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Mehta V, Mahajan R, Midha V, Narang V, Kaur K, Singh A, Malhotra A, Parvez A, Sood A. Impact of Direct Acting Antiviral Therapy for Treatment of Hepatitis C Genotypes 1, 3 and 4: A Real Life Experience from India. J Clin Exp Hepatol 2018; 8:7-14. [PMID: 29743791 PMCID: PMC5938329 DOI: 10.1016/j.jceh.2017.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/12/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To assess impact of Direct Acting Antiviral (DAA) therapies for treatment of Hepatitis C Virus (HCV) genotypes 1, 3 and 4 in a real-world cohort from India. METHODS Adults with chronic HCV infection treated with Sofosbuvir (SOF) and Ledipasvir (LDV) (genotypes 1 and 4) or SOF and Daclatasvir (DCV) (genotype 3), with or without Ribavirin (RBV) between December 2015 and December 2016 were included. The primary endpoint was Sustained Virological Response at Post-treatment Week 12 (SVR12). RESULTS Of the 648 patients, 181 received SOF/LDV (65 with RBV) and 467 received SOF/DCV (135 with RBV). Most patients were males (65.4%), aged 41-60 years (49.4%) and treatment-naïve (92.6%). Genotype 3 (72.1%) was most common, followed by genotypes 1 (22.4%) and 4 (5.6%). Forty two percent patients (n = 271) had cirrhosis (112 patients were decompensated). SVR12 (modified intention-to-treat) was achieved by 98.1% of patients (512/522) (100% in genotypes 1 and 4, and 97.3% (362/372) in genotype 3). On intention to treat analysis, SVR12 was 88.1% (512/581) [genotype 1-96.8% (121/125), genotype 3-85.2%, genotype 4-93.5% (29/31)]. Seventy patients had treatment failure (non response in 6, virological breakthrough in 2, 10 patients relapsed, 2 died and 50 were lost to follow up). High SVR was observed regardless of HCV genotype, presence of cirrhosis or past history of treatment. No major adverse events warranting discontinuation of treatment were noted. CONCLUSIONS DAA therapy for HCV genotypes 1, 3 and 4 achieves high SVR rates in all patients, including those with cirrhosis and previous non-responders.
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Key Words
- DAA, Direct Acting Antiviral
- DCV, Daclatasvir
- EASL, European Association of Study of the Liver (EASL)
- ETR, End of Treatment Response
- HBV, Hepatitis B
- HCC, Hepatocellular Carcinoma
- HCV, Hepatitis C Virus
- HIV, Human Immunedeficiency Virus
- ITT, intention to treat
- LDV, ledipasvir
- RBV, Ribavirin
- RVR, Rapid Virological Response
- SOF, Sofosbuvir
- SVR, Sustained Virological Response
- SVR12, sustained virological response at Post-treatment Week 12
- direct acting antivirals
- hepatitis C
- mITT, modified Intention-to-Treat
- real life experience
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Affiliation(s)
- Varun Mehta
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College, Ludhiana, Punjab, India
| | - Vikram Narang
- Department of Pathology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Kirandeep Kaur
- Department of Pharmacology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Arshdeep Singh
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Anand Malhotra
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Aslam Parvez
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Ajit Sood
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India,Address for correspondence: Ajit Sood, Professor & Head, Department of Gastroenterology, Dayanand Medical College & Hospital, Ludhiana, Punjab, India.
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Vasudevan S, Kavimandan A, Kalra N, Nayak B, Thakur B, Das P, Gupta SD, Panda SK, Acharya SK. Demographic profile, host, disease & viral predictive factors of response in patients with chronic hepatitis C virus infection at a tertiary care hospital in north India. Indian J Med Res 2017; 143:331-40. [PMID: 27241647 PMCID: PMC4892080 DOI: 10.4103/0971-5916.182624] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background & objectives: Standard of care for chronic hepatitis C (CHC) in India is peginterferon and ribavirin (RBV). The response to treatment in real life stetting is unclear. The objectives of this study were to evaluate the demographic profile and assess the virological response and predictors of response in CHC patients. Methods: Consecutive patients with CHC were included in this study. Detailed clinical history, risk factors, and predictive factors of response were noted. Patients were treated with peginterferon α2b (1.5 µg/kg/wk) and RBV (12 mg/kg/day) for 6 to 18 months based on response. Results: A total of 211 patients were included in the analysis, mean age 40.6±12.3 yr, 144 (68%) were males and 71 (34%) had compensated cirrhosis. Commonest risk factor for acquiring CHC was previous transfusion and surgery (51%). Genotype 3 (72%) was most common followed by genotype 1 (23%). Overall sustained virologic response (SVR) was 64 per cent [95% CI 57.1%-70.4%]. The SVR was 66.5 per cent [95% CI 58.34-73.89%] for genotype 3 and 61.2 per cent [95% CI 46.23 to 74.80%] for genotype 1. Non-cirrhotics had better SVR rates compared to cirrhotics (76 vs 41%, P<0.001). On multivariate analysis, BMI ≥23 kg/m2, HOMA-IR ≥2, compliance (≤80%), and fibrosis >2 were predictors of low SVR. Interpretation & conclusions: Genotype 3 was the commonest HCV genotype. The commonest source of infection was previous transfusion and surgery. SVR rates for genotypes 3 were better than genotype 1 patients. Predictors of non-response were high BMI, insulin resistance, significant fibrosis and inadequate compliance.
