1
|
Tu Y, Tang X, Zhou D, Shao H, Liang L, Tang W. Is it time for China to prioritize pan-genotypic regimens for treating patients with hepatitis C? COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:11. [PMID: 38321475 PMCID: PMC10848349 DOI: 10.1186/s12962-024-00519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION The treatment of hepatitis C has entered the pan-genotypic era, but the effectiveness is not good for the genotype 3b patients who have a large proportion in China. The guidelines for hepatitis C recommend the use of gene-specific regimens when the regional 3b prevalence rate greater than 5%. This study is to explore rationality of this proportion and the cost-effectiveness to implement pan-genotypic regimens in China. METHODS A decision Markov model was developed from the health system perspective to evaluate the effectiveness and cost-effectiveness between pan-genotypic and gene-specific treatment regimens for hepatitis C patients. Additionally, we set a regional genotype 3b patient proportion of 0-100% to explore at which proportion it is necessary to perform genotype identification and typing therapy on patients. Model parameters were derived from published literature and public databases. Effectiveness was measured by cured patient numbers, newly diagnosed cases of decompensated cirrhosis, hepatocellular carcinoma, need for liver transplantation, and quality-adjusted life years (QALYs). Cost-effectiveness outcomes included costs and the incremental cost-effectiveness ratio (ICER). The 1-3 times 2022 Chinese per capita gross domestic product was used as the willingness-to-pay threshold. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty of the model parameters. RESULTS Compared with gene-specific regimens, pan-genotypic regimens resulted in an additional 0.13 QALYs and an incremental cost of $165, the ICER was $1,268/QALY. From the view of efficacy, the pan-genotypic regimens cured 5,868 more people per 100,000 patients than gene-specific regimens, avoiding 86.5% of DC cases, 64.6% of HCC cases, and 78.2% of liver transplant needs. Identifying 3b patients before treatment was definitely cost-effectiveness when their prevalence was 12% or higher. The results remained robust in sensitivity analyses. CONCLUSIONS In China, the prioritized recommendation of pan-genotypic therapeutics proves to be both cost-effective and efficacious. But, in regions where the prevalence of genotype 3b exceeds 12%, it is necessary to identify them to provision of more suitable therapies.
Collapse
Affiliation(s)
- Yusi Tu
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
- Department of Public Affairs Management, School of Lnternational Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China
| | - Xiangyan Tang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
- Department of Public Affairs Management, School of Lnternational Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China
| | - Dachuang Zhou
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
- Department of Public Affairs Management, School of Lnternational Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China
| | - Hanqiao Shao
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
- Department of Public Affairs Management, School of Lnternational Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China
| | - Leyi Liang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China
- Department of Public Affairs Management, School of Lnternational Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China
| | - Wenxi Tang
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, 211198, China.
- Department of Public Affairs Management, School of Lnternational Pharmaceutical Business, China Pharmaceutical University, 639#Longmian Road, Nanjing, 211198, China.
| |
Collapse
|
2
|
Tung HD, Chen JJ. Genetic history of hepatitis C virus genotype 6 in Taiwan. J Formos Med Assoc 2023:S0929-6646(23)00431-X. [PMID: 37996321 DOI: 10.1016/j.jfma.2023.10.013] [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: 05/08/2022] [Revised: 03/09/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023] Open
Abstract
Unlike hepatitis C virus (HCV) genotype (GT) 6, which is widely circulated in Southeast Asia and South China, GT 6 was not reported in Taiwan until 2006. GT 1b and 2a, also known as global HCV subtypes, have been reported as major GTs circulating in Taiwan. Because of improvement in genotyping kits and sequencing techniques for the subtyping of HCV, an increasing number of GT 6 subtypes have been reported, especially subtype 6a among intravenous drug users with human immunodeficiency virus infection after an outbreak since 2003. Thus, HCV GT 6 infection is regarded to be closely associated with injection drug use. However, recently, we found an unexpectedly high GT 6 prevalence in the general population in Tainan, southern Taiwan. Most of these GT 6 samples belonged to a putative novel subtype closely related to 6g and 6w instead of 6a. Phylogenetic analyses indicated that this putative 6g-related novel subtype and 6w could be indigenous in southern Taiwan for centuries. Southern Taiwan could be the origin of HCV subtype 6w. This finding might change the perspective of HCV epidemiology in Taiwan.
Collapse
Affiliation(s)
- Hung-Da Tung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi-Mei Hospital, Liouying, Tainan, Taiwan
| | - Jyh-Jou Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chi-Mei Hospital, Liouying, Tainan, Taiwan.
| |
Collapse
|
3
|
Hua R, Kong F, Li G, Wen X, Zhang Y, Yang X, Meng C, Xie W, Jiang Y, Wang X, Han X, Huang Y, Mao Q, Wang J, Guan Y, Chen J, Ma Y, Xiong Q, Ma H, Yan X, Rao H, Zhao Y, Sun T, Zhu L, Mao X, Lian J, Deng G, Xin Y, Wang Y, Ye Y, Xu B, Gao H, Tan Y, Li D, Yang D, Su M, Zhang X, Min J, Shi X, Wei L, Niu J. Alfosbuvir plus Daclatasvir for Treatment of Chronic Hepatitis C Virus Infection in China. Infect Dis Ther 2023; 12:2595-2609. [PMID: 37856013 PMCID: PMC10651614 DOI: 10.1007/s40121-023-00872-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/05/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION A pan-genotypic and effective treatment regimen for patients with chronic hepatitis C virus (HCV) infection remains an unmet medical need in China. Alfosbuvir is a novel potent HCV NS5B polymerase inhibitor in development for the treatment of chronic HCV infection. We conducted a phase 3 study to evaluate the efficacy and safety of alfosbuvir in combination with daclatasvir in Chinese patients with HCV infection. METHODS All patients received 600 mg alfosbuvir tablets plus 60 mg daclatasvir tablets once daily for 12 weeks. The primary endpoint was sustained virological response 12 weeks after the end of treatment (SVR12). A follow-up visit was done at week 4 and 12, and those who achieved SVR12 were followed up at post-treatment week 24. RESULTS Of the 326 patients who received at least one dose of the study drug, 320 (98.2% [95% confidence interval (CI): 96.5%-99.5%]) achieved sustained virological response at post-treatment week 12 (SVR12), which was superior to the historical SVR12 rate of 88% (p < 0.0001). The SVR12 rates were similar regardless of most baseline characteristics. The most common adverse event (AE) (≥ 10%) was hypercholesterolemia. Serious adverse events (SAEs) were reported in 25 (7.7%) patients, none of which was judged to be related to the study drug. The majority of AEs were mild to moderate in severity. CONCLUSIONS Alfosbuvir plus daclatasvir for 12 weeks was highly effective and safe in Chinese patients infected with HCV genotype 1, 2, 3, or 6, suggesting that this regimen could be a promising option for HCV treatment in China irrespective of genotype. TRIAL REGISTRATION ClinicalTrial.gov identifier, NCT04070235.
Collapse
Affiliation(s)
- Rui Hua
- Center of Infectious Diseases and Pathogen Biology, Department of Hepatology, Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, State Key Laboratory of Zoonotic Disease, The First Hospital of Jilin University, Jilin, 130012, China
| | - Fei Kong
- Center of Infectious Diseases and Pathogen Biology, Department of Hepatology, Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, State Key Laboratory of Zoonotic Disease, The First Hospital of Jilin University, Jilin, 130012, China
| | - Guangming Li
- Zhengzhou Sixth People's Hospital, Zhengzhou, China
| | | | - Yuexin Zhang
- The First Hospital Affiliated to Xinjiang Medical University, Urumchi, China
| | | | - Chenxin Meng
- The Sixth People's Hospital of Shenyang, Shenyang, China
| | - Wen Xie
- Beijing Ditan Hospital Affiliated with Capital Medical University, Beijing, China
| | - Yongfang Jiang
- The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaozhong Wang
- Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine, Urumchi, China
| | - Xueji Han
- Affiliated Hospital of Yanbian University, Yanbian, China
| | - Yan Huang
- Xiangya Hospital, Central South University, Changsha, China
| | - Qing Mao
- The First Affiliated Hospital of Army Military Medical University, ChongQing, China
| | - Jiefei Wang
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Yujuan Guan
- Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Jiayu Chen
- The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, China
| | - Yingjie Ma
- Zhengzhou People's Hospital, Zhengzhou, China
| | | | - Hong Ma
- Beijing Friendship Hospital Affiliated with Capital Medical University, Beijing, China
| | - Xuebing Yan
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Huiying Rao
- Peking University People's Hospital, Beijing, China
| | - Yingren Zhao
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Tong Sun
- The Fifthth People's Hospital of Wuxi, Wuxi, China
| | - Liying Zhu
- The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiaorong Mao
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Jianqi Lian
- Tangdu Hospital, The Fourth Military Medical University of the PLA, Xi'an, China
| | | | | | - Yifei Wang
- Tonghua Central Hospital, Tonghua, China
| | - Yinong Ye
- Foshan First People's Hospital, Foshan, China
| | - Bin Xu
- Beijing You'an Hospital Affiliated with Capital Medical University, Beijing, China
| | - Hainv Gao
- Shulan (Hangzhou) Hospital, Hangzhou, China
| | - Youwen Tan
- The Third People's Hospital of Zhenjiang, Zhenjiang, China
| | - Dongliang Li
- The 900Th Hospital of Joint Logistics Support Force of PLA, Fuzhou, China
| | - Dongliang Yang
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Minghua Su
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | | | - Jie Min
- Nanjing Sanhome Pharmaceutical Co., Ltd, Nanjing, China
| | - Xinsheng Shi
- Nanjing Sanhome Pharmaceutical Co., Ltd, Nanjing, China
| | - Lai Wei
- Beijing Tsinghua Changgung Hospital, Beijing, China.
| | - Junqi Niu
- Center of Infectious Diseases and Pathogen Biology, Department of Hepatology, Key Laboratory of Organ Regeneration and Transplantation of the Ministry of Education, State Key Laboratory of Zoonotic Disease, The First Hospital of Jilin University, Jilin, 130012, China.
| |
Collapse
|
4
|
Yang J, Qi JL, Wang XX, Li XH, Jin R, Liu BY, Liu HX, Rao HY. The burden of hepatitis C virus in the world, China, India, and the United States from 1990 to 2019. Front Public Health 2023; 11:1041201. [PMID: 36935711 PMCID: PMC10018168 DOI: 10.3389/fpubh.2023.1041201] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 02/02/2023] [Indexed: 03/06/2023] Open
Abstract
Background and aim Hepatitis C virus infection can lead to an enormous health burden worldwide. Investigating the changes in HCV-related burden between different countries could provide inferences for disease management. Hence, we aim to explore the temporal tendency of the disease burden associated with HCV infection in China, India, the United States, and the world. Methods Detailed data on the total burden of disease related to HCV infection were collected from the Global Burden of Disease (GBD) 2019 database. Joinpoint regression models were used to simulate the optimal joinpoints of annual percent changes (APCs). Further analysis of the age composition of each index over time and the relationship between ASRs and the socio-demographic Index (SDI) were explored. Finally, three factors (population growth, population aging, and age-specific changes) were deconstructed for the changes in the number of incidences, deaths, and DALYs. Results It was estimated that 6.2 million new HCV infections, 0.54 million HCV-related deaths, and 15.3 million DALYs worldwide in 2019, with an increase of 25.4, 59.1, and 43.6%, respectively, from 1990, are mainly due to population growth and aging. China experienced a sharp drop in age-standardized rates in 2019, the United States showed an upward trend, and India exhibited a fluctuating tendency in the burden of disease. The incidence was increasing in all locations recently. Conclusion HCV remains a global health concern despite tremendous progress being made. The disease burden in China improved significantly, while the burden in the United States was deteriorating, with new infections increasing recently, suggesting more targeted interventions to be established to realize the 2030 elimination goals.
Collapse
Affiliation(s)
- Jia Yang
- Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
| | - Jin-Lei Qi
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao-Xiao Wang
- Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
| | - Xiao-He Li
- Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
| | - Rui Jin
- Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
| | - Bai-Yi Liu
- Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
| | - Hui-Xin Liu
- Department of Clinical Epidemiology and Biostatistics, Peking University People's Hospital, Beijing, China
- *Correspondence: Hui-Ying Rao
| | - Hui-Ying Rao
- Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University Hepatology Institute, Peking University People's Hospital, Beijing, China
- Hui-Xin Liu
| |
Collapse
|
5
|
Comparison of time trends in the incidence of primary liver cancer between China and the United States: an age-period-cohort analysis of the Global Burden of Disease 2019. Chin Med J (Engl) 2022; 135:2035-2042. [PMID: 36103990 PMCID: PMC9746748 DOI: 10.1097/cm9.0000000000001980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND China and the United States (US) ranked first and third in terms of new liver cancer cases and deaths globally in 2020. Therefore, a comprehensive assessment of trends in the incidence of primary liver cancer with four major etiological factors between China and the US during the past 30 years with age-period-cohort (APC) analyses is warranted. METHODS Data were obtained from the Global Burden of Disease 2019, and period/cohort relative risks were estimated by APC modeling from 1990 to 2019. RESULTS In 2019, there were 211,000 new liver cancer cases in China and 28,000 in the US, accounting for 39.4% and 5.2% of global liver cancer cases, respectively. For China, the age-standardized incidence rate (ASIR) consecutively decreased before 2005 but increased slightly since then, whereas the ASIR continuously increased in the US. Among the four etiological factors of liver cancer, the fastest reduction in incidence was observed in hepatitis B virus-related liver cancer among Chinese women, and the fastest increase was in nonalcoholic steatosis hepatitis (NASH)-related liver cancer among American men. The greatest reduction in the incidence of liver cancer was observed at the age of 53 years in Chinese men (-5.2%/year) and 33 years in Chinese women (-6.6%/year), while it peaked at 58 years old in both American men and women (4.5%/year vs . 2.8%/year). Furthermore, the period risks of alcohol- and NASH-related liver cancer among Chinese men have been elevated since 2013. Simultaneously, leveled- off period risks were observed in hepatitis C viral-related liver cancer in both American men and women. CONCLUSIONS Currently, both viral and lifestyle factors have been and will continue to play an important role in the time trends of liver cancer in both countries. More tailored and efficient preventive strategies should be designed to target both viral and lifestyle factors to prevent and control liver cancer.
Collapse
|
6
|
The Transmission Route and Selection Pressure in HCV Subtype 3a and 3b Chinese Infections: Evolutionary Kinetics and Selective Force Analysis. Viruses 2022; 14:v14071514. [PMID: 35891494 PMCID: PMC9324606 DOI: 10.3390/v14071514] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/23/2022] [Accepted: 07/04/2022] [Indexed: 12/12/2022] Open
Abstract
Hepatitis C virus (HCV) genotype 3 (GT-3) represents 22–30% of all infections and is the second most common genotype among all HCV genotypes. It has two main subtypes, GT-3a and GT-3b, that present epidemiological differences in transmission groups. This report generated 56 GT-3a and 64 GT-3b whole-genome sequences to conduct an evolutionary kinetics and selective force analysis with reference sequences from various countries. Evolutionary analysis showed that HCV GT-3a worldwide might have been transmitted from the Indian subcontinent to South Asia, Europe, North America and then become endemic in China. In China, GT-3a may have been transmitted by intravenous drug users (IDUs) and become endemic in the general population, while GT-3b may have originated from IDUs and then underwent mutual transmission between blood donors (BDs) and IDUs, ultimately becoming independently endemic in IDUs. Furthermore, the spread of GT-3a and GT-3b sequences from BD and IDU populations exhibit different selective pressures: the proportion of positively selected sites (PPSs) in E1 and E2 from IDUs was higher than in BDs. The number of positive selection sites was higher in GT-3b and IDUs. These results indicate that different selective constraints act along with the GT-3a and GT-3b genomes from IDUs and BDs. In addition, GT-3a and GT-3b have different transmission routes in China, which allows us to formulate specific HCV prevention and control strategies in China.
Collapse
|
7
|
Liu M, Du L, Cheng X, Yuan M, Shang J, Shi Y, Yang H, Tang H. CpG Island Methylation of Suppressor of Cytokine Signaling-1 Gene Induced by HCV Is Associated With HCV-Related Hepatocellular Carcinoma. Front Microbiol 2022; 13:679593. [PMID: 35733955 PMCID: PMC9207397 DOI: 10.3389/fmicb.2022.679593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Suppressor of cytokine signaling 1 (SOCS-1) is implicated in both virus infection and carcinogenesis. This study investigated the role of HCV infection on SOCS-1 in normal and HCV-infected tissues and revealed a possible mechanism underlying HCV-induced hepatocellular carcinoma (HCC) genesis. In total, 10 HCV-HCC tissues, seven adjacent tissues, seven distal tissues, and 16 normal liver tissues were collected. SOCS-1 expression in tissue sections was detected by immunohistochemistry. After viral load was quantified, the correlation between SOCS-1 expression and viral load was analyzed in different tissues. Then, HCV replicon model was used to detect a relationship between HCV and SOCS-1. Subsequently, methylation-specific PCR (MSP) was applied to show the methylation status of SOCS-1 genes in normal tissues and HCV-replicating cell lines. A correlation between gene methylation, SOCS-1 expression, and HCV was analyzed. The lowest expression of SOCS-1 was observed in HCV-HCC tissues. Tissues with a higher HCV viral load showed lower SOCS-1 expression (p = 0.0282). Consistently, SOCS-1 mRNA and protein were lower in HCV-replicating cell lines than in uninfected ones. Furthermore, gene methylation was found in all examined tissues but higher in HCC tissues, and it is positively correlated with HCV viral load (r2 = 0.7309, p < 0.0001). HCV infection would upregulate methylation of the SOCS-1 gene in HCV-replicating cell lines. The downregulation of SOCS-1 in normal and HCV-replicating cell lines may result from HCV infection through epigenetic regulation, in which gene methylation in the CpG island of SOCS-1 promoters upon HCV infection suppresses its expression.
