Sofosbuvir induced steven Johnson Syndrome in a patient with hepatitis C virus-related cirrhosis

Sofosbuvir: Really Meets the Unmet Needs for Hepatitis C Treatment?

Chronic hepatitis C remains a major public health concern with a prevalence of more than 1% worldwide. Of late, with the discovery of newer drugs, chronic HCV treatment has touched new dimensions. The treatment has progressed from Interferons to Pegylated interferon (Peg IFN) based therapy, with or without ribavirin to treatment with orally active Direct Acting Antivirals (DAA) with Peg IFN and ribavirin and eventually to various combinations of DAA, without IFN. Introduction of newer DAAs has transfigured the treatment of chronic HCV. Chronic HCV patients with advanced liver disease, psychiatric condition, anemia or autoimmune diseases, not eligible for Peg IFN based therapy have a ray of hope now. Amongst all DAAs, nucleoside inhibitors have been the most promising agent. Thus the present review focuses on Sofosbuvir, one of the most effective nucleoside inhibitors; in terms of potency, resistance profile, activity against all genotypes of HCV and adverse effects. FDA approved Sofobuvir for clinical use in 2013. Chemically, it is 2'-deoxy-2'-α-fluoro-β-Cmethyluridine- 5'-triphosphate; a phosphoramidate prodrug that is activated by enzyme present in human liver. It is a highly potent inhibitor of HCV NS5B polymerase. Efficacy of the Sofosbuvir has been established in various phase 2 and phase 3 clinical trials like PROTON, ELECTRON, FUSION, POSITRON etc. Sofosbuvir has a good safety profile with few mild to moderate adverse effects. Evidence reveals that sofosbuvir has substantial impact on the treatment of HCV.

Cutaneous Adverse Events in Newly Approved FDA Non-cancer Drugs: A Systematic Review

The prevalence of cutaneous adverse events attributable to newly approved anti-cancer drugs has been well reviewed in the dermatologic literature. In contrast, over 75% of US Food and Drug Administration approvals in the past 5 years have been for non-cancer drugs and indications. This represents multiple other categories of approved medications associated with cutaneous adverse reactions. To investigate the cutaneous adverse events associated with these potentially neglected medications, a systematic review was conducted. Two hundred and forty-one medications approved by the Food and Drug Administration between 2013 and 2018 were reviewed and 180 non-oncologic drugs were identified. The prescribing information for each medication was reviewed for the presence of cutaneous adverse events and a supplemental literature search was performed to better characterize any adverse events outlined within the prescribing information. Most reactions were classified as morbilliform, macular, popular, or maculopapular. Fortunately, only a few severe cutaneous adverse reactions were reported, namely in benznidazole, cannabidiol, and sofosbuvir. This review summarizes available data drawn from clinical trials and case reports involving cutaneous adverse events from the 21 non-oncologic medications associated with cutaneous adverse events.

Tenofovir-induced Stevens-Johnson syndrome in a patient with acute hepatitis B: A rare case report

OBJECTIVE

To report a rare case of a hepatitis B patient who developed the Stevens-Johnson syndrome (SJS) secondary to tenofovir use.

CASE SUMMARY

A 61-year-old woman presented with complaints of jaundice, difficulty in swallowing, and burning sensation all over the body along with erythematous polymorphic rash on the face, upper limbs, and trunk. She was diagnosed with SJS secondary to tenofovir. The causality of adverse drug reaction was assessed using the World Health Organization-Uppsala Monitoring Centre causality scale, and adverse drug reaction was found to be probable. Tenofovir was withdrawn and the patient was conservatively managed.

PRACTICE IMPLICATIONS

Through the observation of this event, we could figure out the association between tenofovir and SJS. Prompt withdrawal of the offending agent and the initiation of therapy with systemic corticosteroids and supportive medication were found to be effective.

Paediatric hepatitis C virus infection and its treatment: Present, past, and future

Hepatitis C virus (HCV) infection is a major cause of chronic liver disease in the world. It is a challenging medico-social problem in the paediatric population. High HCV infection rates are reported in low and middle incomes countries. From the health economic point of view treatment of hepatitis C virus (HCV) with subsequent virus eradication is very effective as it eliminates the long-term sequelae of untreated or maltreated HCV. In this review we summarize the updates and highlight the historical approach of treatment of chronic HCV infection in children in the new era of directly acting antiviral (DAA) agents.

Blistering Disease During the Treatment of Chronic Hepatitis C With Ledipasvir/Sofosbuvir

Hepatitis C virus-associated porphyria cutanea tarda can result from viral-induced inhibition of uroporphyrinogen decarboxylase and the subsequent accumulation of uroporphyrins and associated metabolites in urine.