with improvement of hepatic venous pressure gradients and therefore a decreased risk of de novo esophageal varices, several studies show that viral clearance does not eliminate the risk of variceal progression, liver decompensation and death in patients with pre-established portal hypertension. Although evidence about the effects of direct antiviral agents (DAAs) on clinically significant outcomes is still scarce and with short follow-up, DAAs can decrease the burden of the disease if patients are timely treated before significant fibrosis and portal hypertension develops. Studies with longer follow-up are waited to establish the real magnitude of hepatitis C treatment on portal hypertension. Future studies should also focus on predictors of portal hypertension resolution since it can influence management and avoid unnecessary monitoring
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Moreno-Planas JM, Larrubia-Marfil JR, Sánchez-Ruano JJ, Morillas-Ariño J, Patón-Arenas R, Sáiz-Chumillas RM, Tébar-Romero E, Lucendo-Villarín A, Gancedo-Bringas P, Solera-Muñoz M, Vicente-Gutiérrez MDM, Martínez-Alfaro E. Influence of baseline MELD score in the efficacy of treatment of hepatitis C with simeprevir and sofosbuvir. Enferm Infecc Microbiol Clin 2017. [PMID: 28641865 DOI: 10.1016/j.eimc.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION There are few published studies on predictors of response to treatment with sofosbuvir and simeprevir in HCV patients. OBJECTIVE The objective of the study was to analyse possible predictors of response to simeprevir (SMV) and sofosbuvir (SOF) in patients infected with hepatitis C genotypes 1 or 4. PATIENTS AND METHODS Prospective observational cohort study in 12 hospitals. The primary efficacy endpoint was SVR rate 12 weeks after end of treatment (SVR12). RESULTS 204 patients (62.3% male, mean age 55 years) were included: 186 (91.2%) genotype 1 (60.3% 1b 25% 1a) and 18 (8.8%) genotype 4. 132 (64.7%) cirrhotic (87.9% Child A), 33 (16.2%) F3, 31 (15.2%) F2, 8 (3.9%) F0-1. 80.8% MELD<10. 93 (45.6%) naive. Ribavirin was added in 68 (33.3%). Mean baseline viral load 2,151,549 IU/ml (SD: 2,391,840). Treatment duration 12 weeks in 93.1%. 4 discontinued therapy: suicide, psychotic attack, hyperbilirubinaemia and liver cancer recurrence. 190 (93.1%) achieved SVR12. There were no differences in SVR12 depending on the genotype, treatment duration, ribavirin use, prior therapy, viral load (VL) or baseline platelets. In univariate analysis, undetectable VL at 4 weeks (p=0.042), absence of cirrhosis (p=0.021), baseline albumin ≥ 4g/dl (p=0.001) and MELD<10 (p<0.0001) were associated with higher SVR12. In multivariate analysis, only baseline MELD score <10 patients had higher SVR12 (p<0.001). CONCLUSIONS The combination of simeprevir and sofosbuvir in patients infected with genotype 1 and 4 hepatitis C is highly effective. It is a safe therapy, especially in patients without ribavirin. This combination was more effective in patients with a MELD score below 10.
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Affiliation(s)
- José María Moreno-Planas
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Albacete, Facultad de Medicina, Universidad de Castilla La Mancha, Albacete, España.
| | - Juan Ramón Larrubia-Marfil
- Servicio de Aparato Digestivo, Hospital Universitario de Guadalajara, Guadalajara, España; Facultad de Medicina, Universidad Alcalá de Henares, Alcalá de Henares, Madrid, España
| | | | - Julia Morillas-Ariño
- Servicio de Aparato Digestivo, Hospital Virgen de la Luz de Cuenca, Cuenca, España
| | - Roberto Patón-Arenas
- Servicio de Aparato Digestivo, Hospital General Universitario de Ciudad Real, Ciudad Real, España
| | | | - Emilia Tébar-Romero
- Servicio de Aparato Digestivo, Hospital de Alcázar de San Juan, Ciudad Real, España
| | | | | | - Mario Solera-Muñoz
- Servicio de Medicina Interna, Hospital de Villarrobledo, Albacete, España
| | - María Del Mar Vicente-Gutiérrez
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Albacete, Universidad de Castilla La Mancha, Albacete, España
| | - Elisa Martínez-Alfaro
- Unidad de Enfermedades Infecciosas, Complejo Hospitalario Universitario de Albacete, Universidad de Castilla La Mancha, Albacete, España
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Rezaee-Zavareh MS, Hesamizadeh K, Sharafi H, Alavian SM. Treatment of Hepatitis C Infection with Direct-Acting Antiviral Agents in Liver-Transplant Patients: A Systematic Review and Meta-Analysis. HEPATITIS MONTHLY 2017; 17. [DOI: 10.5812/hepatmon.12324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
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Chen JH, Zeng Z, Zhang XX, Zhang Y, Zhang RW, Wang S, Wu CH, Yu M, Liu D, Xi HL, Zhou YX, An YY, Xu XY. Efficacy and safety of combined directly acting antivirals for treatment of Chinese chronic hepatitis C patients in a real-world setting. World J Gastroenterol 2017; 23:4072-4079. [PMID: 28652660 PMCID: PMC5473126 DOI: 10.3748/wjg.v23.i22.4072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/16/2017] [Accepted: 04/12/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the efficacy and safety of combined directly acting antivirals (DAAs) for the treatment of Chinese chronic hepatitis C (CHC) patients in a real-world setting.
METHODS Hospitalized CHC patients who were treated with DAAs at Peking University First Hospital between January 2015 and December 2016 were enrolled. Samples and clinical data were collected at 0 wk, 2 wk, 4 wk, 8 wk, 12 wk, or 24 wk during DAAs treatment and at 4 wk, 12 wk, and 24 wk after the end of treatment.
RESULTS Fifty-four patients who underwent DAAs treatment were included in our study, of whom 83.3% (45/54) achieved rapid virological response at 2 wk after treatment initiation (RVR 2) and 94.4% (51/54) achieved sustained virological response at 24 wk after the end of treatment (SVR 24). Serum creatinine and uric acid levels at the end of treatment were significantly increased compared with baseline levels (83.6 ± 17.9 vs 88.8 ± 19.4, P01 < 0.001; 320.8 ± 76.3 vs 354.5 ± 87.6, P01 < 0.001), and no significant improvements were observed at 24w after the end of treatment (83.6 ± 17.9 vs 86.8 ± 19.1, P02 = 0.039; 320.8 ± 76.3 vs 345.9 ± 89.4, P02 = 0.001). The total frequency of adverse events (AEs) during treatment was 33.3% (18/54), with major AEs being fatigue (16.7%), headache (7.4%), anorexia (7.4%), and insomnia (5.6%).
CONCLUSION Though based in a small cohort of patients, the abnormal changes in renal function indices and relative high frequency of AEs during combined DAAs treatment should be taken as a note of caution.
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Fernández Carrillo C, Lens S, Llop E, Pascasio JM, Crespo J, Arenas J, Fernández I, Baliellas C, Carrión JA, de la Mata M, Buti M, Castells L, Albillos A, Romero M, Turnes J, Pons C, Moreno-Planas JM, Moreno-Palomares JJ, Fernández-Rodriguez C, García-Samaniego J, Prieto M, Fernández Bermejo M, Salmerón J, Badia E, Salcedo M, Herrero JI, Granados R, Blé M, Mariño Z, Calleja JL. Treatment of hepatitis C virus infection in patients with cirrhosis and predictive value of model for end-stage liver disease: Analysis of data from the Hepa-C registry. Hepatology 2017; 65:1810-1822. [PMID: 28170112 DOI: 10.1002/hep.29097] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/27/2017] [Accepted: 01/27/2017] [Indexed: 12/11/2022]
Abstract
UNLABELLED Direct-acting antiviral agents (DAAs) are highly effective and well tolerated in patients with chronic hepatitis C virus infection, including those with compensated cirrhosis. However, fewer data are available in patients with more advanced liver disease. Our retrospective, noninterventional, national, multicenter study in patients from the Spanish Hepa-C registry investigated the effectiveness and safety of interferon-free DAA regimens in patients with advanced liver disease, including those with decompensated cirrhosis, in routine practice (all currently approved regimens were registered). Patients transplanted during treatment or within 12 weeks of completing treatment were excluded. Among 843 patients with cirrhosis (Child-Turcotte-Pugh [CTP] class A, n = 564; CTP class B/C, n = 175), 90% achieved sustained virologic response 12 weeks after treatment (SVR12). Significant differences in SVR12 and relapse rates were observed between CTP class A and CTP class B/C patients (94% versus 78%, and 4% versus 14%, respectively; both P < 0.001). Serious adverse events (SAEs) were more common in CTP class B/C versus CTP class A patients (50% versus 12%, respectively; P < 0.001). Incident decompensation was the most common serious adverse event (7% overall). Death rate during the study period was 16/843 (2%), significantly higher among CTP class B/C versus CTP class A patients (6.4% versus 0.9%; P < 0.001). Baseline Model for End-Stage Liver Disease (MELD) score alone (cut-off 18) was the best predictor of survival. CONCLUSION Patients with decompensated cirrhosis receiving DAAs present lower response rates and experience more SAEs. In this setting, a MELD score ≥18 may help clinicians to identify those patients with a higher risk of complications and to individualize treatment decisions. (Hepatology 2017;65:1810-1822).