Collapse
Affiliation(s)
- Miao Liu
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Lingyao Du
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Xing Cheng
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Man Yuan
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
| | - Jin Shang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
- Department of Hepatobiliary-Pancreatic Surgery, Cell Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Ying Shi
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hailing Yang
- Molecular Oncology Research Institute, Tufts Medical Center, Boston, MA, United States
- Graduate Program in Cellular and Molecular Physiology, School of Graduate Biomedical Sciences, Tufts University, Boston, MA, United States
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China
- *Correspondence: Hong Tang,
| |
Collapse
|
8
|
Hua R, Kong F, Wen X, Xiong Q, Chen J, Meng C, Ma H, Tan Y, Huang Y, Jiang Y, Guan Y, Mao X, Wang J, Xin Y, Gao H, Xu B, Li C, Wu Q, Zhang X, Wang Z, Zhao L, Zhang Y, Li G, Niu J. Efficacy and safety of alfosbuvir plus daclatasvir in Chinese patients with hepatitis C virus genotypes 1, 2, 3, and 6 infection: An open-label, phase 2 study. J Viral Hepat 2022; 29:455-464. [PMID: 35080256 DOI: 10.1111/jvh.13650] [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: 06/28/2021] [Revised: 12/25/2021] [Accepted: 01/03/2022] [Indexed: 12/09/2022]
Abstract
Alfosbuvir is a novel potent HCV NS5B polymerase inhibitor in development for the treatment of chronic HCV infection. Our previous studies indicated that alfosbuvir monotherapy was well-tolerated and druggable in healthy subjects and HCV-infected patients. Here, we evaluate the efficacy and safety of alfosbuvir in combination with daclatasvir in Chinese patients with HCV genotype 1, 2, 3 or 6. In this open-label study, patients with chronic HCV infection were randomly assigned with a 1:1:1 ratio to receive 12 weeks of daclatasvir 60 mg plus alfosbuvir at a dose of 400, 600 or 800 mg (Cohort A, B or C) daily. Randomization was stratified by HCV genotype and the presence or absence of cirrhosis at screening. The primary endpoint was a sustained virologic response 12 weeks after the end of treatment (SVR12). A total of 124 patients were enrolled in the study, all of whom were available for post-treatment week 12 assessments. SVR12 was achieved in 92.7% (38/41), 95.2% (40/42) and 100% (41/41) of patients in Cohort A, B and C respectively. The most common adverse events were hepatic steatosis, upper respiratory tract infection, hypercholesterolaemia, hypertriglyceridaemia, blood bilirubin increased, and total bile acids increased. There were no discontinuations due to adverse events, and no treatment-related serious adverse events were reported. Once-daily oral administration of alfosbuvir plus daclatasvir were highly effective and safe in Chinese patients infected with HCV genotype 1, 2, 3 or 6, suggesting this regimen could be a promising drug candidate for HCV treatment irrespective of genotype. (ClinicalTrials.gov number, NCT04070235).
Collapse
Affiliation(s)
- Rui Hua
- The First Hospital of Jilin University, Changchun, China
| | - Fei Kong
- The First Hospital of Jilin University, Changchun, China
| | | | | | - Jiayu Chen
- The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou, China
| | - Chenxin Meng
- The Sixth People's Hospital of Shenyang, Shenyang, China
| | - Hong Ma
- Beijing Friendship Hospital Affiliated with Capital Medical University, Beijing, China
| | - Youwen Tan
- The Third People's Hospital of Zhenjiang, Zhenjiang, China
| | - Yan Huang
- Xiangya Hospital, Central South University, Changsha, China
| | - Yongfang Jiang
- The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yujuan Guan
- Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Xiaorong Mao
- The First Hospital of Lanzhou University, Lanzhou, China
| | - Jiefei Wang
- Shanghai Public Health Clinical Center, Shanghai, China
| | | | - Hainv Gao
- Shulan (Hangzhou) Hospital, Hangzhou, China
| | - Bin Xu
- Beijing You'an Hospital Affiliated with Capital Medical University, Beijing, China
| | - Cheng Li
- Zhengzhou Sixth People's Hospital, Zhengzhou, China
| | - Qiong Wu
- Nanjing Sanhome Pharmaceutical Co., Ltd, Nanjing, China
| | - Xian Zhang
- Nanjing Sanhome Pharmaceutical Co., Ltd, Nanjing, China
| | - Zhiqiang Wang
- Nanjing Sanhome Pharmaceutical Co., Ltd, Nanjing, China
| | - Liwen Zhao
- Nanjing Sanhome Pharmaceutical Co., Ltd, Nanjing, China
| | - Yuexin Zhang
- The First Hospital Affiliated to Xinjiang Medical University, Urumchi, China
| | - Guangming Li
- Zhengzhou Sixth People's Hospital, Zhengzhou, China
| | - Junqi Niu
- The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
9
|
Yang J, Liu HX, Su YY, Liang ZS, Rao HY. Distribution and changes in hepatitis C virus genotype in China from 2010 to 2020. World J Clin Cases 2022; 10:4480-4493. [PMID: 35663077 PMCID: PMC9125278 DOI: 10.12998/wjcc.v10.i14.4480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/28/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) causes a large number of infections worldwide. New infections seem to be increasing according to a report of the World Health Organization in 2015. Although direct-acting antivirals are quite effective for most genotypes of the HCV, some genotypes fail to respond. Therefore, the trend of genotype distribution is vital to better control the development of this infection.
AIM To analyze the distribution and trends of the HCV genotype before and after the emergence of direct-acting antivirals in China.
METHODS We searched all literature published in five electronic databases-China National Knowledge Infrastructure, Wan Fang Data, VIP Chinese Journal Database, Chinese Biomedical Literature Service System, and PubMed-from January 1, 2010 to December 31, 2020. The search strategy combined medical subject headings and free-text terms, including “hepatitis C virus” or “HCV” and “genotype” or “subtype” and ”China” or “Chinese”. Additional relevant articles were searched by manual selection. Data were extracted to build a database. All of the data were totaled according to regions, periods, routes of transmission, and sexes. The percentages in various stratifications were calculated.
RESULTS There were 76110 samples from 30 provinces included in the study. Genotype 1 (G1) accounted for 58.2% of cases nationwide, followed by G2, G6, G3b, G3a, unclassified and mixed infections (17.5%, 7.8%, 6.4%, 4.9%, 1.8%, and 1.2%, respectively). The constitution of genotype varied among different regions, with G6 and G3b being more common in the south and southwest, respectively (28.1%, 15.4%). The past ten years have witnessed a decrease in G1 and G2 and an increase in G3 and G6 in almost all regions. The drug-use population had the most abundant genotypes, with G6 ranking first (33.3%), followed by G1 and G3b (23.4%, 18.5%).
CONCLUSION G3 and G6 pose a new challenge for HCV infection. This study revealed the distribution of HCV genotypes in China over the past 10 years, providing information for HCV management strategies.
Collapse
Affiliation(s)
- Jia Yang
- Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University People’s Hospital, Beijing 100044, China
| | - Hui-Xin Liu
- Department of Clinical Epidemiology and Biostatistics, Peking University People’s Hospital, Beijing 100044, China
| | - Ying-Ying Su
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Public Health, Xiamen University, Xiamen 361000, Fujian Province, China
| | - Zhi-Sheng Liang
- Department of Global Health, School of Public Health, Peking University, Beijing 100044, China
| | - Hui-Ying Rao
- Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Peking University People’s Hospital, Beijing 100044, China
| |
Collapse
|
10
|
Liu J, Guo M, Ke L, You R. Cost-Effectiveness of Elbasvir/Grazoprevir for the Treatment of Chronic Hepatitis C: A Systematic Review. Front Public Health 2022; 10:836986. [PMID: 35646774 PMCID: PMC9136222 DOI: 10.3389/fpubh.2022.836986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study aims to systematically review recent economic evaluations of elbasvir/grazoprevir (EBR/GZR) for chronic hepatitis C (CHC), to critically appraise the reporting quality and to summarize the results. Methods A literature search was undertaken using Medline, Embase, the Cochrane Library, EconLit, China National Knowledge Infrastructure, Wanfang Data, and Chongqing VIP to identify original articles containing economic evaluations of EBR/GZR for CHC published between 1 January 2000 and 31 December 2020. The Consolidated Health Economic Evaluation Reporting Standards statement was used to assess the quality of reporting of the articles. Results Of 93 articles identified, 13 studies fulfilled the inclusion criteria. These studies were conducted in 4 countries, and 8 active interventions were assessed. The target population was patients infected with CHC genotype 1 infection in all studies. Eight out of 13 studies that compared EBR/GZR vs. other direct antiviral agents suggested that EBR/GZR was generally more cost-effective or dominant than daclatasvir/asunaprevir (DCV/ASV), sofosbuvir/velpatasvir (SOF/VEL), ledipasvir/sofosbuvir (LDV/SOF), ombitasvir/paritaprevir/ritonavir + dasabuvir (3D) but not more cost-effective than glecaprevir/pibrentasvir (GLE/PIB). Two studies from China and one study from the USA that compared EBR/GZR vs. pegylated interferon and ribavirin (PegIFN/RBV) consistently indicated that EBR/GZR was generally more cost-effective than PegIFN/RBV. One study from Italy compared EBR/GZR with SOF + PegIFN/RBV and suggested that EBR/GZR had a lower cost and higher effectiveness. One study from France and one study from the USA confirmed that compared with non-therapy for patients with chronic kidney disease, EBR/GZR was cost-effective at commonly accepted current standards. All included studies were of good quality of reporting, with an average score of 21.9 (range 19–23). Conclusion EBR/GZR for CHC genotype 1 might be cost-effective or dominant compared with PegIFN/RBV and other direct antiviral agents (SOF/VEL, 3D, DCV/ASV, LDF/SOF) or non-therapy. However, under certain assumptions, EBR/GZR was not a cost-effective alternative for CHC patients vs. GLE/PIB.
Collapse
Affiliation(s)
- Jinyu Liu
- Department of Pharmacy, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Min Guo
- Department of Pharmacy, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Lei Ke
- Department of Pharmacy, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- Lei Ke
| | - Ruxu You
- Department of Pharmacy, Tongji Medical College, Union Hospital, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Ruxu You
| |
Collapse
|
11
|
Xie Z, Deng K, Xia Y, Zhang C, Xu M, Li F, Liu J, Zhou Y, Chen X, Chen X, Yan Q, Huang J, Chen W, Wu S, Bai H, Li J, Guan Y. Efficacy and safety of direct-acting antiviral therapies and baseline predictors for treatment outcomes in hepatitis C patients: a multi-center, real-world study in Guangdong, China. J Med Virol 2022; 94:4459-4469. [PMID: 35545872 DOI: 10.1002/jmv.27851] [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: 01/18/2022] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 11/09/2022]
Abstract
: The data on direct acting antivirals (DAA) in chronic hepatitis C (CHC) patients in southern China with multiple genotypes circulating are limited. This study aims to evaluate the efficacy and safety of DAA regimens among CHC patients in Guangdong, China. A total of 220 patients receiving a variety of DAA were enrolled. The primary outcome was sustained virologic response (SVR) at 12 weeks. Resistance associated substations (RAS) were evaluated by deep sequencing. The overall SVR rate was 96.4%, and was 97.7% for genotype 1, 100% for genotype 2, 91.9% for genotype 3, 95.7% for genotype 6, and 100% for untyped. The overall incidence of adverse events (AEs) was 8.2% (18/220) and all the AEs were mild. Nonstructural protein 5A RAS, 30K/31M and Y93H, were most prevalent at baseline and the end of treatment in non-SVR patients, respectively. Logistics regression showed that elevated ALT and AST at baseline were specifically associated with non-SVR in patients with genotype 3 and 6 infections (P = 0.029 and P = 0.017) but not genotype 1 infection (P = 0.746 and P = 0.971), and baseline AST was the best predictor for SVR in genotype 3 and 6 patients (area under curve = 0.890). CONCLUSION: All DAA regimens achieved ideal SVR and were well tolerated. NS5A RAS were prevalent in non-SVR patients. ALT and AST as baseline predictors for non-SVR in genotype 3 and 6 infections warrant further research in a larger cohort. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Zhiwei Xie
- Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Kai Deng
- Infectious Disease Institute, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yang Xia
- Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Chunlan Zhang
- Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Min Xu
- Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Feng Li
- Infectious Disease Institute, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jinfeng Liu
- Institution of Clinical Research, the First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Yuanping Zhou
- Department of Infectious Disease, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoping Chen
- Department of Infectious Disease, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Xuefu Chen
- Department of Infectious Disease, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Qin Yan
- Department of Hepatology, Shenzhen Union Hospital of Huazhong University of Science and Technology, Shenzhen, Guangdong, China
| | - Jing Huang
- Department of Infectious Disease, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Wenli Chen
- Department of Infectious Disease, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Shuduo Wu
- Department of Hepatology, Guangdong Province Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Honglian Bai
- Institution of Clinical Research, the First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Jianping Li
- Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yujuan Guan
- Department of Hepatology, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| |
Collapse
|
12
|
Geographic Distribution of HCV Genotypes and Efficacy of Direct-Acting Antivirals in Chronic HCV-Infected Patients in North and Northeast China: A Real-World Multicenter Study. Can J Gastroenterol Hepatol 2022; 2022:7395506. [PMID: 35531123 PMCID: PMC9076341 DOI: 10.1155/2022/7395506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the geographic distribution of HCV genotypes, effectiveness, and safety of DAA treatment for HCV-infected patients in North and Northeast China. METHODS The geographic distribution of HCV genotypes was analyzed in 2162 patients recruited from April 2018 to February 2021. Sustained virologic response rates at 12 (SVR12) or 24 (SVR24) weeks posttreatment and safety were analyzed in 405 patients who completed DAA treatment according to patient baseline characteristics and treatment. RESULTS Four genotypes and six subtypes were identified as follows: 1b (1187, 54.90%), 2a (790, 36.54%), 3a/b (134, 6.20%), 6a/n (44, 2.04%), mixed genotypes (2a-6a or 2a-3a) (7, 0.32%). Overall, 99.01% patients achieved SVR12, while 98.43% achieved SVR24. All patients treated with elbasvir/grazoprevir (EBR/GZR), sofosbuvir/velpatasvir ± ribavirin (SOF/VEL ± RBV), and SOF/ledipasvir (LDV) achieved SVR12 or SVR24; 92.86% SVR12 and 95.83% SVR24 were observed in patients using SOF + RBV. SVR12 was higher in noncirrhosis versus compensated cirrhosis patients (100% vs. 97.09%, p=0.022). No severe drug-related adverse event was observed. CONCLUSIONS Genotypes 1b and 2a were dominant subtypes in North and Northeast China. The approved drug regimens EBR/GZR and SOF/LDV for subtype 1b and SOF/VEL for nongenotype 1b are the optimal effective and safety profile.
Collapse
|
13
|
Zhou HJ, Cao J, Shi H, Naidoo N, Semba S, Wang P, Fan YF, Zhu SC. Cost-Effectiveness Analysis of Pan-Genotypic Sofosbuvir-Based Regimens for Treatment of Chronic Hepatitis C Genotype 1 Infection in China. Front Public Health 2021; 9:779215. [PMID: 34957030 PMCID: PMC8695807 DOI: 10.3389/fpubh.2021.779215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/18/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Hepatitis C virus (HCV) genotype 1 is the most prevalent HCV infection in China. Sofosbuvir-based direct antiviral agent (DAA) regimens are the current mainstays of treatment. Sofosbuvir/velpatasvir (SOF/VEL) and sofosbuvir/ledipasvir (SOF/LDV) regimens became reimbursable in China in 2020. Thus, this study aimed to identify the optimal SOF-based regimen and to inform efficient use of healthcare resources by optimizing DAA use in treating HCV genotype 1. Methods and Models: A modeling-based cost-utility analysis was conducted from the payer's perspective targeting adult Chinese patients with chronic HCV genotype 1 infection. Direct medical costs and health utilities were inputted into a Markov model to simulate lifetime experiences of chronically infected HCV patients after receiving SOF/LDV, SOF/VEL or the traditional strategy of pegylated interferon (pegIFN) + ribavirin (RBV). Discounted lifetime cost and quality adjusted life years (QALYs) were computed and compared to generate the incremental cost utility ratio (ICUR). An ICUR below the threshold of 31,500 $/QALY suggests cost-effectiveness. Deterministic and probabilistic sensitivity analyses were performed to examine the robustness of model findings. Results: Both SOF/LDV and SOF/VEL regimens were dominant to the pegIFN + RBV regimen by creating more QALYs and incurring less cost. SOF/LDV produced 0.542 more QALYs but cost $10,390 less than pegIFN + RBV. Relative to SOF/LDV, SOF/VEL had an ICUR of 168,239 $/QALY which did not meet the cost-effectiveness standard. Therefore SOF/LDV was the optimal strategy. These findings were robust to linear and random variations of model parameters. However, reducing the SOF/VEL price by 40% would make this regimen the most cost-effective option. Conclusions: SOF/LDV was found to be the most cost-effective treatment, and SOF/VEL was also economically dominant to pegIFN + RBV. These findings indicated that replacing pegIFN + RBV with DAA regimens could be a promising strategy.
