1
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Kushner T, Nyabanga CT, Cotler SJ, Etzion O, Dahari H. Modeling-Based Response-Guided Hepatitis C Treatment During Pregnancy and Postpartum. Open Forum Infect Dis 2023; 10:ofad027. [PMID: 36776773 PMCID: PMC9907544 DOI: 10.1093/ofid/ofad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/18/2023] [Indexed: 01/22/2023] Open
Abstract
Treating hepatitis C virus (HCV) in pregnancy would address HCV during prenatal care and potentially reduce the risk of vertical transmission. Response-guided therapy could provide a means to individualize and the reduce duration of HCV treatment during pregnancy. Data from a 27-year-old woman indicated that, pretreatment, HCV was stable and that it dropped in a biphasic manner during sofosbuvir/velpatasvir therapy, reaching target not detected at time of delivery-16 days post-initiation of therapy. Mathematical modeling of measured HCV at days 0, 7, and 14 predicted that cure could have been achieved after 7 weeks of sofosbuvir/velpatasvir, reducing the duration of therapy by 5 weeks.
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Affiliation(s)
- Tatyana Kushner
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Custon T Nyabanga
- Department of Gastroenterology, Mount Sinai Beth Israel, New York, New York, USA
| | - Scott J Cotler
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Ohad Etzion
- Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, Beer-Sheva, Israel
| | - Harel Dahari
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
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2
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Goyal A, Churkin A, Barash D, Cotler SJ, Shlomai A, Etzion O, Dahari H. Modeling-Based Response-Guided DAA Therapy for Chronic Hepatitis C to Identify Individuals for Shortening Treatment Duration. Open Forum Infect Dis 2022; 9:ofac157. [PMID: 35493122 PMCID: PMC9045946 DOI: 10.1093/ofid/ofac157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/18/2022] [Indexed: 01/04/2023] Open
Abstract
Shortening duration of direct-acting antiviral therapy for chronic hepatitis C could provide cost savings, reduce medication exposure, and foster adherence and treatment completion in special populations. The current analysis indicates that measuring hepatitis C virus at baseline and on days 7 and 14 of therapy can identify patients for shortening therapy duration.
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Affiliation(s)
- Ashish Goyal
- The Program for Experimental and Theoretical Modeling, Division of Hepatology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA,Current affiliation: Medicine Design, Pharmacokinetics, Dynamics, & Metabolism, Pfizer Worldwide R&D, Cambridge, Massachusetts, USA
| | - Alex Churkin
- Department of Software Engineering, Sami Shamoon College of Engineering, Beer-Sheba, Israel
| | - Danny Barash
- Department of Computer Science, Ben-Gurion University, Beer-Sheba, Israel
| | - Scott J Cotler
- The Program for Experimental and Theoretical Modeling, Division of Hepatology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Amir Shlomai
- Department of Medicine D and The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ohad Etzion
- Soroka University Medical Center, Beer-Sheba, Israel,The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Harel Dahari
- The Program for Experimental and Theoretical Modeling, Division of Hepatology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA,Correspondence: Harel Dahari, PhD, Division of Hepatology, Stritch School of Medicine, Loyola University Chicago, 2160 S. First Ave, Maywood, IL 60153 ()
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3
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Churkin A, Kriss S, Uziel A, Goyal A, Zakh R, Cotler SJ, Etzion O, Shlomai A, Rotstein HG, Dahari H, Barash D. Machine learning for mathematical models of HCV kinetics during antiviral therapy. Math Biosci 2022; 343:108756. [PMID: 34883104 PMCID: PMC8792269 DOI: 10.1016/j.mbs.2021.108756] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
Mathematical models for hepatitis C virus (HCV) dynamics have provided a means for evaluating the antiviral effectiveness of therapy and estimating treatment outcomes such as the time to cure. Recently, a mathematical modeling approach was used in the first proof-of-concept clinical trial assessing in real-time the utility of response-guided therapy with direct-acting antivirals (DAAs) in chronic HCV-infected patients. Several retrospective studies have shown that mathematical modeling of viral kinetics predicts time to cure of less than 12 weeks in the majority of individuals treated with sofosbuvir-based as well as other DAA regimens. A database of these studies was built, and machine learning methods were evaluated for their ability to estimate the time to cure for each patient to facilitate real-time modeling studies. Data from these studies exploring mathematical modeling of HCV kinetics under DAAs in 266 chronic HCV-infected patients were gathered. Different learning methods were applied and trained on part of the dataset ('train' set), to predict time to cure on the untrained part ('test' set). Our results show that this machine learning approach provides a means for establishing an accurate time to cure prediction that will support the implementation of individualized treatment.
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Affiliation(s)
- Alexander Churkin
- Department of Software Engineering, Sami Shamoon College of Engineering, Beer-Sheba, Israel
| | - Stephanie Kriss
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Asher Uziel
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Ashish Goyal
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Rami Zakh
- Department of Computer Science, Ben-Gurion University, Israel
| | - Scott J Cotler
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Ohad Etzion
- Soroka University Medical Center, Beer-Sheba, Israel
| | - Amir Shlomai
- Department of Medicine D and The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Horacio G Rotstein
- Federated Department of Biological Sciences, New Jersey Institute of Technology and Rutgers University, Newark, NJ, USA; Institute for Future Technologies, New Jersey Institute of Technology, Newark, NJ, USA
| | - Harel Dahari
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA.
| | - Danny Barash
- Department of Computer Science, Ben-Gurion University, Israel.