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Affiliation(s)
- Carlos Fernández Carrillo
- Liver Unit, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHIM, CIBERehd, Majadahonda, Madrid, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - Elba Llop
- Liver Unit, Hospital Universitario Puerta de Hierro-Majadahonda, IDIPHIM, CIBERehd, Majadahonda, Madrid, Spain
| | - Juan Manuel Pascasio
- Department of Gastroenterology, Hospital Universitario Virgen del Rocío, IBIS, CIBERehd, Sevilla, Spain
| | - Javier Crespo
- Gastroenterology and Hepatology Unit, Hospital Universitario Marqués de Valdecilla, Santander, IDIVAL, Universidad de Cantabria, Santander, Spain
| | - Juan Arenas
- Department of Gastroenterology, Hospital Universitario Donostia, San Sebastián, Spain
| | - Inmaculada Fernández
- Department of Gastroenterology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Carme Baliellas
- Digestive Service, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Antonio Carrión
- Liver Section, Gastroenterology Department, Hospital del Mar, IMIM, Barcelona, Spain
| | - Manuel de la Mata
- Hepatology & Liver Transplant Unit, Hospital Universitario Reina Sofía, IMIBIC, CIBERehd, Córdoba, Spain
| | - Maria Buti
- Liver Unit, Hospital Universitario Vall d'Hebrón, CIBERehd, Barcelona, Spain
| | - Lluís Castells
- Liver Unit, Hospital Universitario Vall d'Hebrón, CIBERehd, Barcelona, Spain
| | - Agustín Albillos
- Gastroenterology and Hepatology Department, Hospital Universitario Ramón y Cajal, University of Alcalá, IRYCIS, CIBERehd, Madrid, Spain
| | - Manuel Romero
- Digestive Diseases Unit, Hospital Universitario Virgen de Valme, CIBERehd, Sevilla, Spain
| | - Juan Turnes
- Department of Gastroenterology, Complejo Hospitalario Universitario de Pontevedra and IISGS, Pontevedra, Spain
| | - Clara Pons
- Digestive Service, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - José María Moreno-Planas
- Department of Gastroenterology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | | | | | | | - Martín Prieto
- Servicio de Medicina Digestiva, Unidad de Hepatología, Hospital Universitari i Politècnic La Fe and CIBERehd, Valencia, Spain
| | | | - Javier Salmerón
- Digestive Service, Hospital Universitario San Cecilio, CIBERehd, Granada, Spain
| | - Ester Badia
- Digestive Service, Hospital Universitario de Burgos, Burgos, Spain
| | - Magdalena Salcedo
- Liver Unit, Hospital General Universitario Gregorio Marañón, IiSGM, Madrid, Spain
| | | | - Rafael Granados
- Internal Medicine Service, H. U. de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | | | - Zoe Mariño
- Liver Unit, Hospital Clínic de Barcelona, University of Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
| | - José Luis Calleja
- Liver Unit, Hospital Universitario Puerta de Hierro-Majadahonda, Universidad Autónoma de Madrid and CIBERehd, Madrid, Spain
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20
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Boglione L, De Nicolò A, Mornese Pinna S, Cusato J, Favata F, Ariaudo A, Carcieri C, Cariti G, Di Perri G, D'Avolio A. Role of simeprevir plasma concentrations in HCV treated patients with dermatological manifestations. Dig Liver Dis 2017; 49:705-708. [PMID: 28174003 DOI: 10.1016/j.dld.2017.01.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/07/2017] [Accepted: 01/09/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Up till now the role of simeprevir plasma concentrations has not been described in treated patients affected by chronic hepatitis C and with dermatological side-effects. In this study, we have evaluated a possible relationship between plasma levels and the onset of skin complaints for the first time. METHODS We report a clinical and pharmacokinetic analysis of 56 patients treated with simeprevir-based therapies. RESULTS Simeprevir plasma concentrations were significantly related to dermatological side-effects at early time-points (P<0.001). In logistic regression, simeprevir concentrations at 1 week was the best predictive factor forskin symptoms (OR=1.901, 95%IC: 1.001-2.304; P=0.007). CONCLUSION Simeprevir plasma measurements could be a useful tool in a real-life clinical setting for prevention of dermatological symptoms.
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Affiliation(s)
- Lucio Boglione
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy.
| | - Amedeo De Nicolò
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Simone Mornese Pinna
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Jessica Cusato
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Fabio Favata
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Alessandra Ariaudo
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Chiara Carcieri
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Giuseppe Cariti
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Giovanni Di Perri
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
| | - Antonio D'Avolio
- Unit of Infectious Diseases, University of Turin, Department of Medical Sciences, Amedeo di Savoia Hospital, Turin, Italy
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21
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Conti F, Brillanti S, Buonfiglioli F, Vukotic R, Morelli MC, Lalanne C, Massari M, Foschi FG, Bernabucci V, Serio I, Prati GM, Negri E, Badia L, Caraceni P, Muratori P, Vitale G, Porro A, Morotti M, Mazzella G, Andreone P. Safety and efficacy of direct-acting antivirals for the treatment of chronic hepatitis C in a real-world population aged 65 years and older. J Viral Hepat 2017; 24:454-463. [PMID: 27976461 DOI: 10.1111/jvh.12663] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/03/2016] [Indexed: 12/27/2022]
Abstract
The availability of direct-acting antiviral agents (DAA) regimens has expanded the pool of patients eligible for treatment. However, data on the virologic response and tolerability of DAAs in elderly patients are lacking. We evaluated the efficacy and safety of DAAs in patients with advanced fibrosis/cirrhosis in real-life practice with the focus on those aged ≥65 years. Between January and December 2015, all consecutive patients with HCV-related advanced fibrosis/cirrhosis treated with DAA at eleven tertiary referral centres in Emilia Romagna (Italy) were enrolled. Regimen choice was based on viral genotype and stage of disease, according to guidelines. The primary end point was sustained virologic response 12 weeks after the end of treatment (SVR12). Overall, 282 of 556 (50.7%) patients evaluated were elderly, most of them with cirrhosis. Antiviral therapy was stopped prematurely in four (1.4%) patients. Two patients, both with cirrhosis, died during treatment due to worsening of liver/renal function. SVR12 was achieved by 94.7% and was comparable to that obtained in patients aged <65 (P=.074). Similar data were also reported in subgroup of patients aged ≥75 years. All patients with advanced fibrosis achieved virologic response. SVR12 was 80.8% in Child-Pugh-Turcotte (CTP)-B cirrhosis and 95.4% in CTP-A (P=.013). According to genotype, the SVR12 was achieved in 172 of 181 (95%) with genotype 1b cirrhosis and in 44 of 48 (91.7%) with genotype 2 cirrhosis. In conclusions, in a real-world setting, DAAs are safe and effective in elderly patients with HCV-related advanced fibrosis/cirrhosis, but SVR12 is lower with worsening CTP class.
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Affiliation(s)
- F Conti
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - S Brillanti
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - F Buonfiglioli
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - R Vukotic
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - M C Morelli
- U.O. di Medicina Interna per il trattamento delle gravi insufficienze d'organo, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - C Lalanne
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - M Massari
- U.O. di Malattie Infettive, Azienda Ospedaliera S. Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - F G Foschi
- U.O. di Medicina Interna, Ospedale di Faenza, Faenza, Italy
| | - V Bernabucci
- U.O. di Gastroenterologia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - I Serio
- U.O. di Medicina Interna, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - G M Prati
- U.O. di Gastroenterologia ed Epatologia, Ospedale "G da Saliceto", Piacenza, Italy
| | - E Negri
- U.O. di Malattie Infettive ed Epatologia, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - L Badia
- U.O. di Malattie Infettive, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - P Caraceni
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - P Muratori
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - G Vitale
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - A Porro
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - M Morotti
- U.O. di Farmacia Clinica, Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - G Mazzella
- Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
| | - P Andreone
- Centro di Ricerca per lo Studio delle Epatiti, Università di Bologna, Bologna, Italy.,Dipartimento di Scienze Mediche e Chirurgiche, Università di Bologna, Bologna, Italy.,Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola, Bologna, Italy
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22
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Fox DS, McGinnis JJ, Tonnu-Mihara IQ, McCombs JS. Comparative treatment effectiveness of direct acting antiviral regimens for hepatitis C: Data from the Veterans administration. J Gastroenterol Hepatol 2017; 32:1136-1142. [PMID: 27869323 DOI: 10.1111/jgh.13652] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 11/03/2016] [Accepted: 11/08/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Data addressing real world effectiveness of direct acting antiviral agents in hepatitis C infected patients are now emerging. This study compared the sustained virologic response rates achieved 12 weeks post-treatment in patients treated with three such agents by the Veterans Health Administration. METHODS A retrospective cohort study was conducted using patients who terminated treatment by July 1, 2015. Data were retrieved from the Veterans Health Administration electronic medical records system. Patients were included if sufficient viral load laboratory data were available to determine sustained virologic response. Applying an intention to treat approach and logistic regression analysis, the sustained virologic response rates achieved were compared across drug regimens. RESULTS A total of 11 464 patients met study selection criteria. Without controlling for other risk factors, sustained virologic response at least 12 weeks post treatment was achieved in 92% of ledipasvir/ sofosbuvir, 86% of ombitasvir/paritaprevir/ritonavir/dasabuvir, and 83% of simeprevir/sofosbuvir patients. After adjusting for patient characteristics, simeprevir/sofosbuvir (93.3%) and ledipasvir/sofosbuvir (96.2%) patients were statistically more likely than ombitasvir/paritaprevir/ritonavir/dasabuvir (91.8%) patients to demonstrate sustained virologic response. Human immunodeficiency virus, hepatitis B infection, diabetes, obesity, previous treatment history and augmentation therapy using ribavirin did not impact sustained virologic response rates. Sustained virologic response rates were lower for patients under age 65, with cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, indications of fibrosis, or a non-genotype 1 infection. Women and Caucasian patients were more likely to achieve a sustained virologic response. CONCLUSIONS All three direct acting antiviral regimens appear highly effective in achieving sustained virologic response.