Collapse
Affiliation(s)
- Hui Jun Zhou
- Department of Public Administration, Business School, University of Shanghai for Science and Technology, Shanghai, China
| | - Jing Cao
- Department of Public Administration, Business School, University of Shanghai for Science and Technology, Shanghai, China
| | - Hui Shi
- Department of Public Administration, Business School, University of Shanghai for Science and Technology, Shanghai, China
| | - Nasheen Naidoo
- Department of Pathology, Stellenbosch University, Cape Town, South Africa
| | - Sherehe Semba
- Department of Public Administration, Business School, University of Shanghai for Science and Technology, Shanghai, China
- Faculty of Science, Dar es Salaam University College of Education, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Pei Wang
- School of Public Health, Fudan University, Shanghai, China
- Key Lab of Health Technology Assessment, National Health Commission of China (Fudan University), Shanghai, China
| | - Yi Fan Fan
- Department of Public Administration, Business School, University of Shanghai for Science and Technology, Shanghai, China
| | - Shui Cheng Zhu
- Department of Public Administration, Business School, University of Shanghai for Science and Technology, Shanghai, China
| |
Collapse
|
14
|
Wei X, Zhao J, Yang L. Cost-effectiveness of new antiviral treatments for non-genotype 1 hepatitis C virus infection in China: a societal perspective. BMJ Glob Health 2021; 5:bmjgh-2020-003194. [PMID: 33246983 PMCID: PMC7703443 DOI: 10.1136/bmjgh-2020-003194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/29/2020] [Accepted: 11/04/2020] [Indexed: 12/14/2022] Open
Abstract
Objective This study aimed to estimate the cost-effectiveness of direct-acting antivirals (DAAs) among patients with non-genotype 1 for the eradication of hepatitis C virus (HCV) infection in China. Methods A decision-analytic Markov model was developed to estimate the lifetime costs, quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICERs) for DAAs and pegylated interferon plus ribavirin (PEG-RBV) from a societal perspective. The model inputs were derived from the literature, a patient survey, HCV expert opinions and a specialised drug price database available in China. Sensitivity analysis was conducted to evaluate the model robustness and calculate reasonable prices of DAAs. Results For patients infected with HCV genotype 2, the pan-genotypic regimen sofosbuvir/velpatasvir (SOF/VEL) was the most cost-effective strategy compared with PEG-RBV, with an ICER of US$5653/QALY. For genotype 3, the combination of sofosbuvir plus daclatasvir (SOF-DCV) was the most cost-effective approach, with an ICER of US$3314/QALY. All DAA regimens for genotype 6 were cost-saving, and sofosbuvir plus ribavirin (SOF-RBV) was the optimal regimen. One-way sensitivity analysis demonstrated that the ICERs were most sensitive to the utility values, discount rate and drug costs. Probabilistic sensitivity analysis indicated that using a threshold equal to one time the gross domestic product (GDP) per capita in China (US$9769/QALY, 2018), the probability of SOF/VEL, SOF-DCV and SOF-RBV being cost-effective was 58%, 83% and 71% for genotype 2, 3 and 6, respectively. Threshold analysis showed that the price of DAAs should be reduced by some degree to achieve better affordability. Conclusions DAAs were cost-effective compared with traditional treatments. A reasonable reduction in the price of DAAs will increase drug affordability and is of great significance as a global strategy to eradicate viral hepatitis.
Collapse
Affiliation(s)
- Xia Wei
- Department of Health policy and management, School of Public Health, Peking University, Beijing, China
| | - Jingyu Zhao
- Department of Health policy and management, School of Public Health, Peking University, Beijing, China
| | - Li Yang
- Department of Health policy and management, School of Public Health, Peking University, Beijing, China
| |
Collapse
|
15
|
Tang Q, Wei L, Liu X, Hu P. Sofosbuvir-Based Therapies Achieved Satisfactory Virological Response in Chinese Individuals with Genotypes 3 and 6 Infections: A Real-World Experience. Infect Drug Resist 2021; 14:2297-2307. [PMID: 34188496 PMCID: PMC8233542 DOI: 10.2147/idr.s312902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/28/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Previous studies have shown that sofosbuvir-based regimens yield high sustained virological response rates in patients with hepatitis C virus (HCV) infection except for genotype 3b complicated with cirrhosis. This real-world study aims to explore the efficacy and safety of sofosbuvir-based regimens in Chinese patients with genotypes 3 and 6 infections, especially the impact of ribavirin coadministration on sustained virological response in cirrhotic patients with genotype 3b infection. METHODS This is a retrospective cohort study that included 101 patients initiated on sofosbuvir-based regimens. The main endpoint of treatment was sustained virological response at posttreatment week 12 (SVR12). RESULTS Overall, the SVR12 rates were 95.0% (96/101); specifically, the rates were 100% in sofosbuvir, 88.2% in sofosbuvir+ribavirin, 100% in sofosbuvir+daclatasvir, 100% in sofosbuvir+daclatasvir+ribavirin, 95.0% in sofosbuvir/velpatasvir, and 97.1% in sofosbuvir/velpatasvir+ribavirin (p=0.534). The SVR12 rates were comparable in patients infected with genotypes 3 and 6 (93.2% versus 97.6%, p=0.339). The SVR12 rate was 93.9% in cirrhotic patients (31/33). Among those infected with genotype 3, the SVR12 rate was 91.7% (22/24); the rate was 95.0% in those with ribavirin coadministration regimens, which was numerically higher than the 75.0% in those without ribavirin. However, no statistical difference was found (p=0.312). In total, five patients failed to achieve SVR12, including 3 patients with genotype 3b infection treated with ribavirin coadministration regimens (one of them was cirrhotic), 1 cirrhotic patient with genotype 3k infection, and 1 noncirrhotic patient with genotype 6a infection. No severe adverse event occurred. CONCLUSION Real-world data show that sofosbuvir-based regimens are highly effective and safe for patients with HCV genotypes 3 and 6 infections.
Collapse
Affiliation(s)
- Qiao Tang
- Department of Infectious Diseases, Institute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Li Wei
- Department of Infectious Diseases, Institute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xiaoqing Liu
- Department of Infectious Diseases, Institute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Peng Hu
- Department of Infectious Diseases, Institute for Viral Hepatitis, The Key Laboratory of Molecular Biology for Infectious Diseases, Chinese Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| |
Collapse
|
16
|
Pan S, Feng K, Huang P, Zeng Y, Ke L, Yang X, Liu J, Lin C. Efficacy and safety of danoprevir plus sofosbuvir in GT 1, 2, 3, or 6 chronic hepatitis C patients with or without cirrhosis in China. Medicine (Baltimore) 2021; 100:e26312. [PMID: 34128871 PMCID: PMC8213259 DOI: 10.1097/md.0000000000026312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 05/08/2021] [Accepted: 05/24/2021] [Indexed: 01/04/2023] Open
Abstract
ABSTRACT All-oral direct-acting antiviral therapies are becoming the choice for hepatitis C (HCV) treatment. In this study, we aimed to evaluate the efficacy and safety of ritonavir-boosted danoprevir (DNVr) plus sofosbuvir±ribavirin on HCV genotype 1, 2, 3, or 6 in the real world in China.In this observational, prospective, multicenter cohort, we enrolled a total of 58 patients with HCV genotype 1, 2, 3, or 6 patients from July 2018 to December 2019. All patients were treated with DNVr plus sofosbuvir ± ribavirin for 12 weeks and then followed up for 12 weeks. The primary endpoint was the rate of sustained virologic response at week 12 after the end of treatment (SVR12). The secondary endpoint was virologic response rate at end-of-treatment and adverse event outcome.Of the 58 patients who were enrolled, 5.2% (n = 3) had genotype 1a; 43.1% (n = 25) had HCV genotype 1b; 17.2% (n = 10) had genotype 2a; 5.2% (n = 3) had genotype 3a; 8.6% (n = 5) had genotype 3b; and 20.7% (n = 12) had genotype 6a. The virologic response rate at end-of-treatment was 100% (58/58). The HCV-RNA results of 5 patients were absent at week 12 after treatment. Among the 53 patients, SVR12 rate achieved 100% (53/53) with DNVr plus sofosbuvir ± ribavirin treatment in patients with HCV genotype 1b, 2a, 3, and 6a. For compensated cirrhosis and noncirrhosis patients, SVR12 was 100% with DNVr plus sofosbuvir ± ribavirin treatment. No serious event was observed during the treatment and follow-up. Only 5 patients had mild adverse events.DNVr plus sofosbuvir ± ribavirin for 12 weeks provided 100% SVR12 in a broad patient population and were well tolerated, which may be a promising regimen for CHC treatment.
Collapse
Affiliation(s)
- Shufang Pan
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University
| | - Kai Feng
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University
| | - Ping Huang
- Department of Infectious Diseases, The People's Hospital of Lianjiang, Guangdong Province
| | - Yingfu Zeng
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University
| | - Liu Ke
- Liuzhou People's Hospital, Liuzhou, Guangxi
| | | | - Jing Liu
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University
| | - Chaoshuang Lin
- Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-Sen University
| |
Collapse
|
17
|
Chen P, Jin M, Cao Y, Li H. Cost-Effectiveness Analysis of Oral Direct-Acting Antivirals for Chinese Patients with Chronic Hepatitis C. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:371-387. [PMID: 33210262 DOI: 10.1007/s40258-020-00623-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/29/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE All oral direct-acting antivirals (DAAs) have shown excellent efficacy and safety in Chinese patients with chronic hepatitis C (CHC). However, the cost of DAAs used to be expensive; therefore, large numbers of patients had no access to DAAs in China. Recently, prices have been greatly reduced. The objective of this study was to evaluate the cost-effectiveness of ledipasvir/sofosbuvir (LDV/SOF), sofosbuvir/velpatasvir (SOF/VEL), elbasvir/grazoprevir (EBR/GZR) and glecaprevir/pibrentasvir (GLE/PIB) in Chinese CHC patients stratified by hepatitis C virus (HCV) genotype (GT), cirrhosis status, and treatment history. METHODS On the basis of a Chinese healthcare perspective, a Markov model was constructed to estimate the lifetime costs and health outcomes of patients treated with different DAA regimens. Chinese-specific clinical, cost, and utility inputs were obtained or calculated from published sources and expert opinions. Costs, life-years (LYs), quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were reported as primary outcomes. Base-case analysis and sensitivity analysis were conducted. RESULTS At a willing-to-pay (WTP) threshold of US$30,081/QALY (calculated by three times the GDP per capita in China), SOF/VEL was cost-effective in patients with HCV GT 1, 3, and 6 infections, and the probabilities that SOF/VEL was cost-effective were 9.7-75.7%, 39.1-63.9%, and 35.6-88.0%, respectively. For GT2 patients, noncirrhotic patients, treatment-naïve patients, and treatment-experienced patients, LDV/SOF was the most cost-effective regimen, and the probabilities of cost-effectiveness for each of these groups was 92.1-99.8%, 89.9-99.0%, 61.6-91.2%, and 99.3-100.0%, respectively below the WTP threshold. The GLE/PIB regimen (12-week duration) was the most cost-effective in cirrhotic patients, whereas the probability of its cost-effectiveness varied with that of EBR/GZR (4.1-93.8% versus 6.2-93.3%) below the WTP threshold. CONCLUSIONS Overall, SOF/VEL and LDV/SOF regimens are more likely to be cost-effective among various subgroups of Chinese patients with CHC.
Collapse
Affiliation(s)
- Pingyu Chen
- Department of Health Economics, China Pharmaceutical University, Nanjing, China
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China
| | - Min Jin
- Department of Health Economics, China Pharmaceutical University, Nanjing, China
| | - Yang Cao
- Department of Health Economics, China Pharmaceutical University, Nanjing, China
| | - Hongchao Li
- Department of Health Economics, China Pharmaceutical University, Nanjing, China.
- Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, Nanjing, China.
| |
Collapse
|
18
|
Qi M, Yang M, Xu L, Ma C, Huang P, Sun J, Shi J, Hu Y. Complete genome analysis identifies recombinant events and positive selection sites of hepatitis C virus from mainland China during 2010-2019. Virus Res 2021; 296:198354. [PMID: 33639223 DOI: 10.1016/j.virusres.2021.198354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022]
Abstract
Identification of new recombinant HCV strains and positive selection sites are crucially important for the formulation of virus intervention measures. However, little is known about the recombinant variant information and positive selection sites of circulating HCV strains in mainland China. In this study, we systematically identified recombinant variants and positive selection sites of HCV in mainland China during the 2010-2019. Phylogenetic analysis results indicated that HCV-6 was one of the dominant genotypes in mainland China during 2010-2019, whereas genotypes 7 and 8 were not detected. Recombinant analysis based on 102 full-length genome sequences of Chinese epidemic strains of HCV identified four intra-genotypic recombinants (strains WYHCV286, GB28, GZ2983, and HCV156) and one inter-genotypic recombinant (strain HH075). Specifically, two breakpoints in the 5' UTR of two recombinants, the strains HH075 and WYHCV286, are rather unusual and has not been described before. Further, selection pressure analyses revealed five positive selective sites, which were located in the core, E2, and NS5B protein. Notably, positive selective sites in NS5B and core protein may be partially responsible for the drug resistance and immune evasion. To the best of our knowledge, this study firstly reported five specific intertypic and intratypic recombinants of Chinese epidemic strains of HCV, which highlight their significance for anti-HCV treatment and vaccine development.
Collapse
Affiliation(s)
- Mengdi Qi
- Kunming Medical University, Kunming, Yunnan, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan, China
| | - Mengmei Yang
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan, China
| | - Liangzi Xu
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan, China
| | - Chunli Ma
- Kunming Medical University, Kunming, Yunnan, China; Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan, China
| | - Pu Huang
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan, China
| | - Jing Sun
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan, China
| | - Jiandong Shi
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan, China.
| | - Yunzhang Hu
- Yunnan Provincial Key Laboratory of Vector-borne Diseases Control and Research, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, Yunnan, China.
| |
Collapse
|
19
|
Wei L, Jia JD, Duan ZP, Wang FS, Niu JQ, Xie W, Huang WX, Zhang MX, Huang Y, Wang MR, Wu SM, Zhao YR, Jia ZS, Zhao XM, Mu SM, Liang LW, Wang Z, Puenpatom A, Hwang P, Robertson MN, Ingravallo P, Asante‐Appiah E, Wei B, Evans B, Hanna GJ, Talwani R. Efficacy and safety of elbasvir/grazoprevir in treatment-naive Chinese adults with hepatitis C virus infection: A randomized trial. JGH Open 2020; 4:1065-1073. [PMID: 33319038 PMCID: PMC7731814 DOI: 10.1002/jgh3.12387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIM In China, clinical experience with direct-acting antiviral treatments for hepatitis C virus (HCV) infection is still emerging. C-CORAL is a phase 3, multinational, placebo-controlled, double-blind trial of elbasvir/grazoprevir (EBR/GZR) in participants with HCV infection from the Asia-Pacific region and Russia. Here, we report the data from participants enrolled in China. METHODS Treatment-naive participants with chronic HCV genotype (GT) 1, GT4, or GT6 infection were randomly assigned to receive 50 mg EBR/100 mg GZR for 12 weeks (immediate-treatment group, ITG) or placebo followed by deferred treatment with EBR/GZR (deferred-treatment group, DTG). The primary efficacy end-point was sustained virologic response at 12 weeks after completing treatment (SVR12), and the primary safety end-point was a comparison of safety between participants receiving EBR/GZR and placebo (NCT02251990; Protocol PN-5172-067). RESULTS A total of 152 participants in China were randomly assigned (ITG, n = 115; DTG, n = 37). SVR12 was achieved in 96.7% (146/151) participants overall and in 97.3% (142/146) of those with GT1b infection. Four participants relapsed (GT1b, n = 3; GT6a, n = 1). Drug-related AEs were reported in 25 (21.7%) and 9 (24.3%) participants receiving EBR/GZR and placebo, respectively; no drug-related serious adverse events (AEs) occurred. Two (1.7%) participants receiving EBR/GZR had late hepatic transaminase elevations. Patient-reported outcomes indicate improved quality of life at follow-up week 4 in participants receiving EBR/GZR compared to placebo. CONCLUSION EBR/GZR administered for 12 weeks represents a highly effective and safe treatment option for Chinese individuals with HCV GT1 infection.
Collapse
Affiliation(s)
- Lai Wei
- Beijing Key Laboratory for Hepatitis C and Immunotherapy for Liver DiseasePeking University People's Hospital, Peking University Hepatology InstituteBeijingChina
| | - Ji Dong Jia
- Beijing Key Laboratory of Translational Medicine on Cirrhosis, National Clinical Research Center for Digestive DiseasesLiver Research Center, Beijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Zhong Ping Duan
- Artificial Liver CenterBeijing YouAn Hospital, Capital Medical UniversityBeijingChina
| | - Fu Sheng Wang
- Treatment and Research Center for Infectious DiseasesBeijing 302 HospitalBeijingChina
| | - Jun Qi Niu
- Department of HepatologyFirst Hospital, Jilin UniversityChangchunChina
| | - Wen Xie
- Center of Liver DiseasesBeijing Ditan Hospital, Capital Medical UniversityBeijingChina
| | - Wen Xiang Huang
- Division of MicrobiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Ming Xiang Zhang
- Department of Integrated Traditional and Western Medicine on Liver DiseasesThe Sixth People's Hospital of ShenyangShenyangChina
| | - Yan Huang
- Department of Infectious DiseasesHunan Key Laboratory of Viral Hepatitis, Xiangya Hospital, Central South UniversityChangshaChina
| | - Mao Rong Wang
- Center of Liver DiseaseThe 81st Hospital of PLANanjingChina
| | - Shan Ming Wu
- Department of Infectious DiseasesShanghai Public Health CenterShanghaiChina
| | - Ying Ren Zhao
- Department of Infectious DiseaseFirst Affiliated Hospital of Medicine College, Xi'an Jiaotong UniversityXi'anChina
| | - Zhan Sheng Jia
- Center of Infectious DiseasesTangdu Hospital, Fourth Military Medical UniversityXi'anChina
| | - Xu Min Zhao
- Department of Infectious DiseasesMSDChinaBeijing
| | - Sheng Mei Mu
- Department of Infectious DiseasesMSDChinaBeijing
| | - Li Wen Liang
- Department of Infectious DiseasesMSDChinaBeijing
| | - Zaiqi Wang
- Department of Infectious DiseasesMSDChinaBeijing
| | - Amy Puenpatom
- Department of Infectious DiseasesMerck & Co., Inc.KenilworthNew JerseyUSA
| | - Peggy Hwang
- Department of Infectious DiseasesMerck & Co., Inc.KenilworthNew JerseyUSA
| | | | - Paul Ingravallo
- Department of Infectious DiseasesMerck & Co., Inc.KenilworthNew JerseyUSA
| | | | - Bo Wei
- Department of Infectious DiseasesMerck & Co., Inc.KenilworthNew JerseyUSA
| | - Barbara Evans
- Department of Infectious DiseasesMerck & Co., Inc.KenilworthNew JerseyUSA
| | - George J. Hanna
- Department of Infectious DiseasesMerck & Co., Inc.KenilworthNew JerseyUSA
| | - Rohit Talwani
- Department of Infectious DiseasesMerck & Co., Inc.KenilworthNew JerseyUSA
| |
Collapse
|
20
|
Ma Z, Sun Y, Du P, Li X. Association between inosine triphosphatase rs1127354 polymorphisms and ribavirin-induced anaemia and outcome in hepatitis C virus-infected patients: A meta-analysis. J Clin Pharm Ther 2020; 45:1218-1227. [PMID: 32735044 DOI: 10.1111/jcpt.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/15/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES The association between inosine triphosphatase (ITPA) rs1127354 polymorphisms in HCV-infected patients receiving ribavirin (RBV)-based therapy, and the risk of adverse drug reaction and outcomes is still unclear. A meta-analysis was conducted to summarize and clarify this association systematically. METHODS A comprehensive search was performed in PubMed, Embase and Web of Sciences, and twenty-two studies were selected from the literature search. Pooled odds ratio (OR) and 95% confidence interval (95% CI) were estimated by either fixed- or random-effects models. RESULTS Four outcomes were evaluated: (a) haemoglobin decline: significant associations with haemoglobin decline were found for rs1127354 CC VS CA + AA (OR = 10.59, 95% CI = 6.39-17.54); (b) severe anaemia: significant association with severe anaemia was observed for rs1127354 CC VS CA + AA (OR = 16.24, 95% CI = 6.21-42.43); (c) sustained virological response (SVR): CC genotype carriers had a decrease SVR during treatment (OR = 0.65, 95% CI = 0.52-0.81); (d) RBV dose reduction or stopping treatment: although statistical evidence of an association was found between the polymorphism and RBV dose reduction during treatment (OR = 1.80, 95% CI = 1.03-3.13), the sensitivity analysis suggested this result was not robust. WHAT IS NEW AND CONCLUSION Patients with ITPA rs1127354 CC polymorphism are more likely to develop haemolytic anaemia, severe anaemia and decreased SVR. Testing for this genetic polymorphism may benefit patients.
