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Heo J, Kim YJ, Lee JW, Kim JH, Lim YS, Han KH, Jeong SH, Cho M, Yoon KT, Bae SH, Crown ED, Fredrick LM, Alami NN, Asatryan A, Kim DH, Paik SW, Lee YJ. Efficacy and Safety of Glecaprevir/Pibrentasvir in Korean Patients with Chronic Hepatitis C: A Pooled Analysis of Five Phase II/III Trials. Gut Liver 2021; 15:895-903. [PMID: 34053916 PMCID: PMC8593501 DOI: 10.5009/gnl20321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/24/2020] [Accepted: 01/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background/Aims Glecaprevir/pibrentasvir (G/P) is the first pan-genotypic direct-acting antiviral combination therapy approved in Korea. An integrated analysis of five phase II and III trials was conducted to evaluate the efficacy and safety of G/P in Korean patients with chronic hepatitis C virus (HCV) infection. Methods The study analyzed pooled data on Korean patients with HCV infection enrolled in the ENDURANCE 1 and 2, SURVEYOR II part 4 and VOYAGE I and II trials, which evaluated the efficacy and safety of 8 or 12 weeks of G/P treatment. The patients were either treatment-naïve or had received sofosbuvir or interferon-based treatment. Efficacy was evaluated by assessing the rate of sustained virologic response at 12 weeks posttreatment (SVR12). Safety was evaluated by monitoring adverse events (AEs) and laboratory assessments. Results The analysis included 265 patients; 179 (67.5%) were HCV treatment-naïve, and most patients were either subgenotype 1B (48.7%) or 2A (44.5%). In the intention-to-treat population, 262 patients (98.9%) achieved SVR12. Three patients did not achieve SVR12 one had virologic failure and two had non-virologic failures. Most AEs were grade 1/2; eight patients (3.0%) experienced at least one grade ≥3 AE. No serious AEs related to G/P treatment were reported, and grade ≥3 hepatic laboratory abnormalities were rare (0.8%). Conclusions G/P therapy was highly efficacious and well tolerated in Korean patients with HCV infection, with most patients achieving SVR12. The safety profile was comparable to that observed in a pooled analysis of a global pan-genotypic population of patients with HCV infection who received G/P.
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Affiliation(s)
- Jeong Heo
- Department of Internal Medicine, Pusan National University College of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Woo Lee
- Department of Internal Medicine, Inha University School of Medicine, Incheon, Korea
| | - Ji Hoon Kim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kwang-Hyub Han
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Mong Cho
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Ki Tae Yoon
- Department of Internal Medicine, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Si Hyun Bae
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | | | | | | | | | - Seung Woon Paik
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Youn-Jae Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Effect of Direct-Acting Antiviral Therapy on Thrombocytopenic Patients with Hepatitis C Virus-Related Chronic Liver Disease. Gastroenterol Res Pract 2021; 2021:8811203. [PMID: 34122539 PMCID: PMC8169259 DOI: 10.1155/2021/8811203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/25/2021] [Accepted: 04/16/2021] [Indexed: 12/11/2022] Open
Abstract
Background and Aims Thrombocytopenia is a common complication in patients with chronic hepatitis C virus (HCV) that increases the risk of bleeding. We aimed to analyze the hematologic effects of the new direct-acting antiviral (DAA) therapy, particularly on the platelet count in chronic HCV-infected patients with thrombocytopenia. Patients and Methods. One hundred thrombocytopenic patients chronically infected with HCV were included in a prospective study. All patients were eligible for receiving anti-HCV treatment with sofosbuvir-based regimens for 12 weeks, according to the protocol of the National Program for treatment of HCV in Egypt sponsored by the Ministry of Health. Results At the end of treatment (EOT), there was a highly significant increase in platelet count (p < 0.001), a significant increase in white blood cells (WBCs) count (p ≤ 0.032), and a highly significant decrease in hemoglobin level (p < 0.001) as compared to pretreatment levels. Patients with mild to moderate hepatic fibrosis had significantly higher median and interquartile range (IQR) platelet count at baseline and EOT than those with advanced fibrosis and cirrhosis (p ≤ 0.023 and p < 0.001, respectively). There was more elevation in platelet count at EOT in patients with mild to moderate fibrosis than those with advanced fibrosis and cirrhosis. Out of the hundred patients, 73% showed improvement of platelet count, while 27% showed no improvement or even decrease in the platelet count. Conclusion Sofosbuvir-based DAA therapy is a highly effective and safe treatment regimen that results in the improvement of platelet count in thrombocytopenic patients, particularly in mild to moderate stages of hepatic fibrosis.