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4
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Fabbiani M, Lombardi A, Colaneri M, Del Poggio P, Perini P, D'Ambrosio R, Degasperi E, Dibenedetto C, Giorgini A, Pasulo L, Maggiolo F, Castelli F, Brambilla P, Spinelli O, Re T, Lleo A, Rumi M, Uberti-Foppa C, Soria A, Aghemo A, Lampertico P, Baiguera C, Schiavini M, Fagiuoli S, Bruno R. High rates of sustained virological response despite premature discontinuation of directly acting antivirals in HCV-infected patients treated in a real-life setting. J Viral Hepat 2021; 28:558-568. [PMID: 33306247 DOI: 10.1111/jvh.13454] [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: 05/23/2020] [Revised: 08/21/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023]
Abstract
In routine clinical practice, hepatitis C virus-infected patients can prematurely discontinue the prescribed regimen for several reasons. The aim of our study was to investigate sustained virological response (SVR12) rates in patients who prematurely discontinued directly acting antiviral (DAA) regimens and to assess the shortest effective duration of DAA able to lead to SVR12. We retrospectively collected the SVR rates of patients, registered in the NAVIGATORE-Lombardia Network database from January 2015, who discontinued DAAs before the predefined end of treatment. Overall, we included 365 patients, males were the majority (213, 58.4%), mean age was 60.5 years, and 53 (14.5%) patients were HIV-co-infected. Liver cirrhosis was observed in 251 (68.8%) subjects, and the most represented genotypes were 1b (n = 168, 46%) and 3 (n = 59, 16.2%). DAA was discontinued a median of 1 (IQR 1-4) weeks before the predefined EOT, with 164 (44.9%) patients stopping DAAs at least 2 weeks before the planned schedule. In patients with F0-F3 liver fibrosis, lower rates of SVR12 were observed in patients treated for <4 weeks: 50% (n = 2/4) vs. 99.1% (n = 109/110) for ≥4 weeks, p = 0.003. In patients with liver cirrhosis, lower rates of SVR12 were observed in patients treated <8 weeks: 83.3% (n = 25/30) vs. 94.6% (n = 209/221) for ≥8 weeks, p = 0.038. Despite premature discontinuation of DAA, high SVR12 rates were observed in a real-life setting for treatment lasting at least 4 weeks in patients with liver fibrosis F0-F3 and 8 weeks in those with liver cirrhosis. On this basis, feasibility of reducing DAA treatment duration should be explored in randomized clinical trials.
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Affiliation(s)
- Massimiliano Fabbiani
- U.O. Malattie Infettive e Tropicali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,UOC Malattie Infettive e Tropicali, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Andrea Lombardi
- U.O. Malattie Infettive e Tropicali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marta Colaneri
- U.O. Malattie Infettive e Tropicali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Paolo Perini
- Divisione di Medicina, Policlinico San Pietro, Bergamo, Italy
| | - Roberta D'Ambrosio
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,UOC Gastroenterologia ed Epatologia, CRC 'AM e A Migliavacca' per lo studio e la cura delle malattie del fegato, Milan, Italy
| | - Elisabetta Degasperi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,UOC Gastroenterologia ed Epatologia, CRC 'AM e A Migliavacca' per lo studio e la cura delle malattie del fegato, Milan, Italy
| | - Clara Dibenedetto
- Unità di Epatologia e Gastroenterologia, Ospedale San Paolo, Milan, Italy
| | - Alessia Giorgini
- Unità di Epatologia e Gastroenterologia, Ospedale San Paolo, Milan, Italy
| | - Luisa Pasulo
- Unità di Gastroenterologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Franco Maggiolo
- U.O. Malattie Infettive, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Paola Brambilla
- U.O. Malattie Infettive, Istituti Ospitalieri, Cremona, Italy
| | | | - Tiziana Re
- U.O. Malattie Infettive, ASST Ovest Milanese, Legnano, Italy
| | - Ana Lleo
- Medicina Interna ed Epatologia, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Mariagrazia Rumi
- U.O. Epatologia, Ospedale San Giuseppe Multimedica, Università degli Studi di Milano, Milan, Italy
| | - Caterina Uberti-Foppa
- Division of Infectious Diseases, Vita-Salute San Raffaele University Milan, Milan, Italy.,Division of Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Soria
- UO Malattie Infettive, Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - Alessio Aghemo
- Medicina Interna ed Epatologia, Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Pietro Lampertico
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,UOC Gastroenterologia ed Epatologia, CRC 'AM e A Migliavacca' per lo studio e la cura delle malattie del fegato, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Chiara Baiguera
- UO Malattie Infettive, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Monica Schiavini
- Dipartimento di Malattie Infettive, Ospedale Luigi Sacco, Milan, Italy
| | - Stefano Fagiuoli
- Unità di Gastroenterologia, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Raffaele Bruno
- U.O. Malattie Infettive e Tropicali, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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5
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Lombardo SD, Lombardo S. Some stability results for a model of Hepatitis C including alanine aminotransferase and immune system. INT J BIOMATH 2020. [DOI: 10.1142/s1793524520500801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In clinical practice, many cirrhosis scores based on alanine aminotransferase (ALT) levels exist. Although the most recent direct acting antivirals (DAAs) reduce fibrosis and ALT levels, the Hepatitis C virus (HCV) is not always removed. In this paper, we study a mathematical model of the HCV virus, which takes into account the role of the immune system, to investigate the ALT behavior during therapy. We find five equilibrium points and analyze their stability. A sufficient condition for global asymptotical stability of the infection-free equilibrium is obtained and local asymptotical stability conditions are given for the immune-free infection and cytotoxic T lymphocytes (CTL) response equilibria. The stability of the infection equilibrium with the full immune response is numerically performed.