Collapse
Affiliation(s)
- Zhichao Ma
- Department of Pharmacy, Affiliated Hospital of Chifeng University, Chifeng, China
| | - Yi Sun
- Department of Pharmacy, Affiliated Hospital of Chifeng University, Chifeng, China
| | - Pengqiang Du
- Department of Pharmacy, Fuwai Central China Cardiovascular Hospital, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, China
| | - Xingang Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
21
|
Li C, Liang J, Xiang H, Chen H, Tian J. Effectiveness of direct-acting antivirals in maintenance hemodialysis patients complicated with chronic hepatitis C. Medicine (Baltimore) 2020; 99:e23384. [PMID: 33235113 PMCID: PMC7710190 DOI: 10.1097/md.0000000000023384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/21/2020] [Accepted: 10/29/2020] [Indexed: 11/28/2022] Open
Abstract
Hepatitis C virus (HCV) infection is very common in maintenance hemodialysis patients, causing high morbidity and mortality. This study aimed to evaluate the effectiveness and adverse events of direct-acting antivirals (DAAs) in maintenance hemodialysis patients complicated with chronic hepatitis C in real-world clinical practice.In this retrospective observational study, hemodialysis patients with chronic hepatitis C infection in the Third Central Hospital of Tianjin outpatient were screened, and appropriate treatment plans were selected accordingly. Totally 25 patients diagnosed with chronic hepatitis C and treated with DAAs for 12 weeks or 24 weeks were included. The sustained virologic response (SVR) rate obtained 12 weeks post-treatment (SVR12) was evaluated. Laboratory indexes and adverse reactions during the treatment process were also assessed.A total of 25 cases met the eligibility criteria and provided informed consent. Except for 1 patient who discontinued the treatment due to gastrointestinal bleeding, the remaining 24 cases completed the treatment cycle with 100% rapid virologic response (RVR) and 100% SVR12, with no serious adverse reactions recorded.Maintenance hemodialysis patients complicated with chronic hepatitis C in Chinese real-world setting tolerate DAAs very well, with a viral response rate reaching 100%.
Collapse
Affiliation(s)
- Chunhong Li
- Depatrment of Nephrology, The Third Central Clinical College of Tianjin Medical University
- Department of Nephrology, The Third Central Hospital of Tianjin
| | - Jing Liang
- Depatrment of Nephrology, The Third Central Clinical College of Tianjin Medical University
- Department of Nephrology, The Third Central Hospital of Tianjin
| | - Huiling Xiang
- Department of Nephrology, The Third Central Hospital of Tianjin
| | - Haiyan Chen
- Department of Blood Purification Center, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jie Tian
- Department of Nephrology, The Third Central Hospital of Tianjin
| |
Collapse
|
22
|
Impact of hepatitis C virus genotype 3 on liver disease progression in a Chinese national cohort. Chin Med J (Engl) 2020; 133:253-261. [PMID: 31934936 PMCID: PMC7004615 DOI: 10.1097/cm9.0000000000000629] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Supplemental Digital Content is available in the text Background: Hepatitis C virus (HCV) genotype 3, particularly subtype 3b, is increasing in prevalence and distribution in China. This study evaluated the prevalence, regional distribution, clinical characteristics, host factors, treatment outcomes, and disease progression of patients with HCV genotype 3 in China. Methods: A 5-year follow-up was preceded by a cross-sectional study. Treatment choices were at the discretion of treating physicians. Estimated infection time to overall-disease-progression (defined by ≥1 of: newly diagnosed cirrhosis; cirrhosis at baseline, Child-Turcotte-Pugh score increased 2 points or more; progression from compensated cirrhosis to decompensated cirrhosis; hepatocellular carcinoma; liver transplantation; or death) was calculated using the Kaplan-Meier method. Cox regression analyses were conducted to evaluate the risk factors for disease progression. Results: The cross-sectional study enrolled 997 patients, including 91 with HCV genotype 3 infection. Among them, subtype 3b (57.1%) was more dominant than subtype 3a (38.5%). Five hundred and twelve patients were included into the follow-up phase. Among patients analyzed for estimated infection time to overall-disease-progression, 52/304 (17.1%) patients with HCV genotype 1 and 4/41 (9.8%) with HCV genotype 3 (4/26 with genotype 3b, 0/13 with genotype 3a, and 0/2 with undefined subtype of genotype 3) experienced overall-disease-progression. Patients with HCV genotype 3 were younger than those with genotype 1 (mean age: 39.5 ± 8.7 vs. 46.9 ± 13.6 years) and demonstrated more rapid disease progression (mean estimated infection time to overall-disease-progression 27.1 vs. 35.6 years). Conclusions: HCV genotype 3, specifically subtype 3b, is associated with more rapid progression of liver disease. Further analysis to compare HCV subtype 3a and 3b is needed in high prevalence regions. Trial registration: NCT01293279, https://clinicaltrials.gov/ct2/show/NCT01293279; NCT01594554, https://clinicaltrials.gov/ct2/show/NCT01594554.
Collapse
|
23
|
Gao Y, Kong F, Li G, Li C, Zheng S, Lin J, Wen X, Hu J, Wang X, Wu X, Xing H, Jia J, Jia Z, Guan Y, Li C, Wu G, Gao Z, Mou Z, Ning Q, Mao Q, Yang Y, Ning J, Li L, Pan H, Zhou D, Ding Y, Qin H, Niu J. Coblopasvir and sofosbuvir for treatment of chronic hepatitis C virus infection in China: A single-arm, open-label, phase 3 trial. Liver Int 2020; 40:2685-2693. [PMID: 33047868 PMCID: PMC7702130 DOI: 10.1111/liv.14633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/26/2020] [Accepted: 07/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIM An affordable, pangenotypic regimen remains as an unmet medical need for chronic hepatitis C patients in China. This single-arm, open-label, multicenter, phase 3 trial evaluated the efficacy and safety of coblopasvir, a pangenotypic non-structural protein 5A (NS5A) inhibitor, combined with sofosbuvir for treating Chinese patients with chronic hepatitis C virus (HCV) infection. METHODS Treatment-naïve and interferon-experienced adult patients, including those with advanced fibrosis (F3) or compensated cirrhosis (F4), were treated with a universal, combinational regimen of coblopasvir 60 mg and sofosbuvir 400 mg, once daily, for 12 weeks. The primary efficacy endpoint was sustained virological response at post-treatment week 12 (SVR12). RESULTS Overall, 371 patients (men, 51%; age, 47 ± 11 years; genotype 1a < 1%, 1b 48%, 2a 26%, 3a 6%, 3b 7% and 6 12%) were enrolled from 19 sites. Fifty-one patients (14%) had F3, 39 patients (11%) had F4 and 39 patients (11%) were interferon experienced. The overall SVR12 was 97% (95% CI, [94%, 98%]) for the full analysis set and was equal to or above 90% for all predefined subsets. Ten patients (3%) experienced virological relapse and two patients did not complete follow-up. No adverse events (AEs) occurred at a frequency ≥5%, and the most often reported AEs (≥1%) were neutropenia and fatigue. The majority of AEs were mild to moderate and transient without specific medical intervention. CONCLUSIONS The universal, pangenotypic combo of coblopasvir plus sofosbuvir is an efficacious and safe treatment for Chinese patients monoinfected with HCV of genotype 1, 2, 3 and 6, including those with compensated cirrhosis. LAY SUMMARY The regimen of coblopasvir and sofosbuvir is a safe and effective treatment for Chinese patients with genotype 1, 2, 3 and 6 HCV infection, including those with compensated cirrhosis. Therefore, this regimen would be a novel choice of treatment for this patient population.
Collapse
Affiliation(s)
- Yanhang Gao
- Department of Hepatologythe First Hospital of Jilin UniversityChangchunChina
| | - Fei Kong
- Department of Hepatologythe First Hospital of Jilin UniversityChangchunChina
| | - Guangming Li
- Cirrhosis DepartmentZhengzhou Sixth Municipal People’s HospitalZhengzhouHenanChina
| | - Cheng Li
- Cirrhosis DepartmentZhengzhou Sixth Municipal People’s HospitalZhengzhouHenanChina
| | - Sujun Zheng
- Difficult & Complicated Liver Diseases and Artificial Liver CenterBeijing You An HospitalCapital Medical UniversityBeijingChina
| | - Jianmei Lin
- Department of Infectious DiseasesSichuan Provincial People’s HospitalChengduSichuanChina
| | - Xiaofeng Wen
- Department of HepatologyLiuzhou People’s HospitalLiuzhouChina
| | - Jinghua Hu
- Liver Failure Treatment and Research Centerthe Fifth Medical Center of PLA General HospitalBeijingChina
| | - Xiaozhong Wang
- Department of HepatologyXinjiang Uygur Autonomous Region Traditional Chinese Medicine HospitalUrumqiXinjiangChina
| | - Xiaofeng Wu
- Department of HepatologyShenyang Sixth People’s HospitalShenyang, LiaoningChina
| | - Huichun Xing
- Department of Hepatology Division 3Beijing Ditan HospitalCapital Medical UniversityBeijingChina
| | - Jidong Jia
- Liver Research CenterBeijing Youyi Hospital Affiliated to Capital Medical UniversityBeijingChina
| | - Zhansheng Jia
- Department of Infectious Diseasesthe Second Affiliated Hospital of People’s Liberation Army Air Force Medical UniversityXi’an, ShaanxiChina
| | - Yujuan Guan
- Department of HepatologyGuangzhou Eighth People’s HospitalGuangzhouChina
| | - Chenghao Li
- Department of GastroenterologyYanbian University Affiliated HospitalYanjiJilinChina
| | - Guicheng Wu
- Department of HepatologyChongqing University Three Gorges HospitalChongqing Three Gorges Central HospitalWanzhou, ChongqingChina
| | - Zhiliang Gao
- Department of Infectious Diseasesthe Third Affiliated Hospital of Dr Sun Yat‐Sen UniversityGuangzhouGuangdongChina
| | - Zhuangbo Mou
- Department of HepatologyJi’nan Municipal Hospital of Infectious DiseasesJi’nan, ShandongChina
| | - Qin Ning
- Department of Infectious DiseasesTongji Hospital Affiliated to Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanHubeiChina
| | - Qing Mao
- Institute of Infectious Diseasesthe First Affiliated Hospital of People’s Liberation Army Medical UniversityChongqingChina
| | - Yongfeng Yang
- Department of HepatologyNanjing Second Municipal HospitalNanjingChina
| | - Jing Ning
- Research and Development CenterBeijing Kawin Technology Share‐Holding Co., LtdBeijingChina
| | - Li Li
- Research and Development CenterBeijing Kawin Technology Share‐Holding Co., LtdBeijingChina
| | - Hai Pan
- Research and Development CenterBeijing Kawin Technology Share‐Holding Co., LtdBeijingChina
| | - Desheng Zhou
- Research and Development CenterBeijing Kawin Technology Share‐Holding Co., LtdBeijingChina
| | - Yanhua Ding
- The Department of Phase I Clinical Trialthe First Hospital of Jilin UniversityChangchun, JilinChina
| | - Hong Qin
- Research and Development CenterBeijing Kawin Technology Share‐Holding Co., LtdBeijingChina
- Present address:
Clinical DevelopmentHangzhou Sciwind Biosciences Co., LtdHangzhouZhejiangChina
| | - Junqi Niu
- Department of Hepatologythe First Hospital of Jilin UniversityChangchunChina
| |
Collapse
|
24
|
Mei YY, Chen YM, Wu YK, Zhang XH, Xu WX. Efficacy and Safety of Sofosbuvir-Based Direct-Acting Antiviral Agents Treatment for Patients with Genotype 3/6 Hepatitis C Virus Infection. Can J Gastroenterol Hepatol 2020; 2020:8872120. [PMID: 33194875 PMCID: PMC7648714 DOI: 10.1155/2020/8872120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023] Open
Abstract
Aims The aim is to evaluate the efficacy and safety of Sofosbuvir- (SOF-) based direct-acting antiviral agents (DAAs) treatment for patients with genotype (GT) 3/6 hepatitis C virus (HCV) infection. Methods Patients infected with GT 3/6 HCV and treated with SOF-based DAAs were enrolled in this prospective, open, single-center, and real-world study. Drugs included Sofosbuvir (SOF), Velpatasvir (VEL), Daclatasvir (DCV), and Ribavirin (RBV). The treatment regimens included SOF + RBV for 24 weeks, SOF + DCV ± RBV for 12/24 weeks, and SOF/VEL ± RBV for 12 weeks. Results A total of 54 patients were included. Age was 42.5 ± 10.4 years. Baseline HCV RNA was 6.29 ± 0.89log10 IU/mL. The numbers of GT 3a, 3b, and 6a patients were 10, 12, and 32, respectively. The numbers of chronic hepatitis, compensated cirrhosis, and decompensated cirrhosis patients were 39, 9, and 6, respectively. In patients with chronic hepatitis C and liver cirrhosis, sustained virological response 12 weeks after the end of treatment (SVR12) was 97.4% and 96.7%, respectively, and rapid virological response (RVR) was 75.0% and 57.1%, respectively. SVR12 of GT3a, GT3b, and GT6a was 100%, 83.3%, and 97%, respectively. ALT normality rate in chronic hepatitis group is higher than that in cirrhosis group at 4 weeks of treatment (89.7% versus 60.0%, p = 0.033) and at 12 weeks after EOT (94.9% versus 66.7%, p = 0.021). The overall incidence rate of adverse events was 44.4%, with fatigue being the most common (13.0%). Conclusion SOF-based DAAs regimen can achieve ideal SVR12 for Chinese patients with both GT3a and GT6a HCV infection. The tolerance and safety of SOF-based DAAs regimen are good.
Collapse
Affiliation(s)
- Yong-yu Mei
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
- Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
| | - You-ming Chen
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
- Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
| | - Yuan-kai Wu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
- Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
| | - Xiao-hong Zhang
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
- Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
| | - Wen-xiong Xu
- Department of Infectious Diseases, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
- Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou 510630, Guangdong, China
| |
Collapse
|
25
|
Rao H, Xie Q, Shang J, Gao Z, Chen H, Sun Y, Jiang J, Niu J, Zhang L, Wang L, Zhao L, Li J, Yang R, Zhu S, Li R, Wei L. Real-world clinical outcomes among individuals with chronic HCV infection in China: CCgenos study. Antivir Ther 2020; 24:473-483. [PMID: 31566575 DOI: 10.3851/imp3334] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND This 5-year follow-up of the CCgenos cross-sectional study aimed to observe real-life outcomes in a cohort of 997 Han Chinese patients with chronic HCV infection and to explore the impacts of HCV genotype, patient characteristics and treatment status. METHODS Clinical information and centralized HCV RNA measures were collected every 6/3 months for untreated/treated patients. Overall disease progression was defined as ≥1 of: de novo development of cirrhosis, Child-Turcotte-Pugh score increased by ≥2 points (if cirrhosis at baseline), progression to decompensated cirrhosis, hepatocellular carcinoma (HCC), liver transplant or death. Cox regression assessed risk factors for the time from estimated infection to cirrhosis or HCC. Logistic regression assessed risk factors for incidence rates of cirrhosis and overall disease progression. RESULTS 281 of 514 patients enrolled across China completed 5 years of follow-up. Overall disease progression occurred in 36/364 (9.9%) treated patients and 35/148 (23.6%) untreated patients (odds ratio = 0.35; 95% CI 0.21, 0.59; P<0.0001). Overall disease progression occurred in 6/231 (2.6%) patients achieving sustained virological response at 24 weeks (SVR24) versus 11/82 (13.4%) who did not (P=0.0002). Cirrhosis development was significantly associated with abnormal aspartate aminotransferase (AST), age ≥40 years, body mass index ≥28 kg/m2, HCV GT1, platelet count <100×109/l, and AST to platelet ratio index (APRI) ≥2 (multivariate Cox regression, P<0.05). HCC was significantly associated with HCV GT1 and platelet count <100×109/l (multivariate Cox regression, P<0.05). CONCLUSIONS Achieving SVR24 significantly reduced the probability of overall disease progression but no significant difference was seen for both cirrhosis and HCC during 5 years of follow-up.