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Affiliation(s)
- Sreejith Vasudevan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Amit Kavimandan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Nancy Kalra
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Baibaswata Nayak
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhaskar Thakur
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Prasenjit Das
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Subrat Kumar Panda
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Subrat Kumar Acharya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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Sood A, Midha V, Mahajan R, Narang V, Mehta V, Wander P, Sharma S, Kaur K, Singh D. Results of sofosbuvir-based combination therapy for chronic hepatitis C cohort of Indian patients in real-life clinical practice. J Gastroenterol Hepatol 2017; 32:894-900. [PMID: 27787910 DOI: 10.1111/jgh.13628] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/29/2016] [Accepted: 10/10/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM The introduction of sofosbuvir has revolutionized the treatment of chronic hepatitis C. This study was planned to observe whether the efficacy and tolerability of sofosbuvir-based regimens demonstrated in phase 3 clinical trial results translate into real-life clinical practice. METHODS This prospective, non-randomized observational study conducted in Dayanand Medical College and Hospital, Punjab, included all consecutive treatment-naïve patients with chronic hepatitis C (genotypes 1-5) who were treated with sofosbuvir-based regimens. Response to therapy was assessed at week 4 (rapid virological response), week 12 or 24 (end of treatment response), and 12 weeks after cessation of therapy (sustained virological response [SVR]). RESULTS Of 947 patients diagnosed with chronic hepatitis C virus and considered for treatment with direct-acting antivirals, 736 patients (77.1%) opted for treatment (age 45.1 ± 10.1 years, 64% men, genotype 3 [80%], genotype 1 [14.7%], and genotype 4 [4.9%]). Viral load was high (>600 000 IU/mL) in 361/736 (49%); 330 patients (44.8%) had cirrhosis (80 [14.3%] were decompensated). Patients with genotypes 1, 4, and 5 (n = 135) were treated with triple drug regime (pegylated interferon, ribavirin, and sofosbuvir) for 12 weeks. Patients with genotype 3 (n = 589) were treated either with dual therapy (sofosbuvir and ribavirin) for 24 weeks (n = 405) or triple therapy for 12 weeks (n = 184). SVR was achieved in 453/473 (95.8%). SVR rates did not differ among different genotypes but were higher in non-cirrhotics. CONCLUSION Sofosbuvir-based treatment regimens achieve high SVR rates in real-life cohort of Indian patients with chronic hepatitis C infection (including those with cirrhosis).
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Affiliation(s)
- Ajit Sood
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Vandana Midha
- Department of Internal Medicine, Dayanand Medical College, Ludhiana, Punjab, India
| | - Ramit Mahajan
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Vikram Narang
- Department of Pathology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Varun Mehta
- Department of Gastroenterology, Dayanand Medical College, Ludhiana, Punjab, India
| | | | - Suresh Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Omata M, Kanda T, Yokosuka O, Crawford D, Al-Mahtab M, Wei L, Ibrahim A, Lau GKK, Sharma BC, Hamid SS, Chuang WL, Dokmeci AK. Features of hepatitis C virus infection, current therapies and ongoing clinical trials in ten Asian Pacific countries. Hepatol Int 2015; 9:486-507. [PMID: 25941137 DOI: 10.1007/s12072-015-9630-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 04/06/2015] [Indexed: 02/07/2023]
Abstract
Estimated hepatitis C virus (HCV) infection rates in the general populations were 1.3, 0.9, 0.4-1.0, 14.7, 0.1-0.3, 0.9-1.9, 1.0-2.0, 5, 4.4-8.6 and 0.5-1.3 % in Australia, Bangladesh, Mainland China, Egypt, Hong Kong, India, Japan, Pakistan, Taiwan and Turkey, respectively. The main HCV genotypes (Gs) are G1, G3, G1b, G4, G1b, G3, G1b, G3, G1b and G2, and G1 in Australia, Bangladesh, Mainland China, Egypt, Hong Kong, India, Japan, Pakistan, Taiwan and Turkey, respectively. Of IL28B genotypes, favorable alleles are ~50 % in Australia and Turkey, but 60-70 % in most of the other Asian countries. Peginterferon plus ribavirin is available in all ten Asian Pasific countries. In addition, HCV NS3/4A protease inhibitors with peginterferon plus ribavirin are currently available in several countries. Clinical trials of interferon-free regimens for HCV are ongoing in most of the ten Asian Pacific countries.
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Affiliation(s)
- Masao Omata
- Yamanashi Hospitals (Central and Kita) Organization, 1-1-1 Fujimi, Kofu-shi, Yamanashi, 400-8506, Japan. .,University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Tatsuo Kanda
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Osamu Yokosuka
- Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8677, Japan.
| | - Darrell Crawford
- University of Queensland, School of Medicine, Woolloongabba, QLD, 4102, Australia.
| | - Mamun Al-Mahtab
- Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, 1000, Bangladesh.