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Affiliation(s)
- Salvo Danilo Lombardo
- CeMM Research Center for Molecular Medicine of the Austrian, Academy of Sciences, Lazarettgasse 14, AKH BT 25.3, A-1090 Vienna, Austria
| | - Sebastiano Lombardo
- Department of Mathematics and Computer Science, University of Catania (Ret.), 95125, Catania, Italy
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6
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Etzion O, Dahari H, Yardeni D, Issachar A, Nevo-Shor A, Cohen-Naftaly M, Ashur Y, Uprichard SL, Arbib OS, Munteanu D, Braun M, Cotler SJ, Abufreha N, Keren-Naus A, Shemer-Avni Y, Mor O, Murad J, Novack V, Shlomai A. Response guided therapy for reducing duration of direct acting antivirals in chronic hepatitis C infected patients: a Pilot study. Sci Rep 2020; 10:17820. [PMID: 33082372 PMCID: PMC7575564 DOI: 10.1038/s41598-020-74568-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/30/2020] [Indexed: 02/06/2023] Open
Abstract
The advent of direct-acting antivirals (DAAs) has transformed the landscape of hepatitis C virus (HCV) management. We aimed to prospectively (real-time) evaluate the feasibility of using a response-guided therapy approach, based on mathematical modeling of early viral kinetics, to reduce the duration of DAAs therapy. Patients were treated with DAAs according to the physicians' preference. HCV was measured at baseline and at day 2 and weeks 1, 2 and 4 after treatment initiation. The primary endpoint was the proportion of patients with sustained-virological response (SVR) at 12 and/or 24 weeks post-treatment. Twenty-nine patients (mean age 54 ± 16, 44% females, 73% with HCV genotype 1), were enrolled and all completed therapy. Treatment duration was shortened in 11 of the 29 patients (38%). SVR was achieved in 28 of the 29 patients (97%). Relapse occurred post treatment in a single case of a non-cirrhotic male with genotype 3, who was treated with sofosbuvir/velpatasvir for 6 weeks. Virus sequencing did not identify baseline or treatment emergent resistance associated substitutions. Real-time mathematical modeling of early HCV kinetics can be utilized for shortening DAAs duration in approximately 40% of patients without compromising treatment efficacy.Clinical trial registration: ClinicalTrials.gov Identifier: NCT03603327.
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Affiliation(s)
- Ohad Etzion
- grid.412686.f0000 0004 0470 8989Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, 151 Rager Yitzhak Blvd, 84171 Beer-Sheva, Israel ,grid.7489.20000 0004 1937 0511Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Harel Dahari
- grid.164971.c0000 0001 1089 6558The Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, 2160 S. First Ave, Maywood, IL 60153 USA
| | - David Yardeni
- grid.412686.f0000 0004 0470 8989Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, 151 Rager Yitzhak Blvd, 84171 Beer-Sheva, Israel ,grid.7489.20000 0004 1937 0511Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Assaf Issachar
- grid.413156.40000 0004 0575 344XDepartment of Medicine D and The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Anat Nevo-Shor
- grid.412686.f0000 0004 0470 8989Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, 151 Rager Yitzhak Blvd, 84171 Beer-Sheva, Israel ,grid.7489.20000 0004 1937 0511Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michal Cohen-Naftaly
- grid.413156.40000 0004 0575 344XDepartment of Medicine D and The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaffa Ashur
- grid.412686.f0000 0004 0470 8989Medical Management Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Susan L. Uprichard
- grid.164971.c0000 0001 1089 6558The Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, 2160 S. First Ave, Maywood, IL 60153 USA
| | - Orly Sneh Arbib
- grid.413156.40000 0004 0575 344XDepartment of Medicine D and The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniela Munteanu
- grid.412686.f0000 0004 0470 8989Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, 151 Rager Yitzhak Blvd, 84171 Beer-Sheva, Israel ,grid.7489.20000 0004 1937 0511Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Marius Braun
- grid.413156.40000 0004 0575 344XDepartment of Medicine D and The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Scott J. Cotler
- grid.164971.c0000 0001 1089 6558The Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, 2160 S. First Ave, Maywood, IL 60153 USA
| | - Naim Abufreha
- grid.412686.f0000 0004 0470 8989Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, 151 Rager Yitzhak Blvd, 84171 Beer-Sheva, Israel ,grid.7489.20000 0004 1937 0511Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ayelet Keren-Naus
- grid.412686.f0000 0004 0470 8989Laboratory of Clinical Virology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yonat Shemer-Avni