Collapse
Affiliation(s)
- Huiying Rao
- Peking University Hepatology Institute, Beijing Key Laboratory for Hepatitis C and Immunotherapy for Liver Disease, Peking University People's Hospital, Beijing, China
| | - Qing Xie
- Shanghai Ruijin Hospital, Jiaotong University School of Medicine, Shanghai, China
| | - Jia Shang
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Zhiliang Gao
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hong Chen
- The First Affiliated Hospital of Lanzhou University, Lanzhou, China
| | | | - Jianning Jiang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junqi Niu
- The First Hospital of Jilin University, Changchun, China
| | - Lunli Zhang
- The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lei Wang
- The Second Hospital of Shandong University, Jinan, China
| | - Longfeng Zhao
- The First Affiliated Hospital of Shanxi Medical University, Taiyuan, China
| | - Jun Li
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ruifeng Yang
- Peking University Hepatology Institute, Beijing Key Laboratory for Hepatitis C and Immunotherapy for Liver Disease, Peking University People's Hospital, Beijing, China
| | - Siyun Zhu
- Bristol-Myers Squibb, Shanghai, China
| | - Runqin Li
- Bristol-Myers Squibb, Shanghai, China
| | - Lai Wei
- Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| |
Collapse
|
26
|
Rao H, Yang X, Tan Y, Ning Q, Yang D, Wang J, Yang Y, Zheng S, Yang D, Hou J, Xie Q, Zhao C, Zhang L, Mao X, Sun T, Bai L, Zhang F, Jin J, Zhao Y, Wang M, Xie W, Ma Y, Quan J, Yan X, An P, Lin F, Jia J, Hu X, Gong Z, Wu J, Chen Y, Jia Z, Lin M, Wang G, Zhu Y, Zhang Y, Xie H, Luo L, Ren Q, Huang R, Wei L. Efficacy and Safety of All-oral Emitasvir and Sofosbuvir in Patients with Genotype 1b HCV Infections without Cirrhosis. J Clin Transl Hepatol 2020; 8:255-261. [PMID: 33083247 PMCID: PMC7562795 DOI: 10.14218/jcth.2020.00031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/05/2020] [Accepted: 08/12/2020] [Indexed: 02/05/2023] Open
Abstract
Background and Aims: Emitasvir is a new type of hepatitis C virus (HCV) nonstructural protein 5A (NS5A) inhibitor, and the data of phase 2 trial has shown emitasvir-sofosbuvir to have good safety and tolerance. We conducted this phase 3 trial to further verify the efficacy and safety. Methods: We evaluated the antiviral activity and safety of a 12-week regimen of emitasvir phosphate (100 mg) combined with sofosbuvir (400 mg) once daily in non-cirrhotic patients with genotype 1 HCV infection. The primary endpoint was a sustained virological response at 12 weeks (SVR12) after the end of treatment. Results: Of the 362 patients enrolled in the trial, 39.8% were male, 99.2% had HCV genotype 1b, 0.8% had genotype 1a and 79.8% were treatment-naïve. The average age was 47.2 years. All patients completed the treatment and follow-up. All 3 patients with genotype 1a achieved SVR. Two genotype 1b treatment-naïve patients experienced virologic relapse. The rate of SVR12 was 99.7% (358/359), and SVR24 was 99.4% (357/359) in genotype 1b. Overall, 36.2% had resistance-associated substitutions (RASs) in NS5A and 98.3% had RASs in NS5B at baseline. The RASs at baseline had no effect on the rates of response. Serious adverse events were reported in 16 patients and were not related to emitasvir-sofosbuvir. Most adverse events did not require therapy. Conclusions: The 12 weeks of treatment with emitasvir-sofosbuvir was a highly efficient and safe treatment for a wide range of patients with HCV genotype 1b infection without cirrhosis, who had not been treated or who had been treated with interferon-based regimen previously.
Collapse
Affiliation(s)
- Huiying Rao
- Peking University People’s Hospital, Peking University Hepatology Institute, National Clinical Research Center for Infectious Disease, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China
| | - Xingxiang Yang
- Department of Infectious Diseases, Sichuan Provincial People’s Hospital, Chengdu, Sichuan, China
| | - Youwen Tan
- Department of Hepatology, The Third People’s Hospital of Zhenjiang, Zhenjiang, Jiangsu, China
| | - Qin Ning
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Daokun Yang
- Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical College, Xinxiang, Henan, China
| | - Jiefei Wang
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Yongfeng Yang
- Department of Hepatology, The Second Hospital of Nanjing, Nanjing, Jiangsu, China
| | - Sujun Zheng
- Center of Artificial liver, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Dongliang Yang
- Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jinlin Hou
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Caiyan Zhao
- Department of Infectious Diseases, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lunli Zhang
- Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaorong Mao
- Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Tong Sun
- Department of Infectious Diseases, Wuxi Fifth People’s Hospital, Wuxi, Jiangsu, China
| | - Lang Bai
- Infectious Diseases Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fuchun Zhang
- Department of Hepatology, Guangzhou Eighth People’s Hospital, Guangzhou, Guangdong, China
| | - Jinglan Jin
- Department of Hepato-Biliary-Pancreatic Diseases, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yingren Zhao
- Department of Infectious Diseases, Xi’an Jiaotong University First Affiliated Hospital, Xi’an, Shaanxi, China
| | - Maorong Wang
- Department of Infectious Diseases, DiBaYi Hospital of the Chinese People’s Liberation Army, Nanjing, Jiangsu, China
| | - Wen Xie
- Hepatology Center, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Yingjie Ma
- Department of Infectious Diseases, Zhengzhou People’s Hospital, Zhengzhou, Henan, China
| | - Jun Quan
- Department of Infectious Diseases, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xuebing Yan
- Department of Infectious Diseases, Xuzhou Medical College Affiliated Hospital, Xuzhou, Jiangsu, China
| | - Ping An
- Department of Infectious Diseases, Shenyang Sixth People’s Hospital, Shenyang, Liaoning, China
| | - Feng Lin
- Department of Infectious Diseases, Hainan General Hospital, Haikou, Hainan, China
| | - Jidong Jia
- Hepatology Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoxuan Hu
- Department of Infectious Diseases, Hunan Provincial People’s Hospital, Changsha, Hunan, China
| | - Zuojiong Gong
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Jie Wu
- Department of Infectious Diseases, Wuhan central hospital, Wuhan, Hubei, China
| | - Yongping Chen
- Department of Infectious Diseases, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhansheng Jia
- Department of Infectious Diseases, Tangdu Hospital, The Fourth Military Medical University of the People’s Liberation Army, Xi’an, Shaanxi, China
| | - Minghua Lin
- Department of Hepatology, Meng Chao Hepatobiliary Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Guiqiang Wang
- Department of Infectious Diseases, Peking University First Hospital, Beijing, China
| | - Yueyong Zhu
- Department of Infectious Diseases, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Yingjun Zhang
- State Key Laboratory of Anti-Infective Drug Development (NO.2015DQ780357), Sunshine Lake Pharma Co., Ltd, Dongguan, Guangdong, China
- Correspondence to: Lai Wei, Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168, Litang Road, Changping District, Beijing 102218, China. Tel: +86-10-56118881, Fax: +86-10-56118500, E-mail: ; Yingjun Zhang, State Key Laboratory of Anti-Infective Drug Development (NO. 2015DQ780357), Sunshine Lake Pharma Co., Ltd., No. 368, Zhen’an Road, Chang’an Town, Dongguan, Guangdong 523871, China. Tel: +86-769-88615888-2337, Fax: +86-769-85370222-2337, E-mail:
| | - Hongming Xie
- State Key Laboratory of Anti-Infective Drug Development (NO.2015DQ780357), Sunshine Lake Pharma Co., Ltd, Dongguan, Guangdong, China
| | - Lin Luo
- State Key Laboratory of Anti-Infective Drug Development (NO.2015DQ780357), Sunshine Lake Pharma Co., Ltd, Dongguan, Guangdong, China
| | - Qingyun Ren
- State Key Laboratory of Anti-Infective Drug Development (NO.2015DQ780357), Sunshine Lake Pharma Co., Ltd, Dongguan, Guangdong, China
| | - Rui Huang
- Peking University People’s Hospital, Peking University Hepatology Institute, National Clinical Research Center for Infectious Disease, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing International Cooperation Base for Science and Technology on NAFLD Diagnosis, Beijing, China
| | - Lai Wei
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
- Correspondence to: Lai Wei, Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168, Litang Road, Changping District, Beijing 102218, China. Tel: +86-10-56118881, Fax: +86-10-56118500, E-mail: ; Yingjun Zhang, State Key Laboratory of Anti-Infective Drug Development (NO. 2015DQ780357), Sunshine Lake Pharma Co., Ltd., No. 368, Zhen’an Road, Chang’an Town, Dongguan, Guangdong 523871, China. Tel: +86-769-88615888-2337, Fax: +86-769-85370222-2337, E-mail:
| |
Collapse
|
27
|
Yun H, Zhao G, Sun X, Shi L. Cost-utility of sofosbuvir/velpatasvir versus other direct-acting antivirals for chronic hepatitis C genotype 1b infection in China. BMJ Open 2020; 10:e035224. [PMID: 32819983 PMCID: PMC7443302 DOI: 10.1136/bmjopen-2019-035224] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE This study aimed to estimate the cost-utility of sofosbuvir/velpatasvir (SOF/VEL) compared with other direct-acting antivirals (DAAs) in Chinese patients with hepatitis C virus (HCV). DESIGN A Markov model was developed to estimate the disease progression of patients with HCV over a lifetime horizon from the healthcare system perspective. Efficacy, clinical inputs and utilities were derived from the published literature. Drug costs were from the market price survey, and health costs for Markov health states were sourced from a Chinese study. Costs and utilities were discounted at an annual rate of 5%. One-way and probabilistic sensitivity analyses were conducted to test the impact of input parameters on the results. INTERVENTIONS SOF/VEL was compared with sofosbuvir+ribavirin (SR), sofosbuvir+dasabuvir (SD), daclatasvir+asunaprevir (DCV/ASV), ombitasvir/paritaprevir/ritonavir+dasabuvir (3D) and elbasvir/grazoprevir (EBR/GZR). PRIMARY AND SECONDARY OUTCOMES Costs, quality-adjusted life years (QALYs) and incremental cost-utility ratios (ICURs). RESULTS SOF/VEL was economically dominant over SR and SD. However, 3D was economically dominant compared with SOF/VEL. Compared with DCV/ASV, SOF/VEL was cost-effective with the ICUR of US$1522 per QALY. Compared with EBR/GZR, it was not cost-effective with the ICUR of US$369 627 per QALY. One-way sensitivity analysis demonstrated that reducing the cost of SOF/VEL to the lower value of CI resulted in dominance over EBR/GZR and 3D. Probabilistic sensitivity analysis demonstrated that 3D was cost-effective in 100% of iterations in patients with genotype (GT) 1b and SOF/VEL was not cost-effective. CONCLUSIONS Compared with other oral DAA agents, SOF/VEL treatment was not the most cost-effectiveness option for patients with chronic HCV GT1b in China. Lower the price of SOF/VEL will make it cost-effective while simplifying treatment and achieving the goal of HCV elimination.
Collapse
Affiliation(s)
- Haoya Yun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Guoqiang Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xiaojie Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| |
Collapse
|
28
|
Miao M, Jing X, De Clercq E, Li G. Danoprevir for the Treatment of Hepatitis C Virus Infection: Design, Development, and Place in Therapy. DRUG DESIGN DEVELOPMENT AND THERAPY 2020; 14:2759-2774. [PMID: 32764876 PMCID: PMC7368560 DOI: 10.2147/dddt.s254754] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
On June 8, 2018, an NS3/4A protease inhibitor called danoprevir was approved in China to treat the infections of HCV genotype (GT) 1b – the most common HCV genotype worldwide. Based on phase 2 and 3 clinical trials, the 12-week regimen of ritonavir-boosted danoprevir (danoprevir/r) plus peginterferon alpha-2a and ribavirin offered 97.1% (200/206) of sustained virologic response at post-treatment week 12 (SVR12) in treatment-naïve non-cirrhotic patients infected with HCV genotype 1b. Adverse events such as anemia, fatigue, fever, and headache were associated with the inclusion of peginterferon alpha-2a and ribavirin in the danoprevir-based regimen. Moreover, drug resistance to danoprevir could be traced to amino acid substitutions (Q80K/R, R155K, D168A/E/H/N/T/V) near the drug-binding pocket of HCV NS3 protease. Despite its approval, the clinical use of danoprevir is currently limited to its combination with peginterferon alpha-2a and ribavirin, thereby driving its development towards interferon-free, ribavirin-free regimens with improved tolerability and adherence. In the foreseeable future, pan-genotypic direct-acting antivirals with better clinical efficacy and less adverse events will be available to treat HCV infections worldwide.
Collapse
Affiliation(s)
- Miao Miao
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410078, People's Republic of China
| | - Xixi Jing
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410078, People's Republic of China
| | - Erik De Clercq
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, Leuven 3000, Belgium
| | - Guangdi Li
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha 410078, People's Republic of China
| |
Collapse
|
29
|
Efficacy and safety of direct-acting antiviral agent regimens in a real-world cohort of adult Chinese patients with chronic hepatitis C virus infection. LIVER RESEARCH 2020. [DOI: 10.1016/j.livres.2020.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
30
|
Khan A, Nadir A, Mushtaq MH, Junaid K, Khan AM, Ali H, Waqar F, Khan TA, Khan AA. Molecular epidemiology and genotype distribution of hepatitis C in Pakistan; a multicenter cross-sectional study. INFECTION GENETICS AND EVOLUTION 2020; 84:104372. [PMID: 32454246 DOI: 10.1016/j.meegid.2020.104372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 04/13/2020] [Accepted: 05/19/2020] [Indexed: 11/30/2022]
Abstract
Pakistan has second highest burden of hepatitis C virus (HCV) infected patients in the World. Little is known about the molecular epidemiology and risk factors for prevailing HCV genotypes in Pakistan. Considering this a multicenter cross-sectional study was conducted at 23different viral hepatitis control and prevention centers. A total of 175,897 patients were registered and screened for HCV, out of which 73,180 (41.6%) were found positive on Architect screening test. The screened positive patients were sequentially tested on RT-PCR; where 41,241 (56.35%) were detected positive. Molecular characterization results showed genotype 3 (73.9%) as the most prevalent type, followed by genotype 1 (9.7%), and genotype 4 (0.3%) was isolated for the first time in Pakistan. On regression analysis; risk factors associated with genotype 3 and 1 included; age group of 30-50 years, rural residence, exposure to >10 injections, barber shaving, circumcision by barbers, and low literacy rate. Phylogenetic analysis based on genotypes identified in this study and sequences isolated from Pakistan in last 10 years demonstrated that genotype 3 and 1 are endemic locally in Punjab province. The high prevalence rate of HCV is a threat for a generalized epidemic and genetic recombination with such variability of genotypes identified here is an alarming condition. More focused attention and resources should be spent in awareness of the population to prevent the spread of HCV among high risk population.
Collapse
Affiliation(s)
- Amjad Khan
- Department of Community Medicine, King Edward Medical University, Lahore 75500, Pakistan.
| | - Abdul Nadir
- Pakistan Kidney and liver institute and research center, Lahore, Pakistan
| | | | - Khunsa Junaid
- Department of Public Health, Institute of Social and Cultural Studies, University of Punjab, Lahore 75500, Pakistan
| | - Aabish Mehreen Khan
- Department of Community Medicine, King Edward Medical University, Lahore 75500, Pakistan
| | - Hassan Ali
- Department of Public Health, Institute of Social and Cultural Studies, University of Punjab, Lahore 75500, Pakistan
| | - Fatmee Waqar
- Department of Community Medicine, King Edward Medical University, Lahore 75500, Pakistan
| | - Taimoor Akram Khan
- Department of Community Medicine, King Edward Medical University, Lahore 75500, Pakistan
| | - Ali Akram Khan
- Department of Community Medicine, King Edward Medical University, Lahore 75500, Pakistan
| |
Collapse
|
31
|
Li C, Li X, Zhu X, Zhang H, Shen G, Kersey K, Ding Y. Pharmacokinetics, Safety, and Tolerability of Ledipasvir/Sofosbuvir and Sofosbuvir/Velpatasvir in Healthy Chinese Subjects. Clin Ther 2020; 42:448-457. [PMID: 32115243 DOI: 10.1016/j.clinthera.2020.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Ledipasvir/sofosbuvir and sofosbuvir/velpatasvir have been approved worldwide for the treatment of chronic hepatitis C virus (HCV) infection. Although both have been approved in China, there are currently no data on their pharmacokinetic profiles in Chinese individuals. Two studies investigated the pharmacokinetic properties, safety, and tolerability of ledipasvir/sofosbuvir and sofosbuvir/velpatasvir, respectively, in healthy Chinese subjects. METHODS Two Phase I, open-label, single- and multiple-dose studies were conducted in healthy Chinese subjects. Ledipasvir/sofosbuvir (90/400 mg) or sofosbuvir/velpatasvir (400/100 mg), respectively, was administered orally once daily under fasted conditions. Subjects received a single dose (day 1) and multiple doses (days 8-17 [ledipasvir/sofosbuvir]; days 8-14 [sofosbuvir/velpatasvir]). Plasma pharmacokinetic parameters were estimated by using noncompartmental models, and safety was assessed through clinical evaluation and monitoring of adverse events. FINDINGS Fourteen subjects were enrolled in each study (7 men, 7 women each; mean age, 30 years [ledipasvir/sofosbuvir] and 29 years [sofosbuvir/velpatasvir]). The pharmacokinetic parameters for sofosbuvir, GS-566500, GS-331007, and ledipasvir or velpatasvir were similar to historical values in non-Chinese subjects. Consistent with the t1/2 of ledipasvir relative to 24-h dosing, accumulation of 177% (AUC) and 107% (Cmax) was observed. There was no significant accumulation of velpatasvir, sofosbuvir, GS-566500, or GS-331007. Both drugs were generally well tolerated; no serious adverse events or discontinuations due to adverse events were reported. IMPLICATIONS Overall, ledipasvir/sofosbuvir and sofosbuvir/velpatasvir exhibited pharmacokinetic and safety profiles in healthy Chinese subjects similar to those in non-Chinese subjects in historical studies, supporting their use in the Chinese population with HCV infection. ChinaDrugTrials.org.cn identifiers: CTR20160149 (ledipasvir/sofosbuvir); CTR20160602 (sofosbuvir/velpatasvir).