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Affiliation(s)
- D Steven Fox
- Department of Medicine, Keck School of Medicine, Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, USA
| | - Justin J McGinnis
- Department of Pharmaceutical and Health Economics, School of Pharmacy, Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, USA.,Clinical Pharmacy Programs Development and Research, Veterans Affairs Long Beach Healthcare System, Long Beach, California, USA
| | - Ivy Q Tonnu-Mihara
- Clinical Pharmacy Programs Development and Research, Veterans Affairs Long Beach Healthcare System, Long Beach, California, USA
| | - Jeffrey S McCombs
- Department of Pharmaceutical and Health Economics, School of Pharmacy, Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, USA
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23
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Pellicelli AM, Pace Palitti V, Vignally P, Ceccherini-Silberstein F, Siciliano M, Giannelli V, Moretti A, Tarquini P, Scifo G, Messina V, Ascione A, Izzi A, Marignani M, D'Ambrosio C, Fondacaro L, Ettorre GM, Ialongo P, Sacco R, Perno CF, Barbarini G. Efficacy and safety of sofosbuvir/simeprevir plus flat dose ribavirin in genotype 1 elderly cirrhotic patients: A real-life study. Liver Int 2017; 37:653-661. [PMID: 27782373 DOI: 10.1111/liv.13288] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 10/21/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The proportion of HCV-infected patients over age 65 years in Western countries is increasing. This growth and the advent of new antiviral therapy bring into the question the real-world efficacy and safety of the combination of sofosbuvir (SOF) and simeprevir (SMV) plus a flat dose of 800 mg/d ribavirin (RBV) in elderly patients with cirrhosis compared to younger patients. METHODS Retrospective observational multicentre real-life investigation study of SOF/SMV/RBV for a duration of 12 weeks in HCV genotype 1-infected patients with cirrhosis. RESULTS Of the 270 patients enrolled in this study, with compensated cirrhosis, 133 (49.2%) were ≥65 years of age. Sustained virological response at 12 weeks (SVR12) was achieved by 94.2% (129/137) of those aged <65 years and 97.7% (130/133) of those ≥65 years. Diabetes was the most common comorbidity in patients ≥65 years compared to younger patients (26.3% vs 12.4% P<.003). The most common adverse event (AE) in elderly patients was a grade 2 anaemia (35.3% vs 19.9% P<.004). CONCLUSIONS Sofosbuvir/simeprevir plus a daily flat dose of RBV 800 mg for 12 weeks was highly effective and safe in genotype 1 elderly patients with compensated cirrhosis.
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Affiliation(s)
- Adriano M Pellicelli
- Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | | | - Massimo Siciliano
- Internal Medicine, Catholic University Policlinico Gemelli, Rome, Italy
| | - Valerio Giannelli
- Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | - Gaetano Scifo
- Infectious Disease, Umberto I Hospital, Siracusa, Italy
| | - Vincenzo Messina
- Infectious Disease, Sant'Anna and San Sebastiano Hospital Caserta, Rome, Italy
| | - Antonio Ascione
- Center for Liver Disease, Fatebenefratelli Hospital, Napoli, Italy
| | - Antonio Izzi
- Infectious Disease, Cotugno Hospital, Napoli, Italy
| | - Massimo Marignani
- Digestive and Liver Disease Unit, Faculty Medicine and Psychology, S. Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Cecilia D'Ambrosio
- Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Lucia Fondacaro
- Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Giuseppe M Ettorre
- Division of General Surgery and Liver Transplantation, S. Camillo Forlanini Hospital, Rome, Italy
| | | | - Rodolfo Sacco
- Liver Unit, Azienda Universitaria Pisana, Pisa, Italy
| | - Carlo F Perno
- Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy
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24
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Little EC, Berenguer M. The New Era of Hepatitis C: Therapy in Liver Transplant Recipients. Clin Liver Dis 2017; 21:421-434. [PMID: 28364822 DOI: 10.1016/j.cld.2016.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus (HCV) is the leading cause of end-stage liver disease in both Europe and the United States and is the most common reason for liver transplant. In the absence of antiviral therapy, recurrent infection is the norm with subsequent graft hepatitis and impaired survival. Whether it may be better to postpone therapy in patients in whom higher risk of failure and toxicity is coupled with lower chance of liver function improvement likely depends on several factors, including waiting time, center allocation policy, presence of hepatocellular carcinoma and local prevalence of anti-HCV-positive donors.
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Affiliation(s)
- Ester Coelho Little
- Banner Transplant Institute, 1441 North 12th Street, Second floor, Phoenix, AZ 85006, USA; Banner University Medical Center Phoenix, Phoenix, AZ, USA
| | - Marina Berenguer
- Servicio de Medicina Digestivo (Torre F-5), La Fe University Hospital, Ciberehd*, University of Valencia, Avda Fernando Abril Martorell n 106, Valencia 46026, Spain.
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25
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Ponziani FR, Mangiola F, Binda C, Zocco MA, Siciliano M, Grieco A, Rapaccini GL, Pompili M, Gasbarrini A. Future of liver disease in the era of direct acting antivirals for the treatment of hepatitis C. World J Hepatol 2017; 9:352-367. [PMID: 28321272 PMCID: PMC5340991 DOI: 10.4254/wjh.v9.i7.352] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/26/2016] [Accepted: 12/01/2016] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection has been a global health problem for decades, due to the high number of infected people and to the lack of effective and well-tolerated therapies. In the last 3 years, the approval of new direct acting antivirals characterized by high rates of virological clearance and excellent tolerability has dramatically improved HCV infection curability, especially for patients with advanced liver disease and for liver transplant recipients. Long-term data about the impact of the new direct acting antivirals on liver fibrosis and liver disease-related outcomes are not yet available, due to their recent introduction. However, previously published data deriving from the use of pegylated-interferon and ribavirin lead to hypothesizing that we are going to observe, in the future, a reduction in mortality and in the incidence of hepatocellular carcinoma, as well as a regression of fibrosis for people previously affected by hepatitis C. In the liver transplant setting, clinical improvement has already been described after treatment with the new direct acting antivirals, which has often led to patients delisting. In the future, this may hopefully reduce the gap between liver organ request and availability, probably expanding liver transplant indications to other clinical conditions. Therefore, these new drugs are going to change the natural history of HCV-related liver disease and the epidemiology of HCV infection worldwide. However, the global consequences will depend on treatment accessibility and on the number of countries that could afford the use of the new direct acting antivirals.
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Affiliation(s)
- Francesca Romana Ponziani
- Francesca Romana Ponziani, Francesca Mangiola, Cecilia Binda, Maria Assunta Zocco, Massimo Siciliano, Antonio Grieco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine, Gastroenterology and Hepatology, Catholic University Sacred Heart of Rome, Agostino Gemelli Hospital, 00168 Rome, Italy
| | - Francesca Mangiola
- Francesca Romana Ponziani, Francesca Mangiola, Cecilia Binda, Maria Assunta Zocco, Massimo Siciliano, Antonio Grieco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine, Gastroenterology and Hepatology, Catholic University Sacred Heart of Rome, Agostino Gemelli Hospital, 00168 Rome, Italy
| | - Cecilia Binda
- Francesca Romana Ponziani, Francesca Mangiola, Cecilia Binda, Maria Assunta Zocco, Massimo Siciliano, Antonio Grieco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine, Gastroenterology and Hepatology, Catholic University Sacred Heart of Rome, Agostino Gemelli Hospital, 00168 Rome, Italy
| | - Maria Assunta Zocco
- Francesca Romana Ponziani, Francesca Mangiola, Cecilia Binda, Maria Assunta Zocco, Massimo Siciliano, Antonio Grieco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine, Gastroenterology and Hepatology, Catholic University Sacred Heart of Rome, Agostino Gemelli Hospital, 00168 Rome, Italy
| | - Massimo Siciliano
- Francesca Romana Ponziani, Francesca Mangiola, Cecilia Binda, Maria Assunta Zocco, Massimo Siciliano, Antonio Grieco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine, Gastroenterology and Hepatology, Catholic University Sacred Heart of Rome, Agostino Gemelli Hospital, 00168 Rome, Italy
| | - Antonio Grieco
- Francesca Romana Ponziani, Francesca Mangiola, Cecilia Binda, Maria Assunta Zocco, Massimo Siciliano, Antonio Grieco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine, Gastroenterology and Hepatology, Catholic University Sacred Heart of Rome, Agostino Gemelli Hospital, 00168 Rome, Italy
| | - Gian Lodovico Rapaccini
- Francesca Romana Ponziani, Francesca Mangiola, Cecilia Binda, Maria Assunta Zocco, Massimo Siciliano, Antonio Grieco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine, Gastroenterology and Hepatology, Catholic University Sacred Heart of Rome, Agostino Gemelli Hospital, 00168 Rome, Italy
| | - Maurizio Pompili
- Francesca Romana Ponziani, Francesca Mangiola, Cecilia Binda, Maria Assunta Zocco, Massimo Siciliano, Antonio Grieco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine, Gastroenterology and Hepatology, Catholic University Sacred Heart of Rome, Agostino Gemelli Hospital, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Francesca Romana Ponziani, Francesca Mangiola, Cecilia Binda, Maria Assunta Zocco, Massimo Siciliano, Antonio Grieco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine, Gastroenterology and Hepatology, Catholic University Sacred Heart of Rome, Agostino Gemelli Hospital, 00168 Rome, Italy
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26
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Burra P, Belli LS, Ginanni Corradini S, Volpes R, Marzioni M, Giannini E, Toniutto P. Common issues in the management of patients in the waiting list and after liver transplantation. Dig Liver Dis 2017; 49:241-253. [PMID: 28096056 DOI: 10.1016/j.dld.2016.12.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 02/06/2023]
Abstract
The present document contains the recommendations of an expert panel of transplant hepatologists, appointed by the Italian Association for the Study of the Liver (AISF), on how to manage the most common aspects of liver transplantation: the topics covered include: new treatments for HCV in patients on the waiting list for liver transplantation; antiviral treatments in patients with HCV recurrence after liver transplantation; prophylaxis for HBV recurrence after liver transplantation; indications for liver transplantation in alcoholic liver disease; and Immunosuppressive therapy. The statements on each topic were approved by participants at the AISF Transplant Hepatologist Expert Meeting (organized by the Permanent Committee on Liver Transplantation in Mondello on 4-5 October 2015), and are graded according to the Oxford classification of levels of evidence.