- grid.412686.f0000 0004 0470 8989Laboratory of Clinical Virology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Orna Mor
- grid.413795.d0000 0001 2107 2845Central Virology Laboratory, Ministry of Health, Sheba Medical Center, Ramat Gan, Israel
| | - Jayanah Murad
- grid.412686.f0000 0004 0470 8989Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Victor Novack
- grid.412686.f0000 0004 0470 8989Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Amir Shlomai
- grid.413156.40000 0004 0575 344XDepartment of Medicine D and The Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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7
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Churkin A, Lewkiewicz S, Reinharz V, Dahari H, Barash D. Efficient Methods for Parameter Estimation of Ordinary and Partial Differential Equation Models of Viral Hepatitis Kinetics. MATHEMATICS 2020; 8. [PMID: 33224865 PMCID: PMC7676746 DOI: 10.3390/math8091483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Parameter estimation in mathematical models that are based on differential equations is known to be of fundamental importance. For sophisticated models such as age-structured models that simulate biological agents, parameter estimation that addresses all cases of data points available presents a formidable challenge and efficiency considerations need to be employed in order for the method to become practical. In the case of age-structured models of viral hepatitis dynamics under antiviral treatment that deal with partial differential equations, a fully numerical parameter estimation method was developed that does not require an analytical approximation of the solution to the multiscale model equations, avoiding the necessity to derive the long-term approximation for each model. However, the method is considerably slow because of precision problems in estimating derivatives with respect to the parameters near their boundary values, making it almost impractical for general use. In order to overcome this limitation, two steps have been taken that significantly reduce the running time by orders of magnitude and thereby lead to a practical method. First, constrained optimization is used, letting the user add constraints relating to the boundary values of each parameter before the method is executed. Second, optimization is performed by derivative-free methods, eliminating the need to evaluate expensive numerical derivative approximations. The newly efficient methods that were developed as a result of the above approach are described for hepatitis C virus kinetic models during antiviral therapy. Illustrations are provided using a user-friendly simulator that incorporates the efficient methods for both the ordinary and partial differential equation models.
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Affiliation(s)
- Alexander Churkin
- Department of Software Engineering, Sami Shamoon College of Engineering, Beer-Sheva 8410501, Israel
- Correspondence: (A.C.); (D.B.); Tel.: +972-8-647-5281 (A.C.); +972-8-647-2714 (D.B.)
| | - Stephanie Lewkiewicz
- Department of Mathematics, University of California at Los Angeles, Los Angeles, CA 90095, USA
| | - Vladimir Reinharz
- Department of Computer Science, Université du Québec à Montréal, Montreal, QC H3C 3P8, Canada
| | - Harel Dahari
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Medical Center, Maywoood, IL 60153, USA
| | - Danny Barash
- Department of Computer Science, Ben-Gurion University, Beer-Sheva 8410501, Israel
- Correspondence: (A.C.); (D.B.); Tel.: +972-8-647-5281 (A.C.); +972-8-647-2714 (D.B.)
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8
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Dasgupta S, Imamura M, Gorstein E, Nakahara T, Tsuge M, Churkin A, Yardeni D, Etzion O, Uprichard SL, Barash D, Cotler SJ, Dahari H, Chayama K. Modeling-Based Response-Guided Glecaprevir-Pibrentasvir Therapy for Chronic Hepatitis C to Identify Patients for Ultrashort Treatment Duration. J Infect Dis 2020; 222:1165-1169. [PMID: 32363394 PMCID: PMC7768761 DOI: 10.1093/infdis/jiaa219] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/24/2020] [Indexed: 12/14/2022] Open
Abstract
We recently showed in a proof-of-concept study that real-time modeling-based response-guided therapy can shorten hepatitis C virus treatment duration with sofosbuvir-velpatasvir, elbasvir-grazoprevir, and sofosbuvir-ledipasvir without compromising efficacy, confirming our retrospective modeling reports in >200 patients. However, retrospective modeling of pibrentasvir-glecaprevir (P/G) treatment has yet to be evaluated. In the current study, modeling hepatitis C virus kinetics in 44 cirrhotic and noncirrhotic patients predicts that P/G treatment might have been reduced to 4, 6, and 7 weeks in 16%, 34%, and 14% of patients, respectively. These results support the further evaluation of a modeling-based response-guided therapy approach using P/G.