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Bayatpoor ME, Khosravi MH, Sharafi H, Rezaee-Zavareh MS, Behnava B, Alavian SM. Sofosbuvir and Ribavirin with or Without Pegylated-Interferon in Hepatitis C Virus Genotype-2 or -3 Infections: A Systematic Review and Meta-Analysis. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019; In Press. [DOI: 10.5812/archcid.79465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
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4
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Yoo SH, Kwon JH, Nam SW, Kim HY, Kim CW, You CR, Choi SW, Cho SH, Han JY, Song DS, Chang UI, Yang JM, Lee HL, Lee SW, Han NI, Kim SH, Song MJ, Hwang S, Sung PS, Jang JW, Bae SH, Choi JY, Yoon SK. Early development of de novo hepatocellular carcinoma after direct-acting agent therapy: Comparison with pegylated interferon-based therapy in chronic hepatitis C patients. J Viral Hepat 2018; 25:1189-1196. [PMID: 29660199 DOI: 10.1111/jvh.12918] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/26/2018] [Indexed: 01/18/2023]
Abstract
Patients with chronic hepatitis C who achieve a sustained viral response after pegylated interferon therapy have a reduced risk of hepatocellular carcinoma, but the risk after treatment with direct-acting antivirals is unclear. We compared the rates of early development of hepatocellular carcinoma after direct-acting antivirals and after pegylated interferon therapy. We retrospectively analysed 785 patients with chronic hepatitis C who had no history of hepatocellular carcinoma (211 treated with pegylated interferon, 574 with direct-acting antivirals) and were followed up for at least 24 weeks after antiviral treatment. De novo hepatocellular carcinoma developed in 6 of 574 patients receiving direct-acting antivirals and in 1 of 211 patients receiving pegylated interferon. The cumulative incidence of early hepatocellular carcinoma development did not differ between the treatment groups either for the whole cohort (1.05% vs 0.47%, P = .298) or for those patients with Child-Pugh Class A cirrhosis (3.73% vs 2.94%, P = .827). Multivariate analysis indicated that alpha-fetoprotein level >9.5 ng/mL at the time of end-of-treatment response was the only independent risk factor for early development of hepatocellular carcinoma in all patients (P < .0001, hazard ratio 176.174, 95% confidence interval 10.768-2882.473) and in patients treated with direct-acting agents (P < .0001, hazard ratio 128.402, 95% confidence interval 8.417-1958.680). In conclusion, the rate of early development of hepatocellular carcinoma did not differ between patients treated with pegylated interferon and those treated with direct-acting antivirals and was associated with the serum alpha-fetoprotein level at the time of end-of-treatment response.
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Affiliation(s)
- S H Yoo
- Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incehon, Korea.,Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea
| | - J H Kwon
- Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incehon, Korea.,Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea
| | - S W Nam
- Department of Internal Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incehon, Korea.,Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea
| | - H Y Kim
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - C W Kim
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - C R You
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea, Seoul, Korea
| | - S W Choi
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, St. Paul's Hospital, The Catholic University of Korea, Seoul, Korea
| | - S H Cho
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - J-Y Han
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Yeouido St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - D S Song
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - U I Chang
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - J M Yang
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - H L Lee
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - S W Lee
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - N I Han
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - S-H Kim
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - M J Song
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, Korea
| | - S Hwang
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - P S Sung
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - J W Jang
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - S H Bae
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - J Y Choi
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - S K Yoon
- Catholic University Liver Research Center, The Catholic University of Korea, Seoul, Korea.,Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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5
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Mehta R, Kabrawala M, Nandwani S, Desai P, Bhayani V, Patel S, Parekh V. Safety and Efficacy of Sofosbuvir and Daclatasvir for Hepatitis C Virus Infection in Patients with β-Thalassemia Major. J Clin Exp Hepatol 2018; 8:3-6. [PMID: 29743790 PMCID: PMC5938522 DOI: 10.1016/j.jceh.2017.06.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 06/12/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND AIMS β-thalassemia major patients are susceptible to Hepatitis C Virus (HCV) infection owing to life-long dependency for blood-transfusion. Moreover, this patient population is at risk of progression of liver fibrosis or development of cirrhosis as a consequence of both iron overload and HCV infection. Hence, this study was carried out to evaluate efficacy and safety of the combination regimen of sofosbuvir and daclatasvir for HCV infection in β-thalassemia major patients. METHODS The present study was a prospective observational study which enrolled multi-transfused β-thalassemia major patients treated with a combination regimen of sofosbuvir (400 mg) and daclatasvir (60 mg) daily for 12 weeks for HCV infection during May 2016 and November 2016 depending upon inclusion and exclusion criteria of the study. Sustained virological response at post-treatment week-12 (SVR-12) was defined as negative HCV-RNA at week-12 after completion of antiviral treatment. RESULTS A total of 10 multi-transfused patients with β-thalassemia major were included in the study. Average age of the patient was 13.60 ± 4.38 years. All the included patients were treatment-naïve, non-cirrhotic and infected with HCV genotype-3. All the patients achieved SVR-12. There was significant reduction in aspartate aminotransferase (p = 0.005) and alanine aminotransferase level (p = 0.005) and serum ferritin level (p = 0.028) after completion of the antiviral treatment. The reported adverse events include nausea, vomiting and anorexia which were managed conservatively. None of the patient required dose reduction or termination of antiviral treatment. CONCLUSION The study reports safety and efficacy of sofosbuvir-based treatment in non-cirrhotic, treatment-naive β-thalassemia major patients infected with HCV genotype-3. However, further studies with larger patient populations are needed to build up stronger evidence of safety and efficacy of this treatment approach for HCV infection in thalassemic patients.