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Affiliation(s)
- Patrizia Burra
- Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Italy.
| | | | | | - Riccardo Volpes
- Hepatology and Gastroenterology Unit, ISMETT-IRCCS, Palermo, Italy
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27
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Smith HL, Chung RT, Mantry P, Chapman W, Curry MP, Schiano TD, Boucher E, Cheslock P, Wang Y, Molrine DC. Prevention of allograft HCV recurrence with peri-transplant human monoclonal antibody MBL-HCV1 combined with a single oral direct-acting antiviral: A proof-of-concept study. J Viral Hepat 2017; 24:197-206. [PMID: 28127942 DOI: 10.1111/jvh.12632] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/17/2016] [Indexed: 12/25/2022]
Abstract
Patients with active hepatitis C virus (HCV) infection at transplantation experience rapid allograft infection, increased risk of graft failure and accelerated fibrosis. MBL-HCV1, a neutralizing human monoclonal antibody (mAb) targeting the HCV envelope, was combined with a licensed oral direct-acting antiviral (DAA) to prevent HCV recurrence post-transplant in an open-label exploratory efficacy trial. Eight subjects received MBL-HCV1 beginning on the day of transplant with telaprevir initiated between days 3 and 7 post-transplantation. Following FDA approval of sofosbuvir, two subjects received MBL-HCV1 starting on the day of transplant with sofosbuvir initiated on day 3. Combination treatment was administered for 8-12 weeks or until the stopping rule for viral rebound was met. The primary endpoint was undetectable HCV RNA at day 56 with exploratory endpoints of sustained virologic response (SVR) at 12 and 24 weeks post-treatment. Both subjects receiving mAb and sofosbuvir achieved SVR24. Four of eight subjects in the mAb and telaprevir group met the primary endpoint; one subject achieved SVR24 and three subjects relapsed 2-12 weeks post-treatment. The other four subjects experienced viral breakthrough. There were no serious adverse events related to study treatment. This proof-of-concept study demonstrates that peri-transplant immunoprophylaxis combined with a single oral direct-acting antiviral in the immediate post-transplant period can prevent HCV recurrence.
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Affiliation(s)
- H L Smith
- MassBiologics of the University of Massachusetts Medical School, Boston, MA, USA
| | - R T Chung
- Department of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA
| | - P Mantry
- Liver Institute, Methodist Dallas Medical Center, Dallas, TX, USA
| | - W Chapman
- Division of General Surgery, Washington University, St Louis, MO, USA
| | - M P Curry
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - T D Schiano
- Recanati-Miller Transplantation Institute and The Division of Liver Diseases, The Mount Sinai Medical Center, New York, NY, USA
| | - E Boucher
- MassBiologics of the University of Massachusetts Medical School, Boston, MA, USA
| | - P Cheslock
- MassBiologics of the University of Massachusetts Medical School, Boston, MA, USA
| | - Y Wang
- MassBiologics of the University of Massachusetts Medical School, Boston, MA, USA
| | - D C Molrine
- MassBiologics of the University of Massachusetts Medical School, Boston, MA, USA
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28
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Anand AC. Potential Liver Transplant Recipients with Hepatitis C: Should They Be Treated Before or After Transplantation? J Clin Exp Hepatol 2017; 7:42-54. [PMID: 28348470 PMCID: PMC5357718 DOI: 10.1016/j.jceh.2017.01.116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 01/31/2017] [Indexed: 12/12/2022] Open
Abstract
Treatment of hepatitis C virus (HCV) with newer directly acting antivirals (DAAs) and lead to sustained viral response (SVR) in majority of patients and SVR has been documented to be associated with reversal of liver cirrhosis. The improved SVR rates and safety profiles of DAAs have led to the treatment of patients with decompensated cirrhosis awaiting liver transplantation (LT). Several clinical trials of DAAs in decompensated HCV patients have recently demonstrated SVR rates above 80%, which have been associated with significant improvements, in the Child-Pugh-Turcotte scores/or model for end-stage liver disease scores in a proportion of patients. Moreover, it has been shown that HCV RNA becomes negative after 2-4 weeks of treatment, and those who are transplanted after becoming HCV RNA negative will be have very low the risk of HCV recurrence after transplantation. Some of the patients may have reached the "point of no return" and may proceed to worsening of decomposition over time. To avoid the risk of worsening, there is an additional option of treating these patients after LT should they develop recurrent HCV infection. Currently there are no guidelines as to select patients who would benefit from treatment prior to LT as opposed to those who will be better off being treated after the transplant surgery. The article discusses a possible approach for such selection.
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Key Words
- CSA, cyclosporine A
- CTP, Child–Turcotte–Pugh staging
- DAA, directly acting antivirals
- DCV, daclatasvir
- DDLT, deceased donor liver transplant
- DSB, dasabuvir
- EBV, elbasvir
- FCH, fibrosing cholestatic hepatitis
- GRZ, grazoprevir
- GT, genotype
- HCV, hepatitis C virus
- IU, international units
- LDLT, living donor liver transplant
- LDV, ledipasvir
- LT, liver transplantation
- MELD, model for end-stage liver disease RNA
- OMB, ombitasvir
- PTV, paritaprevir
- Peg-IFN, pegylated interferon alfa
- RBV, ribavirin
- SMV, simeprevir
- SOF, sofosbuvir
- SVR, sustained virological response, (SVR 12 signifies SVR at 12 weeks)
- TAC, tacrolimus
- VLP, velpatasvir
- decompensated cirrhosis
- directly acting antivirals
- hepatitis C virus infection
- liver transplantation
- rt, ritonavir
- sustained virological response
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Affiliation(s)
- Anil C. Anand
- Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, India
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Degré D, Sersté T, Lasser L, Delwaide J, Starkel P, Laleman W, Langlet P, Reynaert H, Bourgeois S, Vanwolleghem T, Negrin Dastis S, Gustot T, Geerts A, Van Steenkiste C, de Galocsy C, Lepida A, Orlent H, Moreno C. Sofosbuvir in Combination with Simeprevir +/- Ribavirin in Genotype 4 Hepatitis C Patients with Advanced Fibrosis or Cirrhosis: A Real-World Experience from Belgium. PLoS One 2017; 12:e0170933. [PMID: 28125694 PMCID: PMC5270323 DOI: 10.1371/journal.pone.0170933] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/12/2017] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Hepatitis C virus (HCV) is a major global health issue and successful treatment has been associated with a reduction of risk of all-cause mortality. Advancements have been made in HCV treatment through the use of interferon-free regimens. Most trials have been conducted in HCV genotype (GT) 1 and data for interferon-free regimens in GT4 patients are limited. The aim of this study was to evaluate the safety and efficacy of sofosbuvir plus simeprevir in a real-world cohort of HCV GT4 patients with advanced fibrosis. PATIENTS AND METHODS Eighty-seven GT4 treatment-naïve or -Interferon (IFN) ribavirin (RBV) experienced patients treated with sofosbuvir and simeprevir +/- ribavirin (RBV) were enrolled in this cohort study (41% severe fibrosis, 59% cirrhosis). RESULTS Patients were 51.7% male, 78.2% IFN/RBV treatment-experienced, and 37.9% received RBV treatment. The overall sustained virologic response at least 12 weeks after treatment (SVR12) rate was 87.4% while patients treated with and without RBV had rates of 87.9% and 87% (p = 0.593), respectively, and patients with advanced fibrosis (F3) and patients with cirrhosis had SVR12 rates of 94.4% and 82.4% (p = 0.087), respectively. SVR12 rates in treatment-naïve patients and in IFN/RBV -experienced patients were 78.9% and 89.7% (p = 0.191), respectively. Treatment failure occurred most commonly in patients with cirrhosis and severe disease. The treatment was well tolerated and no patient died or discontinued treatment due to adverse events. CONCLUSIONS Sofosbuvir in combination with simeprevir +/- ribavirin in GT 4 HCV patients with advanced fibrosis achieved high SVR12 rates and was well tolerated. RBV did not appear to increase the rate of SVR12.