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Affiliation(s)
- Swikriti Dasgupta
- The Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Michio Imamura
- Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima, Japan
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Evan Gorstein
- The Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Takashi Nakahara
- Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima, Japan
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masataka Tsuge
- Research Center for Hepatology and Gastroenterology, Hiroshima University, Hiroshima, Japan
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Alexander Churkin
- Department of Software Engineering, Sami Shamoon College of Engineering, Beer-Sheva, Israel
| | - David Yardeni
- Soroka University Medical Center, Beer Sheva, Israel
| | - Ohad Etzion
- Soroka University Medical Center, Beer Sheva, Israel
| | - Susan L Uprichard
- The Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Danny Barash
- Department of Computer Science, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Scott J Cotler
- The Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Harel Dahari
- The Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois, USA
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Software Engineering, Sami Shamoon College of Engineering, Beer-Sheva, Israel
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9
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Modeling based response guided therapy in subjects with recent hepatitis C infection. Antiviral Res 2020; 180:104862. [PMID: 32592829 DOI: 10.1016/j.antiviral.2020.104862] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND & AIMS Mathematical modeling of viral kinetics has been shown to identify patients with chronic hepatitis C virus (HCV) infection who could be cured with a shorter duration of direct-acting antiviral (DAA) treatment. However, modeling therapy duration has yet to be evaluated in recently infected individuals. The aim of this study was to retrospectively examine whether modeling can predict outcomes of six-week sofosbuvir (SOF) and weight-based ribavirin (R) therapy in individuals with recent HCV infection. METHODS Modeling was used to estimate viral host parameters and to predict time to cure for 12 adults with recent HCV infection (<12 months of infection) who received six weeks of treatment with SOF + R. RESULTS Modeling results yielded a 100% negative predictive value for SOF + R treatment response in nine participants and suggested that a median of 13 [interquartile range: 8-16] weeks of therapy would be required for these patients to achieve cure. Modeling predicted cure after 5 weeks of therapy in the only modeled participant who achieved a sustained virological response. However, cure was also predicted for two participants who relapsed following treatment. CONCLUSIONS The modeling results confirm that longer than 6 weeks of SOF + R is needed to reach cure in individuals with recent HCV infection. Prospective real-time modeling under current potent DAA regimens is needed to validate the potential of response-guided therapy in the management of recent HCV infection.
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10
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The Beginning of Ending Hepatitis C Virus: A Summary of the 26th International Symposium on Hepatitis C Virus and Related Viruses. Viruses 2020; 12:v12030302. [PMID: 32168867 PMCID: PMC7150740 DOI: 10.3390/v12030302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/10/2020] [Indexed: 12/14/2022] Open
Abstract
Hepatitis C virus (HCV) infects ~71 million people worldwide, and 399,000 people die annually due to HCV-related liver cirrhosis and hepatocellular carcinoma. The use of direct-acting antivirals results in a sustained virologic response in >95% of patients with chronic HCV infection. However, several issues remain to be solved to eradicate HCV. At the 26th International Symposium on Hepatitis C Virus and Related Viruses (HCV2019) held in Seoul, South Korea, October 5–8, 2019, virologists, immunologists, and clinical scientists discussed these remaining issues and how we can achieve the elimination of HCV.
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11
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Huang CF, Yeh ML, Huang CI, Liang PC, Lin YH, Hsieh MY, Chen KY, Ko YM, Lin ZY, Chen SC, Huang JF, Dai CY, Chuang WL, Yu ML. Ribavirin facilitates early viral kinetics in chronic hepatitis C patients receiving daclatasvir/asunaprevir. J Gastroenterol Hepatol 2020; 35:151-156. [PMID: 31373037 DOI: 10.1111/jgh.14815] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/15/2019] [Accepted: 07/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Ribavirin (RBV) remains crucial in difficult-to-cure chronic hepatitis C patients receiving directly acting antivirals (DAAs). The current study aimed to address whether RBV enhanced early viral kinetics in patients with DAAs. METHODS Hepatitis C virus (HCV) genotype-1b patients were allocated to daclatasvir/asunaprevir +weight-based RBV (1000-1200 mg/day) for 12-24 weeks. HCV RNA levels were compared at day 1, week 1, week 2, and week 4 of treatment. RESULTS The sustained virological response rate was 100% (67/67) and 96.7% (59/61) in the RBV and non-RBV group, respectively. The HCV RNA levels at treatment week 2 (W2) were significantly lower in the RBV group than in the non-RBV group (0.42 ± 0.81 log IU/mL vs 0.79 ± 1.03 log IU/mL, P = 0.04). Among the intermediate responders who remained to have detectable RNA after W1 of treatment, patients with RBV had a significantly higher rate of undetectable HCV RNA (71.4% vs 36.0%, P = 0.003) and lower HCV RNA level at W2 (0.55 ± 0.89 log IU/mL vs 1.32 ± 1.04 log IU/mL, P = 0.001). A more significant magnitude of HCV RNA reduction was also noted from baseline to day 1 (3.15 ± 0.38 log IU/mL vs 2.80 ± 0.70 log IU/mL, P = 0.009) and W1 to W2 (1.40 ± 0.65 log IU/mL vs 0.88 ± 0.78 log IU/mL, P = 0.007) in the RBV group compared to the non-RBV group among the intermediate responders. Logistic regression analysis revealed that adding RBV independently predicted undetectable HCV RNA at W2 (odds ratio/confidence interval: 4.74/1.54-14.57, P = 0.007) in the intermediate responders. CONCLUSIONS Adding RBV to DAAs improved early viral kinetic, in particular, for intermediate responders.