Collapse
Affiliation(s)
- Cuiyun Li
- Phase 1 Clinical Trial Unit, First Hospital, Jilin University, Changchun, Jilin, China
| | - Xiaojiao Li
- Phase 1 Clinical Trial Unit, First Hospital, Jilin University, Changchun, Jilin, China
| | - Xiaoxue Zhu
- Phase 1 Clinical Trial Unit, First Hospital, Jilin University, Changchun, Jilin, China
| | - Hong Zhang
- Phase 1 Clinical Trial Unit, First Hospital, Jilin University, Changchun, Jilin, China
| | - Gong Shen
- Gilead Sciences Inc, Foster City, CA, USA
| | | | - Yanhua Ding
- Phase 1 Clinical Trial Unit, First Hospital, Jilin University, Changchun, Jilin, China.
| |
Collapse
|
32
|
Rao H, Song G, Li G, Yang Y, Wu X, Guan Y, Mao Q, Jiang X, Wang C, Zhang Y, Jia J, Guo X, Li C, Ning J, Qin H, Pan H, Wei L. Safety and efficacy of coblopasvir and sofosbuvir in patients with genotypes 1, 2, 3 and 6 HCV infections without or with compensated cirrhosis. J Viral Hepat 2020; 27:45-51. [PMID: 31520460 DOI: 10.1111/jvh.13208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 08/03/2019] [Accepted: 08/15/2019] [Indexed: 01/20/2023]
Abstract
A simple, pangenotypic and effective treatment regimen for patients with a broad range of chronic hepatitis C virus (HCV) infections remains an unmet medical need. We conducted a phase 2, randomized, open study involving untreated patients with chronic HCV genotypes 1, 2, 3, or 6 infections. Patients without cirrhosis were randomly assigned in a 1:2 ratio to receive capsules of the NS5A inhibitor coblopasvir at a dose of 30 or 60 mg plus tablets of the nucleotide polymerase inhibitor sofosbuvir (400 mg) once daily for 12 weeks. Patients with cirrhosis received 60 mg coblopasvir plus sofosbuvir for 12 weeks. The primary endpoint was the sustained virologic response at 12 weeks after the end of therapy (SVR12). Of the 110 patients who were enrolled in the study, 59 were male, 62.7% had HCV genotype 1, 24.5% had genotype 2, 6.4% had genotype 3, and 6.4% had genotype 6. The average age was 45.5 years. A total of 10.9% of patients had compensated cirrhosis. The rate of SVR12 was 98.2% in the intention-to-treat (ITT). One genotype 6 patient with cirrhosis experienced virologic relapse. One genotype 2 patient without cirrhosis failed to complete the follow-up and quit the study. Serious adverse events (SAEs) were reported in 2 patients and were not related to coblopasvir and sofosbuvir. Most adverse events (AEs) did not require treatment. Coblopasvir plus sofosbuvir taken once daily for 12 weeks provided high rates of sustained virologic response (SVR) and had a good safety profile among patients with HCV genotypes 1, 2, 3, or 6 infections, including those with compensated cirrhosis.
Collapse
Affiliation(s)
- Huiying Rao
- Beijing Key Laboratory for Hepatitis C and Immunotherapy for Liver Disease, Peking University People's Hospital, Peking University Hepatology Institute, Beijing, China
| | - Guangjun Song
- Hepatology Department, Peking University People's Hospital, Beijing, China
| | - Guangming Li
- Zhengzhou Municipal Sixth People's Hospital, Zhengzhou, China
| | | | - Xiaofeng Wu
- Shenyang Municipal Sixth People's Hospital, Shenyang, China
| | - Yujuan Guan
- Guangzhou Municipal Eighth People's Hospital, Guanzhou, China
| | - Qing Mao
- Chinese PLA Third Military Medical University First Affiliated Hospital, Chongqing, China
| | | | - Changyuan Wang
- Ji'nan Municipal Hospital of Infectious Disease, Ji'nan, Shandong, China
| | - Ying Zhang
- Dalian Municipal Sixth People's Hospital, Dalian, China
| | - Jidong Jia
- Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Xiaolin Guo
- Jilin University First Hospital, Changchun, China
| | - Chenghao Li
- Yanbian University Affiliated Hospital, Yanji, China
| | - Jing Ning
- Beijing Kawin Technology Share-holding Co., Ltd., Beijing, China
| | - Hong Qin
- Beijing Kawin Technology Share-holding Co., Ltd., Beijing, China
| | - Hai Pan
- Beijing Kawin Technology Share-holding Co., Ltd., Beijing, China
| | - Lai Wei
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| |
Collapse
|
33
|
Xu X, Feng B, Guan Y, Zheng S, Sheng J, Yang X, Ma Y, Huang Y, Kang Y, Wen X, Li J, Tan Y, He Q, Xie Q, Wang M, An P, Gong G, Liu H, Ning Q, Hua R, Ning B, Xie W, Zhang J, Huang W, Yang Y, Lin M, Zhao Y, Yu Y, Jia J, Yang D, Chen L, Ye Y, Nan Y, Gong Z, Zhang Q, Hu P, Wang F, Li Y, Li D, Jia Z, Hou J, Chen C, Wu JJ, Wei L. Efficacy and Safety of All-oral, 12-week Ravidasvir Plus Ritonavir-boosted Danoprevir and Ribavirin in Treatment-naïve Noncirrhotic HCV Genotype 1 Patients: Results from a Phase 2/3 Clinical Trial in China. J Clin Transl Hepatol 2019; 7:213-220. [PMID: 31608212 PMCID: PMC6783683 DOI: 10.14218/jcth.2019.00033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 02/05/2023] Open
Abstract
Background and Aims: Ravidasvir (RDV) is a new generation pangenotypic hepatitis C virus (HCV) NS5A inhibitor, with high barrier to baseline resistance-associated species. This is the first phase 2/3 study conducted in Mainland China confirming the efficacy and safety of RDV + ritonavir-boosted danoprevir + ribavirin for 12 weeks in treatment-naïve noncirrhotic patients with genotype 1 infection in a large population. Methods: In this multicenter, randomized, double-blinded, placebo-controlled phase 2/3 trial (NCT03362814), we enrolled 424 treatment-naïve, noncirrhotic adult HCV genotype 1 patients. All patients were randomized at 3:1 ratio to receive a combination of RDV 200mg once daily plus ritonavir-boosted danoprevir 100mg/100mg twice daily and oral ribavirin 1000/1200mg/day (body weight <75/≥75 kg) (n = 318) or placebo (n = 106) for 12 weeks. The primary end-point was the rate of sustained virologic response 12 weeks after the end of treatment, and the safety was evaluated and compared between treatment and placebo groups. Results: The overall rate of sustained virological response at 12 weeks after treatment is 99% (306/309, 95%, CI: 97%–100%) under per protocol set analysis. All patients harboring baseline NS5A resistance-associated species in the treatment group (76/76, per protocol set) achieved sustained virological response at 12 weeks after treatment. No treatment-related serious adverse events were reported. Laboratory abnormalities showed mild or moderate severity (grade 1 and grade 2) in liver function tests. Conclusions: In treatment-naïve, noncirrhotic HCV Chinese patients infected with HCV genotype 1, all-oral regimen of RDV + ritonavir-boosted danoprevir + ribavirin for 12 weeks was highly efficacious, safe, and well tolerated.
Collapse
Affiliation(s)
- Xiaoyuan Xu
- Peking University First Hospital, Beijing, China
| | - Bo Feng
- Peking University People's Hospital, Beijing, China
| | - Yujuan Guan
- Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Sujun Zheng
- Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Jifang Sheng
- The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China
| | | | - Yuanji Ma
- West China Hospital, Sichuan University, Chengdu, China
| | - Yan Huang
- Xiangya Hospital, Central South University, Changsha, China
| | - Yi Kang
- Henan Provincial People's Hospital, Zhengzhou, China
| | | | - Jun Li
- Jiangsu Province Hospital, Nanjing, China
| | - Youwen Tan
- Zhenjiang No.3 People's Hospital, Zhenjiang, China
| | - Qing He
- The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Qing Xie
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Maorong Wang
- People's Liberation Army Bayi Hospital, Nanjing, China
| | - Ping An
- Shenyang Sixth People's Hospital, Shenyang, China
| | - Guozhong Gong
- The 2nd Xiangya Hospital of Central South University, Changsha, China
| | - Huimin Liu
- Xixi Hospital of Hangzhou, Hangzhou, China
| | - Qin Ning
- Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Rui Hua
- The First Hospital of Jilin University, Changchun, China
| | - Bo Ning
- Baoji Center Hospital, Baoji, China
| | - Wen Xie
- Beijing Ditan Hospital, Beijing, China
| | - Jiming Zhang
- Huashan Hospital Affiliated to Fudan University, Shanghai, China
| | - Wenxiang Huang
- Chongqing Medical University No.1 Affiliated Hospital, Chongqing, China
| | | | - Minghua Lin
- Fujian Fuzhou Municipal Infectious Disease Hospital, Fuzhou, China
| | - Yingren Zhao
- No.1 Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yanhong Yu
- The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jidong Jia
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | | | - Liang Chen
- Shanghai Public Health Clinical Center, Shanghai, China
| | - Yinong Ye
- Foshan No.1 People's Hospital, Foshan, China
| | - Yuemin Nan
- The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | | | - Quan Zhang
- The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Peng Hu
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Yongguo Li
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Dongliang Li
- Fuzhou General Hospital of Nanjing Military Command, Fuzhou, China
| | - Zhansheng Jia
- Tang Du Hospital, Fourth military Medical University, Xi'an, China
| | - Jinlin Hou
- Nanfang Hospital, Nanfang Medical University, Guangzhou, China
| | - Chengwei Chen
- The 85 branch of the Chinese People's Liberation Army Hospital, Shanghai, China
| | - Jinzi J Wu
- Ascletis BioScience Co., Ltd. Hangzhou, China
| | - Lai Wei
- Tsinghua Changgeng Hospital, Beijing, China
| |
Collapse
|
34
|
Wei L, Shang J, Ma Y, Xu X, Huang Y, Guan Y, Duan Z, Zhang W, Gao Z, Zhang M, Li J, Jia J, Yang Y, Wen X, Wang M, Jia Z, Ning B, Chen Y, Qi Y, Du J, Jiang J, Tong L, Xie Y, Wu JJ. Efficacy and Safety of 12-week Interferon-based Danoprevir Regimen in Patients with Genotype 1 Chronic Hepatitis C. J Clin Transl Hepatol 2019; 7:221-225. [PMID: 31608213 PMCID: PMC6783684 DOI: 10.14218/jcth.2019.00018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/12/2019] [Accepted: 06/30/2019] [Indexed: 02/05/2023] Open
Abstract
Background and Aims: Genotype (GT) 1 remains the predominant hepatitis c virus (HCV) GT in Chinese patients. Over 80% of those Chinese patients harbor the interferon-sensitive CC allele of IFNL4rs12979860, which is favorable for interferon-based treatment regimens. This phase III clinical trial aimed to evaluate the efficacy and safety of the ritonavir-boosted danoprevir plus pegylated-interferon α-2a and ribavirin regimen for 12 weeks in treatment-naïve mainland Chinese patients infected with HCV GT1 without cirrhosis. Methods: One hundred and forty-one treatment-naïve, non-cirrhotic HCV GT1 Chinese patients (age ≥18 years) were enrolled for this single-arm, multicenter, phase III MANASA study (NCT03020082). Patients received a combination of ritonavir-boosted danoprevir (100 mg/100 mg) twice a day plus subcutaneous injection of weekly pegylated-interferon α-2a (180 μg) and oral ribavirin (1000/1200 mg/day body weight <75/≥75 kg) for 12 weeks. The primary end-point was sustained virologic response rate at 12 weeks after the end of treatment. The secondary end-points were safety outcomes, tolerability, virologic response over time and relapse rate. Results: All enrolled patients were HCV GT1-infected, and most among them (97.9%, 123/141) had the HCV GT1b subtype. Single-nucleotide polymorphism test showed that the majority of patients were of the IFNL4 rs12979860 CC genotype (87.2%, 123/141). Overall, 140 patients completed the 12-week treatment, and 97.1% (136/140) patients achieved sustained virologic response at 12 weeks (per protocol population group, 95% confidence interval: 92.9-99.2%). Only drug-related serious adverse event occurred. Most of the adverse events were grade 1 and grade 2 alanine aminotransferase elevation or liver dysfunction. One patient discontinued treatment because of severe head injury in a car accident. Conclusions: The triple regimen of ritonavir-boosted danoprevir plus pegylated-interferon α-2a and ribavirin produced a sustained virologic response rate of 97.1% after 12 weeks treatment in noncirrhotic HCV GT1-infected Chinese patients, and was safe and well tolerated. Trial Registration Clinical-Trials.gov Identifier: NCT03020082.
Collapse
Affiliation(s)
- Lai Wei
- Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing, China
- Correspondence to: Lai Wei, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing 100191, China. Tel: +86-1-88326666, Fax: +86-1-68318386, E-mail:
| | - Jia Shang
- People’s Hospital of Henan Province, Henan, China
| | - Yuanji Ma
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoyuan Xu
- Peking University People’s Hospital, Beijing, China
| | - Yan Huang
- Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yujuan Guan
- Guangzhou Eighth People’s Hospital, Guangzhou, Guangdong, China
| | - Zhongping Duan
- Artificial Liver Center, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | | | - Zhiliang Gao
- The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Mingxiang Zhang
- The Sixth People’s Hospital of Shenyang, Shenyang, Liaoning, China
| | - Jun Li
- People’s Hospital of Jiangsu Province, Nanjing, Jiangsu, China
| | - Jidong Jia
- Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yongfeng Yang
- Nanjing Medical University Affiliated Second Hospital, Nanjing, Jiangsu, China
| | | | - Maorong Wang
- Liver Disease Center of PLA, The 81st Hospital of PLA, Nanjing, Jiangsu, China
| | - Zhansheng Jia
- Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi, China
| | - Bo Ning
- Baoji Central Hospital, Baoji, Shaanxi, China
| | - Yongping Chen
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yue Qi
- The First Hospital Affiliated to Jilin University, Changchun, Jilin, China
| | - Jie Du
- The First Hospital of Changsha, Changsha, Hunan, China
| | - Jianning Jiang
- The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Lixin Tong
- The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yao Xie
- Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Jinzi J. Wu
- Ascletis BioScience Co., Ltd., Hangzhou, Zhejiang, China
| |
Collapse
|
35
|
Zhang M, Wu R, Xu H, Uhanova J, Gish R, Wen X, Jin Q, Gerald MY, Nguyen MH, Gao Y, Niu J. Changing incidence of reported viral hepatitis in China from 2004 to 2016: an observational study. BMJ Open 2019; 9:e028248. [PMID: 31427323 PMCID: PMC6701656 DOI: 10.1136/bmjopen-2018-028248] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE China's national hepatitis burden is high. This study aims to provide a detailed national-level description of the reported incidence of viral hepatitis in China during 2004-2016. DESIGN Observational study. SETTING Data were obtained from China's National Notifiable Disease Reporting System, and changing trends were estimated by joinpoint regression analysis. PARTICIPANTS In this system, 16 927 233 reported viral hepatitis cases occurring during 2004-2016 were identified. PRIMARY OUTCOME MEASURE Incidence rates per 100 000 person-years and changing trends were calculated. RESULTS There were 16 927 233 new cases of viral hepatitis reported in China from 2004 to 2016. Hepatitis B (HBV) (n=13 543 137, 80.00%) and hepatitis C (HCV) (n=1 844 882, 10.90%) accounted for >90% of the cases. The overall annual percent change (APC) in reported cases of viral hepatitis and HBV were 0.3%(95% CI -2.0 to 0.8, p=0.6) and -0.2% (95% CI -1.6 to 1.2, p=0.8), respectively, showing a stable trend. HBV rates were highest in the 20-29 year old age group and lowest in younger individuals, likely resulting from the universal HBV vaccination. The reported incidence of HCV and hepatitis E (HEV) showed increasing trends; the APCs were 14.5% (95% CI 13.1 to 15.9, p<0.05) and 4.7% (95% CI 2.8 to 6.7, p<0.05), respectively. The hepatitis A (HAV) reporting incidence decreased, and the APC was -13.1% (95% CI -15.1 to -11.0, p<0.05). There were marked differences in the reporting of hepatitis among provinces. CONCLUSIONS HBV continues to constitute the majority of viral hepatitis cases in China. Over the entire study period, the HBV reporting incidence was stable, the HCV and HEV incidence increased and the HAV incidence decreased. There were significant interprovincial disparities in the burden of viral hepatitis, with higher rates in economically less-developed areas. Vaccination is important for viral hepatitis prevention and control.