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Affiliation(s)
- Delphine Degré
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Sersté
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Department of Hepato-Gastroenterology, CHU Saint-Pierre, Brussels, Belgium
| | - Luc Lasser
- Department of Gastroenterology, Brugmann Hospital, Brussels, Belgium
| | - Jean Delwaide
- Department of Hepatogastroenterology, CHU Sart Tilman, University of Liège, Liège, Belgium
| | - Peter Starkel
- Department of Hepato-Gastroenterology, Clinique Universitaire Saint-Luc, Brussels, Belgium
| | - Wim Laleman
- Department of Gastroenterology and Hepatology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Philippe Langlet
- Department of Hepato-Gastroenterology, CHIREC, Brussels, Belgium
| | - Hendrik Reynaert
- Department of Gastroenterology and Hepatology, VUB, UZ Brussels, Brussels, Belgium
| | - Stefan Bourgeois
- Department of Gastroenterology and Hepatology, ZNA, Antwerp, Belgium
| | - Thomas Vanwolleghem
- Department of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium
- Laboratory of Gastroenterology and Hepatology, Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Thierry Gustot
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Anja Geerts
- Department of Gastroenterology and Hepatology, University Hospital Ghent, Ghent, Belgium
| | | | - Chantal de Galocsy
- Department of Gastroenterology and Hepatology, Hôpitaux IRIS sud, Brussels, Belgium
| | - Antonia Lepida
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
- Department of Gastroenterology and Hepatology, Hôpitaux IRIS sud, Brussels, Belgium
| | - Hans Orlent
- Department of Gastroenterology and Hepatology, AZ Bruges, Bruges, Belgium
| | - Christophe Moreno
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Reddy KR, Lim JK, Kuo A, Di Bisceglie AM, Galati JS, Morelli G, Everson GT, Kwo PY, Brown RS, Sulkowski MS, Akuschevich L, Lok AS, Pockros PJ, Vainorius M, Terrault NA, Nelson DR, Fried MW, Manns MP. All-oral direct-acting antiviral therapy in HCV-advanced liver disease is effective in real-world practice: observations through HCV-TARGET database. Aliment Pharmacol Ther 2017; 45:115-126. [PMID: 27790729 DOI: 10.1111/apt.13823] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 10/21/2015] [Accepted: 09/17/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Chronic hepatitis C virus therapy in patients with advanced liver disease remains a clinical challenge. HCV-TARGET collects data in patients treated at tertiary academic and community centres. AIM To assess efficacy of all-oral HCV therapy in advanced liver disease. METHODS Between December 2013 and October 2014, 240 patients with a MELD score of ≥10 initiated HCV treatment with an all-oral regimen. Data from the 220 patients who completed 12-week follow-up were analysed. RESULTS Genotype 1 (GT1) patients had higher sustained virological response (SVR) when treated with sofosbuvir plus simeprevir ± ribavirin than with sofosbuvir plus ribavirin (66-74% vs. 54%); GT1b vs GT1a (84% vs. 64%). SVR for GT2 was 72% with sofosbuvir plus ribavirin, while GT3 patients had a substantially lower response (35%). A decrease in MELD score was not clearly related to SVR over the short course of follow-up although some had improvements in MELD score, serum bilirubin and albumin. A predictor of virological response was albumin level while negative predictors were elevated bilirubin level and GT1a. Most patients with GT1 were treated with approximately 12-week duration of sofosbuvir and simeprevir ± ribavirin therapy while GT2 and GT3 patients were treated with approximately 12 and 24 weeks of sofosbuvir plus ribavirin respectively. CONCLUSIONS All-oral therapies are effective among patients with advanced liver disease with high levels of success in GT2 and GT1b, and may serve to reduce the severity of liver disease after SVR. Treatment for GT3 patients remains an unmet need. Clinical trial number: NCT01474811.
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Backus LI, Belperio PS, Shahoumian TA, Loomis TP, Mole LA. Real-world effectiveness and predictors of sustained virological response with all-oral therapy in 21,242 hepatitis C genotype-1 patients. Antivir Ther 2016; 22:481-493. [PMID: 27934775 DOI: 10.3851/imp3117] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Predictors of sustained virological response (SVR) to all-oral HCV regimens can inform nuanced treatment decisions. We evaluated effectiveness and identified predictors of SVR for ledipasvir/sofosbuvir ± ribavirin (LDV/SOF ±RBV) and ombitasvir/paritaprevir/ritonavir + dasabuvir (OPrD) ±RBV in patients treated in routine practice. METHODS Observational, intent-to-treat cohort of 21,142 genotype-1 patients initiating 8 or 12 weeks of LDV/SOF ±RBV or 12 weeks of OPrD ±RBV at any Veterans Affairs facility. Multivariate logistic regression models were constructed to model SVR and identify predictors. RESULTS SVR was 91.2% (9,781/10,720) for LDV/SOF, 89.6% (3,266/3,646) for LDV/SOF+RBV, 91.7% (1,197/1,306) for OPrD and 87.8% (3,365/3,832) for OPrD+RBV. For LDV/SOF ±RBV, reduced odds of SVR occurred in African-Americans (0.80, 95% CI 0.70, 0.92, P<0.001), body mass index (BMI)<25 (0.77, 95% CI 0.66, 0.90, P<0.001), BMI≥30 (0.77, 95% CI 0.67, 0.89, P<0.001), proton pump inhibitors (PPIs; 0.81, 95% CI 0.71, 0.92, P<0.001), decompensated liver disease (0.58, 95% CI 0.45, 0.74, P<0.001) and FIB4>3.25 (0.60, 95% CI 0.53, 0.69, P<0.001). For OPrD ±RBV, FIB-4>3.25 negatively predicted SVR (0.72, 95% CI 0.59, 0.88, P<0.001). Detectable 4-week on-treatment HCV RNA≥15 IU/ml reduced SVR odds for both regimens (LDV/SOF ±RBV OR 0.49, 95% CI 0.41, 0.58, P<0.001; OPrD ±RBV OR 0.38, 95% CI 0.29, 0.50, P<0.001). Receipt of OPrD+RBV compared to LDV/SOF reduced odds of SVR (OR 0.70, 95% CI 0.62, 0.80, P<0.001). Mental health diagnosis did not impact likelihood of SVR. CONCLUSIONS The diversity and size of this cohort allowed for extensive examination of regimen-specific predictors of SVR. FIB-4>3.25 and detectable 4-week on-treatment HCV RNA had the greatest negative impact. African-American race, low or high BMI, and PPIs negatively impacted odds of SVR for LDV/SOF ±RBV. Mental health diagnoses did not.
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Affiliation(s)
- Lisa I Backus
- Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, Palo Alto, CA, USA
| | - Pamela S Belperio
- Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, Palo Alto, CA, USA
| | - Troy A Shahoumian
- Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, Palo Alto, CA, USA
| | - Timothy P Loomis
- Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, Palo Alto, CA, USA
| | - Larry A Mole
- Department of Veterans Affairs, Population Health Services, Palo Alto Health Care System, Palo Alto, CA, USA
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Gimeno-Ballester V, Simón MÁ, Trigo C, Mar J, San Miguel R. Sofosbuvir plus simeprevir for the treatment of genotype 1 chronic hepatitis C: a review of evidence. Expert Rev Gastroenterol Hepatol 2016; 10:1289-1303. [PMID: 27626505 DOI: 10.1080/17474124.2016.1236682] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sofosbuvir (SOF) with simeprevir (SIM) combination was the first interferon-free regimen that reached optimal results in terms of sustained viral response (SVR). Areas covered: A systematic review of the scientific literature concerning the effects that the SOF/SIM combination had on hepatitis C genotype 1 patients yielded 771 references. After the revision process, four clinical trials and 15 observational studies met the inclusion criteria; in total, these studies involved 5,766 patients. The SVR ranged from 67% to 100% depending on the patients' viral subtype and cirrhosis status. Adverse effects were common, but treatment discontinuation related to drug toxicity occurred in less than 5% of cases. Expert commentary: The SOF/SIM combination exhibits efficacy and tolerability profiles that are similar to those of the other available interferon-free combinations used for non-cirrhotic genotype 1b patients. Meanwhile, for patients with advanced cirrhosis or genotype 1a, this approach cannot be considered a routine treatment option due to the unsatisfactory results.
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Affiliation(s)
- Vicente Gimeno-Ballester
- a Department of Pharmacy , Hospital Universitario Miguel Servet , Zaragoza , Spain.,b Faculty of Pharmacy of the University of Granada , Granada , Spain
| | - Miguel Ángel Simón
- c Department of Digestive Diseases , Hospital Clinico Universitario Lozano Blesa , Zaragoza , Spain
| | - Cristina Trigo
- d Department of Pharmacy , Hospital Royo Villanova , Zaragoza , Spain
| | - Javier Mar
- e Clinical Management Service , Hospital Alto Deba , Mondragón , Spain
| | - Ramón San Miguel
- b Faculty of Pharmacy of the University of Granada , Granada , Spain.,f Department of Pharmacy , Complejo Hospitalario de Navarra , Pamplona , Spain
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Maasoumy B, Vermehren J. Diagnostics in hepatitis C: The end of response-guided therapy? J Hepatol 2016; 65:S67-S81. [PMID: 27641989 DOI: 10.1016/j.jhep.2016.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/20/2016] [Accepted: 07/21/2016] [Indexed: 02/07/2023]
Abstract
On-treatment hepatitis C virus (HCV) RNA has been used to predict response to interferon (IFN)-based therapy. The concept of response-guided treatment (RGT) was established to determine optimal treatment duration and to early identify patients not responding to futile therapies. RGT helped to improve sustained virologic response (SVR) rates and lower the rates of adverse effects. RGT was of particular importance for telaprevir- and boceprevir-based triple therapies. RGT strategies are dependent on highly sensitive and reproducible HCV RNA quantification. However, different HCV RNA assays are used in routine clinical practice and these differ significantly in their performance characteristics. The development of IFN-free therapies has fundamentally changed the role of on-treatment HCV RNA for SVR prediction. Given the high efficacy and excellent tolerability of IFN-free regimens, the interest in treatment individualization has decreased. However, shorter treatment durations may still be desirable, particularly with respect to the high costs of current IFN-free direct-acting antiviral agents (DAAs). Moreover, some difficult-to-treat patients remain, e.g., those infected with HCV genotype 3 in whom the current standard of care may not always be sufficient to achieve SVR, especially in treatment-experienced patients with cirrhosis. Here, a RGT extension may be feasible. However, current data on the predictive value of on-treatment HCV RNA are limited and have shown conflicting results. As more potent DAAs become available, the role of response prediction may diminish further. Currently, shorter treatment duration is only based on baseline HCV RNA whereas no RGT strategy is recommended for any of the approved DAA regimens available.