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Affiliation(s)
- Chung-Feng Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, Center for Cancer Research, and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Occupational Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lun Yeh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, Center for Cancer Research, and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-I Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Cheng Liang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yi-Hung Lin
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Yen Hsieh
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuan-Yu Chen
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Min Ko
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Zu-Yau Lin
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, Center for Cancer Research, and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shinn-Cherng Chen
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, Center for Cancer Research, and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jee-Fu Huang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, Center for Cancer Research, and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Yen Dai
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, Center for Cancer Research, and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Preventive Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, Center for Cancer Research, and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, Center for Cancer Research, and Center for Liquid Biopsy, Kaohsiung Medical University, Kaohsiung, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan.,Center For Intelligent Drug Systems and Smart Bio-devices (IDS2B) and Department of Biological Science and Technology, College of Biological Science and Technology, National Chiao Tung University, Hsin-Chu, Taiwan.,Center for Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
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12
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Goyal A, Liao LE, Perelson AS. Within-host mathematical models of hepatitis B virus infection: Past, present, and future. ACTA ACUST UNITED AC 2019; 18:27-35. [PMID: 31930181 DOI: 10.1016/j.coisb.2019.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mathematical modeling has been instrumental in enhancing our understanding of the viral dynamics of hepatitis B virus (HBV) infection. We give a primer on HBV infection in humans and a brief overview of the development of within-host mathematical models of HBV infection. In the last decade, models have advanced from considering chronic HBV infections under therapy to the pathogenesis of infection. We also summarize estimates of key viral dynamic parameters that have varied greatly among studies, and show that they impact model predictions. Future directions for mathematical modeling of HBV infection are proposed to better understand emerging therapies, the HBV life cycle, predicting cure, and the mechanisms involved in the immune response to HBV infection.
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Affiliation(s)
- Ashish Goyal
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, New Mexico, 87545, USA
| | - Laura E Liao
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, New Mexico, 87545, USA
| | - Alan S Perelson
- Theoretical Biology and Biophysics, Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, New Mexico, 87545, USA
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13
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Reinharz V, Churkin A, Lewkiewicz S, Dahari H, Barash D. A Parameter Estimation Method for Multiscale Models of Hepatitis C Virus Dynamics. Bull Math Biol 2019; 81:3675-3721. [PMID: 31338739 PMCID: PMC7375976 DOI: 10.1007/s11538-019-00644-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/10/2019] [Indexed: 12/11/2022]
Abstract
Mathematical models that are based on differential equations require detailed knowledge about the parameters that are included in the equations. Some of the parameters can be measured experimentally while others need to be estimated. When the models become more sophisticated, such as in the case of multiscale models of hepatitis C virus dynamics that deal with partial differential equations (PDEs), several strategies can be tried. It is possible to use parameter estimation on an analytical approximation of the solution to the multiscale model equations, namely the long-term approximation, but this limits the scope of the parameter estimation method used and a long-term approximation needs to be derived for each model. It is possible to transform the PDE multiscale model to a system of ODEs, but this has an effect on the model parameters themselves and the transformation can become problematic for some models. Finally, it is possible to use numerical solutions for the multiscale model and then use canned methods for the parameter estimation, but the latter is making the user dependent on a black box without having full control over the method. The strategy developed here is to start by working directly on the multiscale model equations for preparing them toward the parameter estimation method that is fully coded and controlled by the user. It can also be adapted to multiscale models of other viruses. The new method is described, and illustrations are provided using a user-friendly simulator that incorporates the method.
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Affiliation(s)
- Vladimir Reinharz
- Department of Computer Science, Ben-Gurion University, Beersheba, Israel
| | - Alexander Churkin
- Department of Software Engineering, Sami Shamoon College of Engineering, Beersheba, Israel
| | - Stephanie Lewkiewicz
- Department of Mathematics, University of California at Los Angeles, Los Angeles, CA, USA
| | - Harel Dahari
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Medical Center, Maywoood, IL, USA
| | - Danny Barash
- Department of Computer Science, Ben-Gurion University, Beersheba, Israel.
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14
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Lhomme S, DebRoy S, Kamar N, Abravanel F, Metsu D, Marion O, Dimeglio C, Cotler SJ, Izopet J, Dahari H. Plasma Hepatitis E Virus Kinetics in Solid Organ Transplant Patients Receiving Ribavirin. Viruses 2019; 11:E630. [PMID: 31323954 PMCID: PMC6669701 DOI: 10.3390/v11070630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/06/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) infection causes chronic hepatitis in solid organ transplant (SOT) recipients. Antiviral therapy consists of three months of ribavirin, although response rates are not optimal. We characterized plasma HEV kinetic patterns in 41 SOT patients during ribavirin therapy. After a median pharmacological delay of three (range: 0-21) days, plasma HEV declined from a median baseline level of 6.12 (3.53-7.45) log copies/mL in four viral kinetic patterns: (i) monophasic (n = 18), (ii) biphasic (n = 13), (iii) triphasic (n = 8), and (iv) flat-partial response (n = 2). The mean plasma HEV half-life was estimated to be 2.0 ± 0.96 days. Twenty-five patients (61%) had a sustained virological response (SVR) 24 weeks after completion of therapy. Viral kinetic patterns (i)-(iii) were not associated with baseline characteristics or outcome of therapy. A flat-partial response was associated with treatment failure. All patients with a log concentration decrease of plasma HEV at day seven of >15% from baseline achieved SVR. In conclusion, viral kinetic modeling of plasma HEV under ribavirin therapy showed, for the first time, four distinct kinetic profiles, a median pharmacologic delay of three days, and an estimated HEV half-life of two days. Viral kinetic patterns were not associated with response to therapy, with the exception of a flat-partial response.