Collapse
Affiliation(s)
- Mingyuan Zhang
- Hepatology Department, First Hospital of Jilin University, Changchun, Jilin, China
| | - Ruihong Wu
- Hepatology Department, First Hospital of Jilin University, Changchun, Jilin, China
| | - Hongqin Xu
- Hepatology Department, First Hospital of Jilin University, Changchun, Jilin, China
| | - Julia Uhanova
- Department of Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - Robert Gish
- Department of Medicine, Stanford Hospital and Clinics, Stanford, California, USA
| | - Xiaoyu Wen
- Hepatology Department, First Hospital of Jilin University, Changchun, Jilin, China
| | - Qinglong Jin
- Hepatology Department, First Hospital of Jilin University, Changchun, Jilin, China
| | - Minuk Y Gerald
- Department of Internal Medicine, University of Manitoba College of Medicine, Winnipeg, Manitoba, Canada
| | - M H Nguyen
- Department of Medicine, Stanford Hospital and Clinics, Stanford, California, USA
| | - Yanhang Gao
- Hepatology Department, First Hospital of Jilin University, Changchun, Jilin, China
| | - J Niu
- Hepatology Department, First Hospital of Jilin University, Changchun, Jilin, China
- Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, First Hospital of Jilin University, Changchun, Jilin, China
| |
Collapse
|
36
|
Xiao J, Wang F, Wong NK, He J, Zhang R, Sun R, Xu Y, Liu Y, Li W, Koike K, He W, You H, Miao Y, Liu X, Meng M, Gao B, Wang H, Li C. Global liver disease burdens and research trends: Analysis from a Chinese perspective. J Hepatol 2019; 71:212-221. [PMID: 30871980 DOI: 10.1016/j.jhep.2019.03.004] [Citation(s) in RCA: 323] [Impact Index Per Article: 64.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/14/2019] [Accepted: 03/03/2019] [Indexed: 02/05/2023]
Abstract
Liver diseases affect millions of people worldwide. In most developed countries, the incidence of viral hepatitis is waning as a result of modern advances in disease prevention, diagnosis, and therapies. Expanded programmes for systematic immunisation against hepatitis B virus have also significantly brought down the number of new cases in many countries, including China. In contrast, with the improvement in living standards, the prevalence of metabolic liver diseases including non-alcoholic fatty liver disease and alcohol-related liver disease is set to rise, ultimately leading to more cases of end-stage liver diseases (liver failure, cirrhosis, and liver cancer). Over the past 30 years, visionary governments of major nations have provided strong incentives for basic/clinical research, vaccination programmes, and drug discovery and development in the field of hepatology. To get rid of her unflattering title as the "leader in liver diseases", China has also made a serious effort to initiate nationwide preventive measures for liver diseases, global partnerships, and mentoring programmes for young hepatologists. Instrumental to such progress is the continuous support of the National Natural Science Foundation of China (NSFC), which has helped hepatology to thrive in virtually all research directions within the country. In this article, we seek to provide stimulating glimpses into the evolving liver disease epidemiology, institutional research profiles, funding landscape, and drug development trends in China, with an attempt to compare her status and achievements with those of the United States, European countries, and Japan.
Collapse
Affiliation(s)
- Jia Xiao
- Laboratory of Neuroendocrinology, Fujian Key Laboratory of Developmental and Neurobiology, School of Life Sciences, Fujian Normal University, Fuzhou, China; Department of Health Sciences, National Natural Science Foundation of China, Beijing, China
| | - Fei Wang
- Department of Health Sciences, National Natural Science Foundation of China, Beijing, China; Division of Gastroenterology and Hepatology, Digestive Disease Institute, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Nai-Kei Wong
- State Key Discipline of Infectious Diseases, Shenzhen Third People's Hospital, The Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
| | - Jinhan He
- Department of Pharmacy, West China Hospital of Sichuan University, Chengdu, China
| | - Rui Zhang
- Clinical Research Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ruijuan Sun
- Department of Health Sciences, National Natural Science Foundation of China, Beijing, China
| | - Yanying Xu
- Department of Health Sciences, National Natural Science Foundation of China, Beijing, China
| | - Yingxia Liu
- State Key Discipline of Infectious Diseases, Shenzhen Third People's Hospital, The Second Hospital Affiliated to Southern University of Science and Technology, Shenzhen, China
| | - Wei Li
- Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Kazuo Koike
- Faculty of Pharmaceutical Sciences, Toho University, Chiba, Japan
| | - Weiling He
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hong You
- Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yinglei Miao
- Department of Gastroenterology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaowei Liu
- Department of Gastroenterology, Xiangya Hospital, Central South University, Changsha, China
| | - Mingming Meng
- Department of Gastroenterology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Bin Gao
- Laboratory of Liver Diseases, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Hua Wang
- Department of Oncology, The First Affiliated Hospital, Institute for Liver Diseases of Anhui Medical University, Hefei, China.
| | - Cui Li
- Department of Health Sciences, National Natural Science Foundation of China, Beijing, China.
| |
Collapse
|
37
|
Xie Q, Xuan JW, Tang H, Ye XG, Xu P, Lee IH, Hu SL. Hepatitis C virus cure with direct acting antivirals: Clinical, economic, societal and patient value for China. World J Hepatol 2019; 11:421-441. [PMID: 31183003 PMCID: PMC6547290 DOI: 10.4254/wjh.v11.i5.421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 04/05/2019] [Accepted: 04/19/2019] [Indexed: 02/06/2023] Open
Abstract
About 10 million people in China are infected with hepatitis C virus (HCV), with the seroprevalence of anti-HCV in the general population estimated at 0.6%. Delaying effective treatment of chronic hepatitis C (CHC) is associated with liver disease progression, cirrhosis, hepatocellular carcinoma, and liver-related mortality. The extrahepatic manifestations of CHC further add to the disease burden of patients. Managing CHC-related advanced liver diseases and systemic manifestations are costly for both the healthcare system and society. Loss of work productivity due to reduced well-being and quality of life in CHC patients further compounds the economic burden of the disease. Traditionally, pegylated-interferon plus ribavirin (PR) was the standard of care. However, a substantial number of patients are ineligible for PR treatment, and only 40%-75% achieved sustained virologic response. Furthermore, PR is associated with impairment of patient-reported outcomes (PROs), high rates of adverse events, and poor adherence. With the advent of direct acting antivirals (DAAs), the treatment of CHC patients has been revolutionized. DAAs have broader eligible patient populations, higher efficacy, better PRO profiles, fewer adverse events, and better adherence rates, thereby making it possible to cure a large proportion of all CHC patients. This article aims to provide a comprehensive evaluation on the value of effective, curative hepatitis C treatment from the clinical, economic, societal, and patient experience perspectives, with a focus on recent data from China, supplemented with other Asian and international experiences where China data are not available.
Collapse
Affiliation(s)
- Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Jian-Wei Xuan
- Health Economic Research Institute, School of Pharmacy, Sun Yat-Sen University, Guangzhou 510006, Guangdong Province, China
| | - Hong Tang
- Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xiao-Guang Ye
- Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510260, Guangdong Province, China
| | - Peng Xu
- Gilead Sciences Inc, Shanghai 200122, China
| | - I-Heng Lee
- Gilead Sciences Inc, Foster City, CA 94404, United States
| | - Shan-Lian Hu
- School of Public Health, Fudan University, Shanghai 200032, China
- Shanghai Health Development Research Center, Shanghai 200032, China.
| |
Collapse
|
38
|
Yang F, Ma L, Yang Y, Liu W, Zhao J, Chen X, Wang M, Zhang H, Cheng S, Shen F, Wang H, Zhou W, Cao G. Contribution of Hepatitis B Virus Infection to the Aggressiveness of Primary Liver Cancer: A Clinical Epidemiological Study in Eastern China. Front Oncol 2019; 9:370. [PMID: 31179237 PMCID: PMC6537574 DOI: 10.3389/fonc.2019.00370] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 04/23/2019] [Indexed: 12/25/2022] Open
Abstract
Background and aims: The contribution of hepatitis B virus (HBV) infection to the aggressiveness of primary liver cancer (PLC) remains controversial. We aimed to characterize this in eastern China. Methods: We enrolled 8,515 PLC patients whose specimens were reserved at the BioBank of the hepatobiliary hospital (Shanghai, China) during 2007-2016. Of those, 3,124 who received primary radical resection were involved in survival analysis. A nomogram was constructed to predict the survivals using preoperative parameters. Results: Hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), and combined hepatocellular cholangiocarcinoma (CHC) accounted for 94.6, 3.7, and 1.7%, respectively. The rates of HBV infection were 87.5, 49.2, and 80.6%, respectively. HBV infection was significantly associated with 10-year earlier onset, more cirrhosis, higher α-fetoprotein, higher carbohydrate antigen 19-9 (CA19-9), more microvascular invasion (MVI), lower neutrophil-to-lymphocyte ratio (NLR), and lower platelet-to-lymphocyte ratio (PLR) in HCC. HBV infection was also associated with 7-year earlier onset, more cirrhosis, higher α-fetoprotein, more MVI, and lower PLR in ICC. In the multivariate Cox analysis, high circulating HBV DNA, α-fetoprotein, CA19-9, NLR, tumor size, number, encapsulation, Barcelona Clinic Liver Cancer (BCLC) stage, and MVI predicted an unfavorable prognosis in HCC; only CA19-9 and BCLC stage, rather than HBV-related parameters, had prognostic values in ICC. A nomogram constructed with preoperative HBV-related parameters including HBV load, ultrasonic cirrhosis, and α-fetoprotein perform better than the current staging systems in predicting postoperative survival in HCC. Conclusion: HBV promotes the aggressiveness of HCC in Chinese population. The contributions of HBV to ICC and other etiological factors to HCC might be indirect via arousing non-resolving inflammation.
Collapse
Affiliation(s)
- Fan Yang
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Longteng Ma
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Yuan Yang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wenbin Liu
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Jun Zhao
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Xi Chen
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Mengchao Wang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Hongwei Zhang
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Shuqun Cheng
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Feng Shen
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Hongyang Wang
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Weiping Zhou
- Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Guangwen Cao
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| |
Collapse
|
39
|
Abstract
OBJECTIVE Direct-acting antiviral agents (DAAs) have been approved for treating hepatitis C virus (HCV) infection in China. However, they are substantially more expensive. The current analysis will investigate the cost-effectiveness of novel regimens compared with pegylated interferon and ribavirin (PR) therapies for informing Chinese decision-makers. METHODS A Markov model was developed to measure economic and health outcomes of novel regimens for genotype 1b, 2, 3, and 6 HCV infections compared with PR treatment. Clinical, cost, and utility inputs were gathered from published sources. Discounted quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness ratios (ICERs) are shown. The uncertainty was facilitated by one-way and probabilistic sensitivity analyses. RESULTS For genotype 1b HCV infection, the combination of paritaprevir, ritonavir, ombitasvir and dasabuvir was cost-saving compared with four competing alternatives. The ICERs of sofosbuvir plus ribavirin for genotypes 2 and 3 were lower than the threshold ($18,234/QALY). Among available strategies for patients with genotype 6, sofosbuvir in combination with ribavirin was the cost-saving alternative compared with PR. The results were robust to sensitivity analyses. CONCLUSIONS For both genotype 1b and 6 HCV infections in the context of Chinese patients, there were combinations of DAAs that were cost-saving compared with the usual PR treatment, and cost-effective for genotypes 2 and 3.
Collapse
Affiliation(s)
- Bin Wu
- a Medical Decision and Economic Group, Department of Pharmacy , Ren Ji Hospital, South Campus , School of Medicine , Shanghai Jiaotong University , Shanghai , PR China
| | - Zhenhua Wang
- b Department of Gastroenterology , Ren Ji Hospital , School of Medicine , Shanghai Jiaotong University , Shanghai , PR China
| | - Qing Xie
- c Department of Infectious Diseases, Ruijin Hospital , Shanghai Jiaotong University School of Medicine , Shanghai , PR China
| |
Collapse
|
40
|
Huang R, Rao H, Xie Q, Gao Z, Li W, Jiang D, Mo H, Massetto B, Stamm LM, Brainard DM, Wei L. Comparison of the efficacy of sofosbuvir plus ribavirin in Chinese patients with genotype 3a or 3b HCV infection. J Med Virol 2019; 91:1313-1318. [PMID: 30861150 DOI: 10.1002/jmv.25454] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/04/2019] [Accepted: 03/04/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND AIM Genotype 3b hepatitis C virus (HCV) infection represents approximately 50% of patients with genotype 3 in China. We compared the efficacy of sofosbuvir (SOF) plus ribavirin (RBV) in Chinese patients with genotype 3a and 3b HCV. METHODS The analyzed data are from a phase 3, open-label study of SOF plus RBV for 24 weeks conducted in China. The primary endpoint for the trial was sustained virologic response at 12 weeks after the end of therapy (SVR12). RESULTS Of 126 patients included in this analysis, 58 (46%) had genotype 3a and 68 (54%) had genotype 3b. Both the subtypes were similar in age, sex, body mass index, IL28B, and baseline HCV RNA. However, more treatment-experienced and cirrhotic patients were in the genotype 3b group. All 100% of patients with genotype 3a (95% confidence interval [CI], 94-100), and 91% (95% CI, 82-97) of patients with genotype 3b achieved SVR12 (P = 0.030). For treatment-experienced patients with genotype 3b, the SVR12 rate was 73% (95% CI, 39-94) and 88% (95% CI, 64-99) among patients with and without cirrhosis (P = 1.00), respectively. CONCLUSION SOF plus RBV for 24 weeks in patients with HCV genotype 3 infection resulted in high rates of SVR. However, the SVR12 rate among patients with genotype 3b was lower than that observed in patients with genotype 3a infection, particularly among treatment-experienced patients with cirrhosis.
Collapse
Affiliation(s)
- Rui Huang
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory for Hepatitis C and Immunotherapy for Liver Disease, Beijing, China
| | - Huiying Rao
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory for Hepatitis C and Immunotherapy for Liver Disease, Beijing, China
| | - Qing Xie
- Department of Infectious Disease, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiliang Gao
- Infectious Disease Department, The Third Affiliated Hospital, Sun Yet-Sen University, Guangzhou, China
| | - Wu Li
- First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Deyuan Jiang
- Biostatistics, Gilead Sciences, Inc, Foster City, California
| | - Hongmei Mo
- Biostatistics, Gilead Sciences, Inc, Foster City, California.,Virology, Gilead Sciences, Inc, Foster City, California
| | - Benedetta Massetto
- Biostatistics, Gilead Sciences, Inc, Foster City, California.,Clinical Research, Gilead Sciences, Inc, Foster City, California
| | - Luisa M Stamm
- Biostatistics, Gilead Sciences, Inc, Foster City, California.,Clinical Research, Gilead Sciences, Inc, Foster City, California
| | - Diana M Brainard
- Biostatistics, Gilead Sciences, Inc, Foster City, California.,Clinical Research, Gilead Sciences, Inc, Foster City, California
| | - Lai Wei
- Peking University People's Hospital, Peking University Hepatology Institute, Beijing Key Laboratory for Hepatitis C and Immunotherapy for Liver Disease, Beijing, China
| |
Collapse
|
41
|
Zha J, Ding B, Wang H, Zhao W, Yu C, Alves K, Mobashery N, Luo Y, Menon RM. Pharmacokinetics of Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir in Healthy Chinese Subjects and HCV GT1b-Infected Chinese, South Korean and Taiwanese Patients. Eur J Drug Metab Pharmacokinet 2019; 44:43-52. [PMID: 29909549 DOI: 10.1007/s13318-018-0492-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND/PURPOSE The 3 direct-acting antiviral (3D) regimen of ombitasvir/paritaprevir/ritonavir plus dasabuvir has recently been approved in several Asian geographic regions for the treatment of hepatitis C virus (HCV) genotype (GT) 1 infection. The pharmacokinetics of the components of the 3D regimen with or without ribavirin were evaluated in healthy Chinese subjects and HCV GT1b-infected Chinese, South Korean, and Taiwanese patients, with or without cirrhosis, to determine how the drug exposures in Asian populations compare with historical data in Western populations. METHODS Participants received ombitasvir/paritaprevir/ritonavir 25/150/100 mg once daily plus dasabuvir 250 mg twice daily for 14 days (healthy subjects, n = 36) or 12 weeks (HCV patients, n = 754). Patients with compensated cirrhosis also received ribavirin 1000 or 1200 mg divided twice daily, per the local label. Intensive or sparse pharmacokinetic sampling was performed for assessments of plasma drug concentrations. RESULTS The exposures [maximum plasma concentration (Cmax) and area under the plasma concentration-time curve (AUC)] of the components of the 3D regimen were comparable (< 20% difference) in healthy Chinese subjects residing in China or the United States. In addition, the trough plasma concentrations (Ctrough) in HCV GT1b-infected Asian patients were either similar to (ombitasvir) or within 75% of (paritaprevir and dasabuvir) those in Western patients without cirrhosis, or similar to (ombitasvir and paritaprevir) or within 100% of (dasabuvir) those in Western patients with cirrhosis, with widely overlapping ranges of individual values. Generally comparable drug exposures were observed among Chinese, South Korean, and Taiwanese ethnicities for noncirrhotic and cirrhotic patients. CONCLUSION Collectively, the results of these pharmacokinetic analyses support the use of the same dose of the 3D regimen for Asian and Western patients. CLINICALTRIALS.GOV: NCT02534870, NCT02517515, NCT02517528.
Collapse
Affiliation(s)
- Jiuhong Zha
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc, 1 North Waukegan Road, Bldg. AP31-3, North Chicago, IL, 60064, USA.
| | - Bifeng Ding
- Data and Statistical Sciences, AbbVie Inc., North Chicago, IL, USA
| | - Haoyu Wang
- Data and Statistical Sciences, AbbVie Inc., North Chicago, IL, USA
| | - Weihan Zhao
- Data and Statistical Sciences, AbbVie Inc., North Chicago, IL, USA
| | - Chen Yu
- Phase I Clinical Research Center, Shanghai Xuhui Central Hospital, Shanghai, China
| | - Katia Alves
- Clinical Development, AbbVie Inc., North Chicago, IL, USA
| | | | - Yan Luo
- Clinical Development, AbbVie Inc., North Chicago, IL, USA
| | - Rajeev M Menon
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc, 1 North Waukegan Road, Bldg. AP31-3, North Chicago, IL, 60064, USA
| |
Collapse
|
42
|
A retrospective study of the efficacy of sofosbuvir plus NS5A inhibitors for patients with hepatitis C virus genotype-2 chronic infection. Eur J Gastroenterol Hepatol 2019; 31:382-388. [PMID: 30383554 DOI: 10.1097/meg.0000000000001299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND A combination of sofosbuvir (SOF)+NS5A inhibitor therapies is the main treatment for patients with hepatitis C virus (HCV) genotype-2 (GT-2) chronic infection, but the data are rarely reported in China. This study aimed to investigate the virological response and liver fibrosis improvement among GT-2 patients receiving SOF+NS5A inhibitors. PATIENTS AND METHODS In this retrospective study, patients who received SOF+NS5A inhibitors between March 2016 and July 2017 were recruited. The treatment duration was 12 weeks and the treatment strategies included SOF+daclatasvir, SOF/ledipasvir, and SOF/velpatasvir. The primary endpoint was a sustained virologic response (serum HCV RNA undetectable) at week 12 after the end of therapy and the secondary endpoint was the improvement in liver stiffness and scores of apartate aminotransferase to platelet ratio index and fibrosis-4. RESULTS A total of 30 GT-2 patients were enrolled, with 13 (43.3%) patients in SOF+daclatasvir, 13 (43.3%) patients in SOF/ledipasvir, and four (13.3%) patients in SOF/velpatasvir. All patients [30/30 (100%)] achieved SVR, irrespective of treatment regimens and degree of liver fibrosis. After the treatment, liver fibrosis scores of apartate aminotransferase to platelet ratio index (2.27±2.14 vs. 0.89±0.77, P=0.003) and fibrosis-4 (1.17±1.22 vs. 0.42±0.25, P=0.013) were both significantly lower than those before treatment. CONCLUSION SOF+NS5A inhibitor therapies may induce an excellent virological response and fibrosis improvement in HCV GT-2-infected patients.