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Affiliation(s)
- Benjamin Maasoumy
- Medizinische Hochschule Hannover, Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Hannover, Germany
| | - Johannes Vermehren
- Universitätsklinikum Frankfurt, Medizinische Klinik 1, Frankfurt am Main, Germany.
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van der Meer AJ, Berenguer M. Reversion of disease manifestations after HCV eradication. J Hepatol 2016; 65:S95-S108. [PMID: 27641991 DOI: 10.1016/j.jhep.2016.07.039] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 12/13/2022]
Abstract
Chronic infection with the hepatitis C virus (HCV) may lead to hepatic fibrosis and eventually cirrhosis, at which stage, patients have a substantial risk of liver failure, hepatocellular carcinoma (HCC) and liver-related death. Moreover, HCV infection is associated with several extrahepatic manifestations which impact the quality of life and increase the non-liver-related mortality rate. For patients with compensated liver disease, interferon (IFN)-based antiviral therapy has been a treatment option for over two decades. Long-term follow-up studies indicated that among those with sustained virological response (SVR) the extend of hepatic fibrosis can regress and that their risk of cirrhosis-related complications (including HCC) is reduced, also in case of cirrhosis. Recent population-based studies extended these observations for solid extrahepatic outcomes, such as end-stage renal failure and cardiovascular events. Most importantly, SVR has been associated with prolonged overall survival. These results highlight the importance of the development of new direct-acting antivirals (DAAs), by which almost all patients are able to eradicate HCV in a comfortable manner. Based on the excellent first experiences with the DAAs, physicians gained confidence to use these drugs among patients with decompensated cirrhosis on a more regular basis as well. This was not possible with interferon therapy. Also in this high risk population the DAAs show high SVR rates with improvements in biochemical parameters of liver function shortly after therapy, especially in case of SVR. In fact, some patients could actually be removed from the liver transplantation waiting list due to clinical improvement following DAA therapy. How these short-term results translate into a prolonged (long-term) survival has yet to be determined, as well as which patients with decompensated liver disease are likely or not to benefit from viral eradication. Here we review the current data regarding the beneficial clinical outcome with antiviral therapy as well the remaining uncertainties in this field, both for patients with compensated liver disease and patients with decompensated liver disease.
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Affiliation(s)
- Adriaan J van der Meer
- Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Marina Berenguer
- Hepatology and Liver Transplant Unit and Ciberehd, La Fe Univ. Hospital and Univ. Valencia, Spain
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Lutchman G, Nguyen NH, Chang CY, Ahmed A, Daugherty T, Garcia G, Kumari R, Gupta S, Doshi D, Nguyen MH. Effectiveness and tolerability of simeprevir and sofosbuvir in nontransplant and post-liver transplant patients with hepatitis C genotype 1. Aliment Pharmacol Ther 2016; 44:738-46. [PMID: 27506182 DOI: 10.1111/apt.13761] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/16/2016] [Accepted: 07/21/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Hepatitis C virus genotype 1a (HCV-1a), prior treatment, cirrhosis and post-transplant status are historically associated with poor treatment responses. The new oral direct-acting agents appear to be effective and safe in these patients. AIMS To evaluate the effectiveness and tolerability of simeprevir and sofosbuvir in a diverse real-life cohort of patients, including difficult-to-treat patients. METHODS We conducted a retrospective cohort study in 198 consecutive patients with hepatitis C genotype 1 (148 nontransplant, 50 post transplant), who were treated with simeprevir and sofosbuvir for 12 weeks between December 2013 and December 2014. Primary outcome was sustained virological response with undetectable HCV RNA 12 weeks after completion of therapy (SVR12). Risk factors evaluated for lack of SVR12 included HCV 1a (vs. 1b), prior treatment (vs. none), and cirrhosis (vs. no cirrhosis). RESULTS SVR12 rates were similar in non- and post-transplant settings, 82% and 88%, respectively. There were no significant differences in adverse events in patients regardless of cirrhosis or transplant status. On multivariate analysis also inclusive of gender and liver transplant status, negative predictors of SVR12 were having at least 2 or 3 risk factors (OR 0.30, 95% CI 0.10-0.87, P = 0.027 or 0.29, 95% CI 0.09-0.85, P = 0.025, respectively). CONCLUSION Simeprevir and sofosbuvir combination is a safe and effective regimen for the treatment of non- and post-transplant patients with traditional risk factors for poor treatment response, unless more than 2 difficult-to-treat risk factors are present.
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Affiliation(s)
- G Lutchman
- Gastroenterology and Hepatology, Liver Transplant Program, Stanford University Medical Center, Palo Alto, CA, USA
| | - N H Nguyen
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - C Y Chang
- Gastroenterology and Hepatology, Liver Transplant Program, Stanford University Medical Center, Palo Alto, CA, USA
| | - A Ahmed
- Gastroenterology and Hepatology, Liver Transplant Program, Stanford University Medical Center, Palo Alto, CA, USA
| | - T Daugherty
- Gastroenterology and Hepatology, Liver Transplant Program, Stanford University Medical Center, Palo Alto, CA, USA
| | - G Garcia
- Gastroenterology and Hepatology, Liver Transplant Program, Stanford University Medical Center, Palo Alto, CA, USA
| | - R Kumari
- Gastroenterology and Hepatology, Liver Transplant Program, Stanford University Medical Center, Palo Alto, CA, USA
| | - S Gupta
- Medical Affairs, Janssen Scientific Affairs, Titusville, NJ, USA
| | - D Doshi
- Health Economics & Outcomes Research, Janssen Scientific Affairs, Titusville, NJ, USA
| | - M H Nguyen
- Gastroenterology and Hepatology, Liver Transplant Program, Stanford University Medical Center, Palo Alto, CA, USA
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Carmona I, Cordero P, Ampuero J, Rojas A, Romero-Gómez M. Role of assessing liver fibrosis in management of chronic hepatitis C virus infection. Clin Microbiol Infect 2016; 22:839-845. [PMID: 27677698 DOI: 10.1016/j.cmi.2016.09.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 08/25/2016] [Accepted: 09/20/2016] [Indexed: 12/16/2022]
Abstract
Fibrosis progression is common in hepatitis C. Both host and viral factors influence its natural history. Liver fibrosis is a key predictive factor for advanced disease including endpoints such as liver failure, cirrhosis and hepatocellular carcinoma (HCC). METAVIR fibrosis stages F3-F4 have been considered as the threshold for antiviral therapy. However, this aspect is controversial after the advent of new direct-acting antivirals (DAAs) because they show an excellent efficacy and safety profile. Moreover, in the DAA era, fibrosis stage seems not to be a predictive factor of a sustained virological response (SVR). Viral eradication decreases liver damage by improving the inflammation, as well as by regressing fibrosis irrespective of the treatment regimen. Non-invasive methods are useful in the assessment of liver fibrosis, replacing liver biopsy in clinical practice; but their usefulness for monitoring fibrosis after SVR needs to be demonstrated. Fibrosis regression has been demonstrated after the eradication of hepatitis C virus infection and is associated with a lower risk of hepatic cirrhosis and liver cancer. However, patients showing advanced fibrosis and cirrhosis must be followed-up after SVR, as risks of portal hypertension and HCC remain.
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Affiliation(s)
- I Carmona
- Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen del Rocio-Virgen Macarena University Hospitals, Sevilla, Spain
| | - P Cordero
- Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen del Rocio-Virgen Macarena University Hospitals, Sevilla, Spain
| | - J Ampuero
- Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen del Rocio-Virgen Macarena University Hospitals, Sevilla, Spain; Institute of Biomedicine of Seville, Sevilla, Spain
| | - A Rojas
- Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen del Rocio-Virgen Macarena University Hospitals, Sevilla, Spain; Institute of Biomedicine of Seville, Sevilla, Spain
| | - M Romero-Gómez
- Inter-Centre Unit of Digestive Diseases and CIBERehd, Virgen del Rocio-Virgen Macarena University Hospitals, Sevilla, Spain; Institute of Biomedicine of Seville, Sevilla, Spain.
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Optimum timing of treatment for hepatitis C infection relative to liver transplantation. Lancet Gastroenterol Hepatol 2016; 1:165-172. [PMID: 28404073 DOI: 10.1016/s2468-1253(16)30008-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 12/19/2022]
Abstract
The approval of direct-acting antiviral agents that may be given orally in an interferon-free regimen has greatly changed the landscape of treatment for hepatitis C virus (HCV) infection, especially for patients with the most severe disease, who have decompensated cirrhosis, or who are waiting for or have undergone liver transplantation. Treatment with interferon proved to be ineffective and poorly tolerated because of high risks of infection and transplant rejection. The availability of new drugs poses new questions about the optimum time to give treatment to prevent HCV recurrence, taking into account efficacy, tolerance, and drug-drug interactions. Treatment is acceptable before and after transplantation, but the two strategies have subtle differences. In this Review, we present the available data on the treatment of HCV infection before and after transplantation, and discuss new challenges for practice.