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Affiliation(s)
- Sebastien Lhomme
- National Reference Center for Hepatitis E, Department of Virology, Federative Institute of Biology, CHU Purpan, INSERM U1043, University Toulouse III-Paul Sabatier, 31300 Toulouse, France.
| | - Swati DebRoy
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL 60153, USA
- Department of Mathematics and Computational Science, University of South Carolina-Beaufort, Bluffton, SC 29909, USA
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, University Toulouse III-Paul Sabatier, 31300 Toulouse, France
| | - Florence Abravanel
- National Reference Center for Hepatitis E, Department of Virology, Federative Institute of Biology, CHU Purpan, INSERM U1043, University Toulouse III-Paul Sabatier, 31300 Toulouse, France
| | - David Metsu
- Department of Pharmacokinetics and Toxicology, Federative Institute of Biology, CHU Purpan, INTHERES, INRA, ENVT, University Toulouse III-Paul Sabatier, 31300 Toulouse, France
| | - Olivier Marion
- Department of Nephrology and Organ Transplantation, CHU Rangueil, INSERM U1043, University Toulouse III-Paul Sabatier, 31300 Toulouse, France
| | - Chloé Dimeglio
- National Reference Center for Hepatitis E, Department of Virology, Federative Institute of Biology, CHU Purpan, INSERM U1043, University Toulouse III-Paul Sabatier, 31300 Toulouse, France
| | - Scott J Cotler
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Jacques Izopet
- National Reference Center for Hepatitis E, Department of Virology, Federative Institute of Biology, CHU Purpan, INSERM U1043, University Toulouse III-Paul Sabatier, 31300 Toulouse, France
| | - Harel Dahari
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL 60153, USA.
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15
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Gambato M, Canini L, Lens S, Graw F, Perpiñan E, Londoño MC, Uprichard SL, Mariño Z, Reverter E, Bartres C, González P, Pla A, Costa J, Burra P, Cotler SJ, Forns X, Dahari H. Early HCV viral kinetics under DAAs may optimize duration of therapy in patients with compensated cirrhosis. Liver Int 2019; 39:826-834. [PMID: 30499631 PMCID: PMC6483833 DOI: 10.1111/liv.14014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/21/2018] [Accepted: 11/20/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Detailed hepatitis C virus (HCV) kinetics modelling is scarce in patients with advanced liver disease receiving direct-acting antivirals (DAAs). Due to budget restrictions, patients and health systems would benefit from the shortest possible treatment course. We investigated whether modelling very early HCV kinetics in cirrhotic patients under DAAs therapy could be used to individualize care and reduce treatment duration to achieve cure. METHODS We included 74 patients with HCV-related cirrhosis who received interferon-free treatments for 12-24 weeks. HCV genotype, liver disease stage and treatment regimen were recorded. Viral load was determined prospectively at very frequent intervals until target not detected (TND, <15 IU/mL). A viral kinetic model was used to predict time to cure based on HCV clearance in extracellular body fluid (CL-EF). RESULTS Sixty-eight patients (92%) achieved cure. Thirteen (18%) had MELD ≥15, 35 (47%) were Child-Pugh (CTP) ≥7. Median time to reach TND was 2 weeks (IQR: 1-4 weeks). Modelling indicated an average DAAs efficacy in blocking viral production of ε = 99.1%. HCV half-life (t1/2 ) was significantly shorter in patients with CTP <7, LSM <21 kPa or MELD <15 (1.5 vs 2.5 hours; P = 0.0057). The overall median CL-EF was 5.6 weeks (4.1-7.8). A CTP >7 and a LSM ≥21 kPa were significantly (P = 0.016) associated with longer CL-EF. CONCLUSIONS The study provides insights into HCV dynamics during DAAs therapy in patients with compensated and decompensated cirrhosis. Viral kinetics modelling suggests that treatment duration may be optimized in patients with compensated cirrhosis.