Collapse
|
43
|
Yang RF, Liu Y, Zhao CY, Ding YX, Chen Y, Wang YD, Duan ZP. A novel point-of-care oral anti-HCV assay: Is it reliable for screening hepatitis C virus infection in the era of direct-acting antivirals? PLoS One 2019; 14:e0211795. [PMID: 30753207 PMCID: PMC6372169 DOI: 10.1371/journal.pone.0211795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/21/2019] [Indexed: 02/08/2023] Open
Abstract
Recent advance in the direct-acting antivirals (DAAs) offers the potentials to eradicate hepatitis C virus (HCV) worldwide and makes universal screening more urgent. A point-of-care (POC) oral anti-HCV assay, the Fortune assay, was developed and its performance was evaluated. Individuals with or without HCV infection were recruited in three Centers. Paired oral and serum samples were tested using the Fortune and InTec anti-HCV assays. The Kehua serum anti-HCV assay served as a supplemental test to verify the discordant results. Some oral samples were also tested using the OraQuick anti-HCV assay. Furthermore, the Fortune assay results were compared with the documented RNA results. Sensitivity, specificity, and accuracy of the Fortune assay was 93.11%, 98.48%, and 96.58%, respectively (n = 1,022). Consistency between the Fortune and OraQuick assays was 96.35% (264/274); the Fortune assay detected additional 8 positive oral samples missed by the OraQuick assay. The Fortune assay demonstrated a 97.46% (115/118) positivity among the viremic patients. Furthermore, its sensitivity was HCV genotype independent. In conclusion, the Fortune assay was highly specific and accurate. It had comparable sensitivity as the serum assays for the diagnosis of active HCV infection. It provides a completely non-invasive and reliable tool for HCV screening in the DAA era.
Collapse
Affiliation(s)
- Rui-Feng Yang
- Peking University People’s Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing, China
| | - Yan Liu
- Peking University People’s Hospital, Peking University Hepatology Institute, Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases, Beijing, China
| | - Cai-Yan Zhao
- Infectious Diseases Department, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya-Xing Ding
- Tianjin Center for Diseases Control and Prevention, Tianjin, China
| | - Yu Chen
- Artificial Liver Center, Beijing You’an Hospital, Capital Medical University, Beijing, China
| | - Ya-Dong Wang
- Infectious Diseases Department, the Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhong-Ping Duan
- Artificial Liver Center, Beijing You’an Hospital, Capital Medical University, Beijing, China
- * E-mail:
| |
Collapse
|
44
|
Wei L, Lim SG, Xie Q, Văn KN, Piratvisuth T, Huang Y, Wu S, Xu M, Tang H, Cheng J, Le Manh H, Gao Y, Mou Z, Sobhonslidsuk A, Dou X, Thongsawat S, Nan Y, Tan CK, Ning Q, Tee HP, Mao Y, Stamm LM, Lu S, Dvory-Sobol H, Mo H, Brainard DM, Yang YF, Dao L, Wang GQ, Tanwandee T, Hu P, Tangkijvanich P, Zhang L, Gao ZL, Lin F, Le TTP, Shang J, Gong G, Li J, Su M, Duan Z, Mohamed R, Hou JL, Jia J. Sofosbuvir–velpatasvir for treatment of chronic hepatitis C virus infection in Asia: a single-arm, open-label, phase 3 trial. Lancet Gastroenterol Hepatol 2019; 4:127-134. [DOI: 10.1016/s2468-1253(18)30343-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 02/06/2023]
|
45
|
Huang W, Wang M, Gong Q, Yu D, Chen P, Lin J, Han Y, Su Y, Qu L, Zhang X. Comparison of Naturally Occurring Resistance-Associated Substitutions Between 2008 and 2016 in Chinese Patients with Chronic Hepatitis C Virus Infection. Microb Drug Resist 2019; 25:944-950. [PMID: 30702389 DOI: 10.1089/mdr.2018.0360] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aims: The presence of pre-existing hepatitis C virus (HCV) resistance-associated substitutions (RASs) could attenuate viral susceptibility to direct-acting antiviral agents. The aim of this study was to better understand the differences among HCV RASs over time. We compared the prevalence and characteristics of naturally occurring HCV RASs in the NS3, NS5A, and NS5B genes between 2008 and 2016 in Chinese patients chronically infected with HCV genotypes (GT) 1b, 2a, 3a, 3b, and 6a. Methods: HCV RNA was extracted after serum samples were collected from 242 patients at treatment baseline, including 120 samples in 2008 and 122 samples in 2016. Reverse transcription and nested PCR were performed, and the PCR products of the NS3, NS5A, and NS5B regions were sequenced using the Sanger sequencing method. Finally, RASs were identified from the different viral strains. Results: In GT1b, the overall frequency of NS5A RASs in 2016 was significantly higher than that in 2008 (42.0% vs. 18.4%; p = 0.002). Among NS5A RASs, the most frequently detected RAS was Y93H (5.3% in 2008 vs. 15.9% in 2016; p = 0.035), which confers medium- to high-level resistance to the NS5A inhibitors: daclatasvir (DCV), ledipasvir (LDV), ombitasvir (OMV), and elbasvir. The frequency of NS5A L28 (low-level resistance to DCV/LDV/OMV) in 2016 was also higher than that in 2008 (11.6% vs. 1.3%; p = 0.027). In addition, the highest frequency of clinically relevant NS3 RASs was S122G/A/T (69.7% in 2008 and 72.5% in 2016) in HCV GT1b isolates, which had medium-level resistance to simeprevir and asunaprevir, followed by Y56F (7.9% in 2008 and 14.5% in 2016), which confers resistance to paritaprevir. Although NS5B C316N had the highest substitution rate in GT1b (80.2% in 2008 and 91.3% in 2016), it was associated with low-level resistance to sofosbuvir and dasabuvir. However, HCV RASs were rarely detectable at baseline in other genotypes or subtypes except GT1b in this study. Conclusion: The frequency of NS5A RASs in 2016 was significantly higher than that in 2008, especially at the L28 and Y93 substitution positions, which may be due to their better fitness compared with wild-type viruses.
Collapse
Affiliation(s)
- Wei Huang
- 1 Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Mingjie Wang
- 1 Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Qiming Gong
- 2 Department of Infectious Diseases, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Demin Yu
- 1 Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Peizhan Chen
- 3 Translational Medicine Research Center, Ruijin Hospital North, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Junyu Lin
- 1 Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Yue Han
- 1 Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Yu Su
- 4 Key Laboratory of Medical Molecular Virology, School of Basic Medical Sciences, Fu Dan University, Shanghai, China
| | - Lihong Qu
- 5 Department of Infectious Diseases, East Hospital, Tongji University, Shanghai, China
| | - Xinxin Zhang
- 1 Research Laboratory of Clinical Virology, Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
- 3 Translational Medicine Research Center, Ruijin Hospital North, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| |
Collapse
|
46
|
Hepatitis C virus genotype diversity and distribution among methadone maintenance treatment patients in Jiangsu, China. Drug Alcohol Depend 2019; 194:101-106. [PMID: 30419403 DOI: 10.1016/j.drugalcdep.2018.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 07/31/2018] [Accepted: 09/10/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Heroin users are vulnerable and represent a highly-infected reservoir for hepatitis C virus (HCV) infection. This study investigated HCV prevalence and genotypes distribution among heroin users who received methadone maintenance treatment (MMT) in Jiangsu. METHODS From June to December in 2016, a total of 534 patients among nine MMT clinics in six regions of Jiangsu were enrolled, with their demographic characteristics collected and serum samples tested for HCV antibody. 395 samples were seropositive and furthered to RNA extraction. HCV NS5B region fragments were amplified and subsequently sequenced. RESULTS Among HCV seropositive samples, 240 were characterized by NS5B partial sequences and classified into four genotypes (GPs) and eight subtypes. HCV GP3 predominated and accounted for 66.3%, followed by GP1 (27.5%), GP6 (4.2%) and GP2 (2.1%). HCV subtypes 3b (41.7%) and 3a (24.6%) were the most common subtypes. None of the demographic characteristics showed a significant difference when comparing with HCV genotypes. The geographic feature shown GPs in six regions were the same, but the frequency of subtypes exhibited regional divergence. Phylogenetic analyses demonstrated that 3b had become a local endemic in Jiangsu. CONCLUSION The distribution of HCV subtypes among heroin users in Jiangsu province was complex. The data could provide more precise estimates for HCV prevalence and genotype distribution as well as heroin users of Jiangsu province.
Collapse
|
47
|
Chen P, Ma A, Liu Q. Cost-Effectiveness of Elbasvir/Grazoprevir Versus Daclatasvir Plus Asunaprevir in Patients with Chronic Hepatitis C Virus Genotype 1b Infection in China. Clin Drug Investig 2018; 38:1031-1039. [PMID: 30194584 DOI: 10.1007/s40261-018-0702-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE New direct-acting antivirals (DAAs) have high efficacy and tolerability in the treatment of hepatitis C virus (HCV) infection. The objective of this study was to assess the cost-effectiveness of elbasvir/grazoprevir (EBR/GZR) versus daclatasvir plus asunaprevir (DCV + ASV) in Chinese patients with chronic HCV genotype (GT) 1b infection stratified by cirrhosis status and treatment history. METHODS A cohort state-transition model was constructed to simulate the course of chronic HCV infection in patients stratified by cirrhosis status and treatment history. The model projected lifetime outcomes and costs in terms of HCV treatment, laboratory tests, clinical procedures, and hospitalizations. Mean age of the study cohort at baseline was 45 years, based on published sources. Sustained virologic response (SVR) rates were derived from clinical trials. Healthcare resource utilization and health utilities were extracted or estimated from published studies in Chinese populations. The stability of the base-case analysis was validated by deterministic and probabilistic sensitivity analyses. RESULTS In each subpopulation of Chinese patients, treatment with EBR/GZR dominated treatment with DCV + ASV, with lower costs and higher quality-adjusted life-years (QALYs). Sensitivity analysis demonstrated that EBR/GZR was the cost-effective option compared to DCV + ASV in 77.4-97.4% or 94.1-100% of model simulations in Chinese treatment-naïve or treatment-experienced patients, respectively, as the cost-effectiveness threshold changed from zero to US$24,150/QALY (three times GDP per capita in China). CONCLUSIONS Treatment with EBR/GZR was the cost-effective option for patients with chronic HCV GT1b infection in China, regardless of cirrhosis status or treatment history.
Collapse
Affiliation(s)
- Pingyu Chen
- School of International Pharmaceutical Business, China Pharmaceutical University, No. 639 Longmian Road, Jiangning District, Nanjing, 211198, People's Republic of China
| | - Aixia Ma
- School of International Pharmaceutical Business, China Pharmaceutical University, No. 639 Longmian Road, Jiangning District, Nanjing, 211198, People's Republic of China.
| | - Qiang Liu
- School of International Pharmaceutical Business, China Pharmaceutical University, No. 639 Longmian Road, Jiangning District, Nanjing, 211198, People's Republic of China
| |
Collapse
|
48
|
Abstract
INTRODUCTION Hepatitis C virus (HCV) is divided into 7 genotypes and 67 subtypes. HCV genotype studies reflect the viral transmission patterns as well as human migration routes. In a clinical setting, HCV genotype is a baseline predictor for the sustained virological response (SVR) in chronic hepatitis C patients treated with peginterferon or some direct acting antivirals (DAAs). The Versant HCV genotype 2.0 assay has been globally used for HCV genotyping over a decade. Areas covered: The assay is based on reverse hybridization principle. It is evolved from its former versions, and the accuracy and successful genotyping/subtyping rate are substantially improved. It shows an accuracy of 99-100% for genotypes 1-6. It can also reliably identify subtypes 1a and 1b. However, the assay does not allow a high resolution for many other subtypes. Reasons for indeterminate or inaccurate genotyping/subtyping results are discussed. Expert commentary: Genotyping helps to find the most efficacious and cost-effective treatment regimen. The rapid development of anti-HCV treatment regimens, however, is greatly simplifying laboratory tests. In the near future, the need for HCV genotyping and frequent serial on-treatment HCV RNA tests will decrease along with the wide use of the more potent and pan-genotypic DAA regimens.
Collapse
Affiliation(s)
- Ruifeng Yang
- a Peking University People's Hospital, Peking University Hepatology Institute , Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases , Beijing , China
| | - Lai Wei
- a Peking University People's Hospital, Peking University Hepatology Institute , Beijing Key Laboratory of Hepatitis C and Immunotherapy for Liver Diseases , Beijing , China
| |
Collapse
|
49
|
Ali Q, Kalam I, Ullah S, Jamal A, Imran M, Ullah S, Iqbal K, Waqar AB. Predictive value of IL-28B rs12979860 variants for peg-IFN, sofosbuvir plus ribavirin treatment of HCV infection in Pakistani population. Per Med 2018; 15:503-510. [PMID: 30383478 DOI: 10.2217/pme-2018-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM The correlation of IL28-B genetic variants (rs12979860) with combinational therapy (peg-interferon, sofosbuvir plus ribavirin) of hepatitis C virus infection were studied in 154 chronic hepatitis C patients. METHODS & RESULTS The sustained virological response for efficient antiviral regimen was achieved in 75.32% treated individuals. Three genotypes of rs12979860 (CC, CT and TT) were compared both in sustained virological response and nonresponders groups (p = 0.25, p ≤ 0.001, p = 0.10, respectively). CT genotype demonstrated a significant correlation (p ≤ 0.001) in both groups with higher positive predictive value (81.55%). CONCLUSION IL28 polymorphism and positive predictive value may be considered as the markers for the evaluation of the effectiveness of the treatment regimen. Further clinical trials are recommended to verify the role of IL28-B in hepatitis C virus treatment.
Collapse
Affiliation(s)
- Qaisar Ali
- Department of Medical Laboratory Sciences, Faculty of Health Allied Sciences Imperial College of Business Studies, Lahore, Pakistan
| | - Irfan Kalam
- Department of Medical Laboratory Sciences, Faculty of Health Allied Sciences Imperial College of Business Studies, Lahore, Pakistan
| | - Sajjad Ullah
- Department of Medical Laboratory Sciences, Faculty of Health Allied Sciences Imperial College of Business Studies, Lahore, Pakistan
| | - Arshad Jamal
- Department of Medical Laboratory Sciences, Faculty of Health Allied Sciences Imperial College of Business Studies, Lahore, Pakistan
| | - Muhammad Imran
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | | | - Khurshid Iqbal
- Department of Medical Laboratory Sciences, Faculty of Health Allied Sciences Imperial College of Business Studies, Lahore, Pakistan
| | - Ahmed B Waqar
- Department of Medical Laboratory Sciences, Faculty of Health Allied Sciences Imperial College of Business Studies, Lahore, Pakistan
| |
Collapse
|
50
|
Du G, Li X, Musa TH, Ji Y, Wu B, He Y, Ni Q, Su L, Li W, Ge Y. The nationwide distribution and trends of hepatitis C virus genotypes in mainland China. J Med Virol 2018; 91:401-410. [PMID: 30192393 DOI: 10.1002/jmv.25311] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 09/03/2018] [Indexed: 12/15/2022]
Abstract
Comprehensive data on hepatitis C virus (HCV) genotypes distribution is critical for treatment regimen selection, vaccine design, and drug development. This study aimed to understand the dynamic distribution of HCV genotypes in Mainland China. Three hundred sixty-two studies published from January 1993 to December 2017 involving 64 891 samples (5133 injecting drug users, 2748 volunteer blood donors, 1509 former paid plasma donors, 160 sexually encounters, and 1992 human immunodeficiency virus (HIV)/HCV coinfection patients) were eligible for the quantitative synthesis estimation. Pooled proportion of HCV genotypes (and 95% confidence intervals [CIs]) was estimated through the Freeman-Tukey double arcsine transformation by period, region, and risk group. A sharp decline of the subtype 1b was observed in all regions except in northwestern and central regions. The genotypes 3 and 6 showed an obvious increase in southern and southwestern regions and have already spread nationwide. After 2010, subtype 1b was the most dominant variant in all regions and risk groups, accounting for 54.0% (95% CI, 51.9-56.1) of all national infections. Subtype 2a was the second most prevalent strain in all regions except in the south and southwest, with 15.4% (95% CI, 13.1-17.8) national infections. The subtype 6a in southern region and 3b and 3a in southwestern region had a higher proportion of infections than that in other regions. In addition, the genotypes 3 and 6 are already prevalent in almost all risk groups. The distribution of HCV genotypes were sharply shifting in China in the past three decades. The HCV subtype 1b posed a sharp decline, whereas genotypes 3 and 6 played an increasing role in the regional and populational HCV pandemic.
Collapse
Affiliation(s)
- Guoping Du
- Hospital Office, Southeast University Hospital, Nanjing, China
| | - Xiaoshan Li
- Department of Lung Transplants Center, Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Taha Hussein Musa
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Yu Ji
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Bo Wu
- Department of Lung Transplants Center, Wuxi People's Hospital of Nanjing Medical University, Wuxi, China
| | - Yan He
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Qian Ni
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - Ling Su
- Sichuan Provincial Center for Disease Control and Prevention, Center for AIDS/STD Control and Prevention, Chengdu, China
| | - Wei Li
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| | - You Ge
- Key Laboratory of Environmental Medicine Engineering, Ministry of Education, Department Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing, China
| |
Collapse
|