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China.
| | - Alaaeldin Ibrahim
- GI/Liver Division, Department of Internal Medicine, University of Benha, Benha, Egypt.
| | - George K K Lau
- Humanity and Health Medical Centre, Hong Kong SAR China Institute of Translational Hepatology and Centre of Liver Fibrosis Diagnosis and Treatment Center, 302 Hospital, Beijing, China.
| | - Barjesh C Sharma
- Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.
| | - Saeed S Hamid
- Department of Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, 74800, Pakistan.
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - A Kadir Dokmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
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Optimal Duration of Pegylated Interferon Plus Ribavirin Therapy for Chronic Hepatitis C Genotype 3 Patients who do not Achieve Rapid Virological Response. J Clin Exp Hepatol 2015; 5:2-7. [PMID: 25941428 PMCID: PMC4415195 DOI: 10.1016/j.jceh.2015.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 02/07/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES Chronic hepatitis C (CHC) genotype-3 (G-3) patients treated with standard 24-week pegylated interferon plus ribavirin(PEG-RBV) therapy achieve sustained virological response(SVR) rate of 69-82%. Patients who do not achieve rapid virological response(RVR) have lower SVR rate. Data regarding optimal management of this subgroup is scarce. We aimed to determine the most appropriate treatment duration in CHC G-3 patients who do not achieve RVR. METHODS Treatment naïve CHC G-3 patients treated with PEG-RBV therapy were included in this retrospective analysis. Patients with cirrhosis were excluded. RVR was assessed in all patients beyond the year 2007. RVR non-achievers were advised extended treatment beyond 24 weeks. RESULTS Of the total 685 patients started on treatment, 646 completed treatment (mean age 39.1 ± 12 years, 68.3% males). In the pre-'RVR assessment' period (2004-2006), SVR with standard 24 week therapy was 72.3% (112/155). In post-'RVR assessment' period (2007-2013), 75.8% (402/530) patients achieved RVR; and 91.5% (368/402) of these achieved SVR with standard 24 weeks therapy. Among RVR non-achievers (n = 128), 51 patients opted for extended 36 week therapy, 12 for 48 week therapy, while 65 stopped therapy at 24 weeks. Choice of treatment duration was dependent entirely on the affordability of the patient. SVR with extended therapy (36/48 weeks) was significantly higher than standard 24 week therapy in RVR non-achievers (82.5% vs. 52.3%; P = 0.003). However, SVR rate in 36 week group was not significantly different from 48 week group (84.3% vs. 75%; P = 0.425]. On multivariate analysis, duration of treatment (36/48 week vs. 24 week; P < 0.001) was significantly associated with SVR. CONCLUSIONS SVR rates in CHC G-3 patients treated with PEG-RBV in northern India were comparable to western data. Standard 24 week therapy is adequate for RVR-achievers. However, in RVR non-achievers, extended 36 week therapy significantly improves SVR, while further extension to 48 week does not provide any additional advantage.
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Key Words
- 36 weeks therapy
- ALT, alanine aminotransferase
- BMI, Body mass index
- CHC, Chronic hepatitis C
- EVR, early virological response
- HBV, hepatitis B virus
- HCV, Hepatitis C virus
- HIV, Human Immunodeficiency virus
- PTI, prothrombin time index
- RVR non-achievers
- SVR, sustained virologic response
- cEVR, Complete EVR
- chronic hepatitis C
- pegylated interferon
- ribavirin
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Ray G. Factors affecting outcome of treatment of chronic hepatitis C: result of an open label study from eastern India. Trop Doct 2015; 46:28-33. [PMID: 25646016 DOI: 10.1177/0049475515569519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Standard treatment of hepatitis C involves the use of pegylated interferon (PEGIFN) and ribavirin but directly acting antiviral agents (DAA) with seemingly greater efficacy have now appeared on the market. Thus closer detail needs to be given to optimise the use of the former. METHODS Fifty-two chronic hepatitis C patients (Child class A) were administered PEGIFN and ribavirin in a prospective, open label study in standard dose and duration. Complete therapy was ensured for the best chance of achieving a sustained viral response (SVR) and delineating its controlling factors. RESULTS Seventy-five percent had genotype 3 virus. Compensated cirrhosis was present in 38.5%. Response overall and in cirrhotics were 65.4% and 30%, respectively, without difference between genotypes 1 and 3. Non-cirrhotics had higher response in all groups, especially genotype 1 (83.3%). The factors associated with positive response were age less than 50 years, absence of cirrhosis and presence of risk factors for transmission. CONCLUSION Treatment outcome and factors affecting it are similar to studies from Europe and America.
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Affiliation(s)
- Gautam Ray
- Gastroenterology Unit, Department of Medicine, B. R. Singh Hospital & Centre for Medical Education and Research, Kolkata 700014, West Bengal, India
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