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Sise ME, Wisocky J, Rosales IA, Chute D, Holmes JA, Corapi KM, Babitt JL, Tangren JS, Hashemi N, Lundquist AL, Williams WW, Mount DB, Andersson KL, Rennke HG, Smith RN, Colvin R, Thadhani RI, Chung RT. Lupus-like Immune Complex-mediated Glomerulonephritis in Patients with Hepatitis C Virus Infection Treated with Oral, Interferon-free, Direct-acting Antiviral Therapy. Kidney Int Rep 2016; 1:135-143. [PMID: 27990496 PMCID: PMC5155703 DOI: 10.1016/j.ekir.2016.06.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Meghan E Sise
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jessica Wisocky
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Ivy A Rosales
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Donald Chute
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jacinta A Holmes
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Kristin M Corapi
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jodie L Babitt
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Jessica S Tangren
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Nikroo Hashemi
- Department of Gastroenterology and Hepatology, Brigham and Women's Hospital, Boston, MA
| | - Andrew L Lundquist
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Winfred W Williams
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - David B Mount
- Renal Unit, Brigham and Women's Hospital, Boston, MA
| | - Karin L Andersson
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Helmut G Rennke
- Department of Pathology, Brigham and Women's Hospital, Boston, MA
| | - R Neal Smith
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Robert Colvin
- Department of Pathology, Massachusetts General Hospital, Boston, MA
| | - Ravi I Thadhani
- Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Raymond T Chung
- Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
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39
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Perspectives on treating hepatitis C infection in the liver transplantation setting. Curr Opin Organ Transplant 2016; 21:111-9. [PMID: 26927201 DOI: 10.1097/mot.0000000000000288] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW This article reviews treatment options of the approved and soon-to-be approved direct-acting antiviral (DAA)-based therapies in the transplant setting. RECENT FINDINGS DAA-based therapies have been shown to be effective and safe in achieving viral eradication in the majority of pre- and postliver transplant (LT) populations. Treatment decisions are guided by hepatitis C virus (HCV) genotype, the degree of renal dysfunction, and severity of cirrhosis. The addition of ribavirin is frequently needed to achieve highest viral eradication rates. Viral eradication pre-LT has been associated with fewer portal hypertensive complications and improved survival and effectively prevents recurrent HCV post-LT. For those with shorter time to LT, an alternative strategy is treatment with DAAs up to the time of LT to reduce the risk of post-LT recurrence. Therapies should be considered for all post-LT patients with recurrent HCV given the risk of accelerated disease progression. The sustained virological response rates among LT recipients parallel those of nontransplant patients. SUMMARY With broader application of DAA therapy in the transplant setting, improved graft and patient survival and simplified post-LT management are likely. The availability of high potency DAA therapy with excellent safety profiles has transformed the HCV-infected LT population into a group that is no longer 'difficult-to-treat.'
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Vargas HE. Hepatitis C Treatment in 2016: Reasons to Be an OPTIMIST. Hepatology 2016; 64:330-2. [PMID: 26992027 DOI: 10.1002/hep.28559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/10/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Hugo E Vargas
- Director, Clinical Trials Office Consultant Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ
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41
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Alghamdi AS, Alghamdi M, Sanai FM, Alghamdi H, Aba-Alkhail F, Alswat K, Babatin M, Alqutub A, Altraif I, Alfaleh F. SASLT guidelines: Update in treatment of Hepatitis C virus infection. Saudi J Gastroenterol 2016; 22 Suppl:S25-57. [PMID: 27538727 PMCID: PMC5004485 DOI: 10.4103/1319-3767.188067] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Abdullah S. Alghamdi
- Department of Medicine, Gastroenterology Unit, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Mohammed Alghamdi
- Department of Medicine, Division of Gastroenterology, King Fahd Military Complex, Dhahran, Saudi Arabia
| | - Faisal M Sanai
- Department of Medicine, Division of Gastroenterology, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
| | - Hamdan Alghamdi
- Department of Hepatobiliary Sciences and Liver Transplantation King Abdulaziz Medical City, and King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Faisal Aba-Alkhail
- Department of Medicine, Division of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khalid Alswat
- Department of Medicine, Gastroenterology unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Babatin
- Department of Medicine, Gastroenterology Unit, King Fahad Hospital, Jeddah, Saudi Arabia
| | - Adel Alqutub
- Department of Medical Specialties, Gastroenterology and Hepatology Section, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Altraif
- Department of Hepatobiliary Sciences and Liver Transplantation King Abdulaziz Medical City, and King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Faleh Alfaleh
- Department of Medicine, Gastroenterology unit, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Beinhardt S, Al Zoairy R, Ferenci P, Kozbial K, Freissmuth C, Stern R, Stättermayer AF, Stauber R, Strasser M, Zoller H, Watschinger B, Schmidt A, Trauner M, Hofer H, Maieron A. DAA-based antiviral treatment of patients with chronic hepatitis C in the pre- and postkidney transplantation setting. Transpl Int 2016; 29:999-1007. [DOI: 10.1111/tri.12799] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/29/2016] [Accepted: 05/15/2016] [Indexed: 02/06/2023]
Affiliation(s)
- Sandra Beinhardt
- Division of Gastroenterology and Hepatology; Department of Internal Medicine III; Medical University of Vienna; Vienna Austria
| | - Ramona Al Zoairy
- Division of Gastroenterology and Hepatology; Department of Medicine II; Medical University of Innsbruck; Innsbruck Tirol Austria
| | - Peter Ferenci
- Division of Gastroenterology and Hepatology; Department of Internal Medicine III; Medical University of Vienna; Vienna Austria
| | - Karin Kozbial
- Division of Gastroenterology and Hepatology; Department of Internal Medicine III; Medical University of Vienna; Vienna Austria
| | - Clarissa Freissmuth
- Division of Gastroenterology and Hepatology; Department of Internal Medicine III; Medical University of Vienna; Vienna Austria
| | - Rafael Stern
- Division of Gastroenterology and Hepatology; Department of Internal Medicine III; Medical University of Vienna; Vienna Austria
| | - Albert Friedrich Stättermayer
- Division of Gastroenterology and Hepatology; Department of Internal Medicine III; Medical University of Vienna; Vienna Austria
| | - Rudolf Stauber
- Division of Gastroenterology and Hepatology; Department of Internal Medicine; Medical University of Graz; Graz Austria
| | - Michael Strasser
- Department of Gastroenterology and Hepatology; Paracelsus Medical University Salzburg; Salzburg Austria
| | - Heinz Zoller
- Division of Gastroenterology and Hepatology; Department of Medicine II; Medical University of Innsbruck; Innsbruck Tirol Austria
| | - Bruno Watschinger
- Division of Nephrology; Department of Internal Medicine III; Medical University of Vienna; Vienna Austria
| | - Alice Schmidt
- Division of Nephrology; Department of Internal Medicine III; Medical University of Vienna; Vienna Austria
| | - Michael Trauner
- Division of Gastroenterology and Hepatology; Department of Internal Medicine III; Medical University of Vienna; Vienna Austria
| | - Harald Hofer
- Division of Gastroenterology and Hepatology; Department of Internal Medicine III; Medical University of Vienna; Vienna Austria
| | - Andreas Maieron
- Department of Gastroenterology; Elisabethinen Hospital; Linz Austria
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Bunchorntavakul C, Reddy KR. Treat chronic hepatitis C virus infection in decompensated cirrhosis - pre- or post-liver transplantation? the ironic conundrum in the era of effective and well-tolerated therapy. J Viral Hepat 2016; 23:408-18. [PMID: 27018088 DOI: 10.1111/jvh.12534] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 03/01/2016] [Indexed: 12/12/2022]
Abstract
The management of hepatitis C virus (HCV) infection in patients with decompensated cirrhosis has evolved dramatically over the past few years mainly due to the availability of all-oral antiviral regimens. The currently approved all-oral direct-acting antivirals (DAA) containing sofosbuvir, ledipasvir, daclatasvir and ribavirin, in various combinations, have shown to be safe and effective in patients with decompensated cirrhosis with sustained virological response (SVR) rates nearly comparable to those with well-compensated liver disease. Unique issues yet remain such as the challenges with renal insufficiency, tolerability of ribavirin and risk of further hepatic decompensation with a protease inhibitor-based regimen. While most patients who achieve SVR have demonstrated improvement in hepatic synthetic function over the short course of follow, the long-term beneficial effects are unknown. Further, the baseline predictors of improvement in hepatic function have not been well delineated and thus have left us in a quandary as to what we might expect with successful therapy and thus we are at a loss to well educate our patients. The major concern, in potential liver transplant candidates, is of unintended 'harm' by achieving SVR but without improvement in hepatic function to an extent where the patients might function well. As HCV therapies are as effective in liver transplant recipients, there is a growing sentiment in some of the transplant quarters that those with decompensated liver disease and awaiting liver transplant be treated for HCV after liver transplant. This strategy would thus eliminate any concern of leaving a patient in 'no person's' land by treating HCV successfully pretransplant but not to the point of functional normalcy, while also would maintain the risk of HCC. Yet a contrarian view would be that not all patients have access to liver transplantation (LT), cannot bear the cost, have comorbidities or contraindications to LT. While the debate continues, it is essential that we develop robust predictors of improvement in liver function so that we can carefully select our patients for therapy in the context of liver transplantation.