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Affiliation(s)
- Martina Gambato
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
- Multivisceral Transplant Unit, Padua University Hospital, Italy
| | - Laetitia Canini
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, Illinois, United States
- Centre for Immunity, Infection and Evolution, University of Edinburgh, Edinburgh, United Kingdom
| | - Sabela Lens
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Frederik Graw
- Center for Modeling and Simulation in the Biosciences, BioQuant Center, Heidelberg University, Heidelberg, Germany
| | - Elena Perpiñan
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Maria-Carlota Londoño
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Susan L. Uprichard
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Zoe Mariño
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Enric Reverter
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Concepcio Bartres
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Patricia González
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Anna Pla
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Josep Costa
- Microbiology Service, Hospital Clínic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Patrizia Burra
- Multivisceral Transplant Unit, Padua University Hospital, Italy
| | - Scott J. Cotler
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, Illinois, United States
| | - Xavier Forns
- Liver Unit, Hospital Clinic, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Spain
| | - Harel Dahari
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, Illinois, United States
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16
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Sandmann L, Manns MP, Maasoumy B. Utility of viral kinetics in HCV therapy - It is not over until it is over? Liver Int 2019; 39:815-817. [PMID: 31020775 DOI: 10.1111/liv.14047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 01/10/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Lisa Sandmann
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael P Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Benjamin Maasoumy
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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17
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Koh C, Dubey P, Han MAT, Walter PJ, Garraffo HM, Surana P, Southall NT, Borochov N, Uprichard SL, Cotler SJ, Etzion O, Heller T, Dahari H, Liang TJ. A randomized, proof-of-concept clinical trial on repurposing chlorcyclizine for the treatment of chronic hepatitis C. Antiviral Res 2019; 163:149-155. [PMID: 30711416 DOI: 10.1016/j.antiviral.2019.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Chlorcyclizine HCl (CCZ) is a piperazine-class antihistamine with anti-hepatitis C virus (HCV) activity in vitro and in vivo. In a first-in-humans study for HCV, we evaluated the antiviral effects and safety of CCZ±ribavirin (RBV), characterized pharmacokinetic (PK) and viral kinetic (VK) patterns, and provide insights into CCZs mode of action against HCV. METHODS Chronic HCV patients were randomized to CCZ (75 mg twice daily) or CCZ+weight-based RBV (1000/1200 mg daily) for 28 days. Therapy started with a loading dose of CCZ 150 mg ± RBV. Serial assessments of safety, liver tests, PK and VK markers were obtained. RESULTS 24 HCV patients were treated; 54% male, median age 56 years, median HCV RNA 6.30 log IU/ml, without baseline differences between groups. At the end of therapy, subjects treated with CCZ monotherapy did not show any significant or sustained reduction in viremia (p = 0.69), whereas 7/12 (58%) subjects treated with CCZ+RBV had a >3-fold decline in HCV RNA. Subjects who responded demonstrated monophasic (n = 2), biphasic (n = 2) and triphasic (n = 3) VK responses. Contrary to historical RBV monotherapy response, CCZ+RBV demonstrated a continued viral decline suggesting a possible synergistic effect of CCZ+RBV. Mathematical modeling predicts a median effectiveness of CCZ+RBV in blocking viral production (ε) of 59% (Interquartile range, IQR: 50%) and blocking infection (η) of 78% (IQR: 23%). Adverse events (AEs) were mild-moderate without treatment discontinuations for AEs. CONCLUSIONS In this human pilot study, CCZ demonstrated some anti-HCV effects, mostly in combination with RBV. More potent CCZ derivatives with optimal PK features may be more suitable for future therapeutic development. ClinicalTrials.gov number: NCT02118012.
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Affiliation(s)
- Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
| | - Preeti Dubey
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA
| | - Ma Ai Thanda Han
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Peter J Walter
- Clinical Mass Spectrometry Core, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - H Martin Garraffo
- Clinical Mass Spectrometry Core, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Pallavi Surana
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Noel T Southall
- Division of Pre-Clinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Nathaniel Borochov
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA
| | - Susan L Uprichard
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA
| | - Scott J Cotler
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA
| | - Ohad Etzion
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Harel Dahari
- The Program for Experimental & Theoretical Modeling, Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA
| | - T Jake Liang
- Liver Diseases Branch, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
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18
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Ueno T, Osawa M, Imai Y, Ishikawa H, Garimella T. Exposure-Response (Efficacy) Analysis of Daclatasvir and Asunaprevir in Japanese Patients With Hepatitis C Virus Infection. J Clin Pharmacol 2018; 58:1479-1488. [PMID: 30063245 PMCID: PMC6175176 DOI: 10.1002/jcph.1262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 04/19/2018] [Indexed: 12/12/2022]
Abstract
The treatment of hepatitis C virus (HCV) infection has been revolutionized by the development of all-oral combination regimens of direct-acting antiviral agents. The current analysis characterized the relationship between exposures of daclatasvir (DCV; tablets) and asunaprevir (ASV; capsules) and sustained virologic response (SVR) in Japanese patients who are HCV genotype (GT) 1b nonresponders to pegylated interferon (IFN) α/ribavirin or IFNβ/ribavirin, and IFN-based therapy-ineligible naive/intolerant patients receiving DCV and ASV, and provided insight into patient covariates that were most closely associated with efficacy. The relationship between the probability of achieving SVR at 12 weeks after treatment (SVR12) and average steady-state plasma concentrations estimated from population pharmacokinetic models for DCV and ASV is described using a logistic regression model with data from a phase 2 and a phase 3 study in Japanese patients infected with HCV GT 1b (N=265). The functional form characterization, which describes a relationship between DCV and ASV average steady-state plasma concentrations and SVR12, as well as covariate identification (demographic, laboratory, and prognostic and treatment covariates) were investigated during model development. The presence of the signature nonstructural protein 5A Y93H mutation at baseline was the only significant parameter of SVR12 in the final exposure-response model. Model evaluation plots demonstrate that the final model was able to predict the observed SVR rates. Exposure-response analysis supports the clinical utility of the combination regimen of 60-mg once-daily DCV and 100-mg twice-daily ASV in Japanese patients infected with HCV GT 1b.
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