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Affiliation(s)
- C Bunchorntavakul
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, PA, USA
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44
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Han QY, Liu ZW. Current treatment of chronic hepatitis C in China: Dilemma and potential problems. World J Gastroenterol 2016; 22:4615-4618. [PMID: 27217693 PMCID: PMC4870068 DOI: 10.3748/wjg.v22.i19.4615] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/03/2016] [Accepted: 04/20/2016] [Indexed: 02/06/2023] Open
Abstract
Major advances have been made in the treatment of chronic hepatitis C virus (HCV) infection with the advent of direct-acting antiviral agents (DAAs). China has the most cases of HCV infection worldwide, but none of the DAAs has been approved in mainland China so far, and interferon (IFN)-α-based treatment remains the standard of care. HCV patients without response or with contraindications to IFN-based therapy have no alternative options. However, many patients buy DAAs, especially the generic forms of sofosbuvir, from other countries or areas. Under these circumstances, the use of these drugs may cause many predictable and unpredictable problems in ethics, law and medical practice. Given the obstacles of legal accessibility to DAAs and the potential problems of obtaining and using DAAs in China, the early launching of the DAAs in China or the legalization of buying drugs from areas outside China and using these drugs in China is an urgent issue and needs to be dealt with as soon as possible, in the interest of the patients.
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45
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Maan R, van der Meer AJ. Recent advances in managing chronic HCV infection: focus on therapy in patients with severe liver disease. F1000Res 2016; 5:F1000 Faculty Rev-367. [PMID: 27006761 PMCID: PMC4798156 DOI: 10.12688/f1000research.7399.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 12/19/2022] Open
Abstract
Chronic hepatitis C virus (HCV) infection still represents a major public health problem, as it is thought to be responsible for more than 350,000 deaths around the globe on a yearly basis. Fortunately, successful eradication of the virus has been associated with improved clinical outcome and reduced mortality rates. In the past few years, treatment has improved considerably by the implementation of direct-acting antivirals (DAAs). From 2014 onwards, sofosbuvir, simeprevir, daclatasvir, ledipasvir, paritaprevir, ombitasvir, and dasabuvir have been approved by the US Food and Drug Administration (FDA) and European Medicines Agency (EMA). Regimens with various combinations of these new drugs, without the use of interferon (IFN), proved to be very effective and well tolerated, even among patients with advanced liver disease. Moreover, treatment duration could be shortened to 12 weeks in the majority of patients. The high costs of these DAAs, however, limit the availability of IFN-free therapy worldwide. Even in wealthy countries, it is deemed necessary to prioritize DAA treatment in order to limit the immediate impact on the health budget. As patients with advanced liver disease are in most need of HCV clearance, many countries decided to treat those patients first. In the current review, we focus on the currently available IFN-free treatment options for patients with cirrhosis. We discuss the virological efficacy as well as the clinical relevance of these regimens among this specific patient population.
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Affiliation(s)
- Raoel Maan
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, 3015, Netherlands
| | - Adriaan J. van der Meer
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, 3015, Netherlands
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Yee BE, Nguyen NH, Jin M, Lutchman G, Lim JK, Nguyen MH. Lower response to simeprevir and sofosbuvir in HCV genotype 1 in routine practice compared with clinical trials. BMJ Open Gastroenterol 2016; 3:e000056. [PMID: 26966547 PMCID: PMC4780041 DOI: 10.1136/bmjgast-2015-000056] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 11/24/2015] [Accepted: 12/17/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND High sustained virological response at 12 weeks after end of treatment (SVR12) with 12 weeks of simeprevir and sofosbuvir±ribavirin (SMV+SOF±RBV) has been demonstrated in hepatitis C virus genotype 1 (HCV-1) but is based on limited data. Therefore, we performed a meta-analysis of available data evaluating the effectiveness of SMV+SOF±RBV in HCV-1. METHODS We performed a comprehensive literature search in June 2015 to identify randomised controlled trials (RCTs) and observational studies of HCV-1 patients treated with 12 weeks of SMV+SOF±RBV. Original studies with SVR12 data in ≥5 HCV-1 patients were included. We excluded studies on liver transplant recipients and/or patients co-infected with HIV or hepatitis B/D. We estimated pooled effect sizes using a random-effects model and evaluated heterogeneity with Cochrane Q-test, p≤0.10 and I(2) statistic ≥50%. RESULTS Pooled SVR12 was 85.6% (CI 81.3% to 89.0%) in 1389 HCV-1 patients from 15 studies. On subgroup analysis, SVR12 was 83.9% (CI 79.4% to 87.5%) in observational studies, which was lower than 93.5% (CI 85.7% to 97.2%) in RCTs. A trend showed SVR12 was higher in mild fibrosis, 93.0% (CI 86.2% to 96.6%) compared with advanced fibrosis, 81.5% (CI 75.7% to 86.1%), OR 2.22 (CI 0.79 to 6.25, p=0.131). There was no significant difference in SVR12 rates between HCV-1a, 89.9% (CI 81.9% to 94.6%) and HCV-1b, 89.0% (CI 78.9% to 94.6%) with OR 1.35 (CI 0.75 to 2.42, p=0.322). The most common pooled side effects were: headache 15.2% (n=55/361), fatigue 12.1% (n=78/646), nausea 9.5% (n=50/527) and rash 9.3% (n=68/728). CONCLUSIONS SMV+SOF±RBV is an effective regimen in HCV-1 patients. The SVR12 rate in observational studies was lower than that in RCTs, which may reflect the more diverse patient population in real-world settings.
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Affiliation(s)
- Brittany E Yee
- Department of Internal Medicine, University of California San Diego Medical Center, San Diego, California, USA
| | - Nghia H Nguyen
- Department of Internal Medicine, University of California San Diego Medical Center, San Diego, California, USA
| | - Minjuan Jin
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
- Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hang Zhou, China
| | - Glen Lutchman
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
| | - Joseph K Lim
- Yale Liver Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Mindie H Nguyen
- Department of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
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47
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Ideal oral combinations to eradicate HCV: The role of ribavirin. J Hepatol 2016; 64:215-25. [PMID: 26409316 DOI: 10.1016/j.jhep.2015.09.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 09/09/2015] [Accepted: 09/15/2015] [Indexed: 12/19/2022]
Abstract
Current all-oral interferon-free regimens offer sustained virological response (SVR) rates above 90% as well as 12-week treatment durations for the majority of patients with chronic hepatitis C virus (HCV), including treatment-naïve and -experienced patients with or without cirrhosis. There are multiple direct-acting antiviral (DAA) combinations that can be selected to optimize efficacy and safety outcomes. Each of them can be tailored according to different parameters including the use of ribarivin (RBV). For sofosbuvir (SOF)-based combinations, RBV is useful in the following situations: HCV genotype 1, treatment-experienced, cirrhotic patients, or patients with decompensated cirrhosis, and HCV genotype 3, cirrhotic patients. In these situations the addition of RBV allows to shorten the treatment to 12weeks in the majority of cases and therefore decreases the cost of the treatment. The need of RBV remains to be determined in cirrhotic patients with a SOF plus simeprevir regimen. RBV-containing regimens are recommended in all HCV genotype 1a patients who receive the 3-DAA combination: paritaprevir/r, ombitasvir, dasabuvir. Globally, the addition of RBV to the different combinations of DAA increases slightly the risk of anaemia. However severe anaemia was rare and easily manageable with RBV dose reduction without any impact on SVR. In practice, because RBV is cheap and well tolerated when combined with interferon-free regimen, it remains a useful tool to fine tune anti-HCV treatment regimens and optimize their results.
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48
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Coilly A, Roche B, Duclos-Vallée JC, Samuel D. News and challenges in the treatment of hepatitis C in liver transplantation. Liver Int 2016; 36 Suppl 1:34-42. [PMID: 26725895 DOI: 10.1111/liv.13017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 11/02/2015] [Indexed: 02/13/2023]
Abstract
Hepatitis C virus (HCV) infection is one of the main causes of end-stage liver disease and indications for liver transplantation (LT) worldwide. HCV infection always recurs on the graft in patients who undergo LT with detectable serum HCV RNA, leading to cirrhosis in 20-30% within 5 years after transplantation. Achieving a sustained virological response (SVR) greatly improves patient and graft survival. Recently, the efficacy of therapy has radically changed and improved based on new direct acting antiviral agents (DAAs) without pegylated-interferon (PEG-IFN) and/or ribavirin (RBV), leading to SVR rates of more than 90% in transplanted patients. The safety profile in this population is also good, with limited drug-drug interactions. However, there are very few data on patients on the waiting list. Even when the results of combined DAAs are good (>80%), SVR rates are lower than in patients without cirrhosis. This review reports recent available data on the treatment of HCV infection in the transplant setting and discusses new dilemmas and challenges.
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Affiliation(s)
- Audrey Coilly
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, F-94800, France.,Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, F-94800, France.,Unité 1193, Inserm, Villejuif, F-94800, France.,Hepatinov, Villejuif, F-94800, France
| | - Bruno Roche
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, F-94800, France.,Unité 1193, Inserm, Villejuif, F-94800, France.,Hepatinov, Villejuif, F-94800, France
| | - Jean-Charles Duclos-Vallée
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, F-94800, France.,Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, F-94800, France.,Unité 1193, Inserm, Villejuif, F-94800, France.,Hepatinov, Villejuif, F-94800, France
| | - Didier Samuel
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, F-94800, France.,Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, F-94800, France.,Unité 1193, Inserm, Villejuif, F-94800, France.,Hepatinov, Villejuif, F-94800, France
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