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Affiliation(s)
- Rajiv Mehta
- Address for correspondence: Dr. Rajiv Mehta, MD, DNB (Gastroenterology), Consultant Gastroenterologist and Liver Specialist, Department of Gastroenterology, Surat Institute of Digestive Sciences (SIDS), Majura Gate, Ring Road, Surat 395002, India.
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6
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Prevalence of NS5B resistance-associated variants in treatment-naïve Asian patients with chronic hepatitis C. Arch Virol 2017; 163:467-473. [PMID: 29143142 DOI: 10.1007/s00705-017-3640-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/31/2017] [Indexed: 01/06/2023]
Abstract
There is little information on the association between baseline non-structural protein (NS) 5b resistance-associated variants (RAVs) and treatment failure in hepatitis C patients. This study examined the frequencies of natural hepatitis C virus (HCV) NS5B resistance-associated variants (RAVs) in an Asian cohort. Samples from Asian HCV patients enrolled between October 2009 and September 2014 were analyzed for NS5B RAVs within the region from amino acid 230 to 371. Serum samples were tested by PCR genotyping, with sequence alignment performed using the neighbor-joining method. NS5B was detected by Sanger sequencing followed by Geno2pheno analysis. NS5B RAVs were detected in 80.52% (1199/1489) of patients; 68.4% (1019/1489) and 79.7% (1186/1489) were associated with resistance to sofosbuvir (SOF) and dasabuvir (DSV), respectively. These RAVs were present in 95% (1004/1058) of genotype 1b patients. When genotypes 1b and 2a were compared, SOF-associated RAVs were detected at a higher frequency in genotype 1b (94.8% [1004/1058] vs. 2.9% [9/309]; χ2 = 1054.433, P < 0.001), C316H/N was more common in genotype 1b (94.7% [1002/1058] vs. 0% [0/309]; χ2 = 1096.014, P < 0.001), M289F/L/I/W/V had a higher frequency in genotype 2a (0.7% [7/309] vs. 2.3% [7/1058]; χ2 = 4.589, P = 0.032), DSV-associated RAVs were most often found in genotype 1b (95.0% [1005/1058] vs. 40.1% 124/309]; χ2 = 500.577, P < 0.001), and frequency of C316Y/H/N/W was higher in genotype 1b (94.7% [1002/1058] vs. 0% [0/309]; χ2 = 1096.014, P < 0.001). In conclusion, baseline SOF and DSV RAVs are common in Asian HCV patients and predominantly occur in genotype 1b.
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7
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Kim SJ, Jang JY, Kim EJ, Cho EK, Ahn DG, Kim C, Park HS, Jeong SW, Lee SH, Kim SG, Kim YS, Kim HS, Kim BS, Lee JH, Siddiqui A. Ginsenoside Rg3 restores hepatitis C virus-induced aberrant mitochondrial dynamics and inhibits virus propagation. Hepatology 2017; 66:758-771. [PMID: 28329914 PMCID: PMC5755973 DOI: 10.1002/hep.29177] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 02/20/2017] [Accepted: 03/17/2017] [Indexed: 12/17/2022]
Abstract
UNLABELLED Hepatitis C virus (HCV) alters mitochondrial dynamics associated with persistent viral infection and suppression of innate immunity. Mitochondrial dysfunction is also a pathologic feature of direct-acting antiviral (DAA) treatment. Despite the high efficacy of DAAs, their use in treating patients with chronic hepatitis C in interferon-sparing regimens occasionally produces undesirable side effects such as fatigue, migraine, and other conditions, which may be linked to mitochondrial dysfunction. Here, we show that clinically prescribed DAAs, including sofosbuvir, affect mitochondrial dynamics. To counter these adverse effects, we examined HCV-induced and DAA-induced aberrant mitochondrial dynamics modulated by ginsenoside, which is known to support healthy mitochondrial physiology and the innate immune system. We screened several ginsenoside compounds showing antiviral activity using a robust HCV cell culture system. We investigated the role of ginsenosides in antiviral efficacy, alteration of mitochondrial transmembrane potential, abnormal mitochondrial fission, its upstream signaling, and mitophagic process caused by HCV infection or DAA treatment. Only one of the compounds, ginsenoside Rg3 (G-Rg3), exhibited notable and promising anti-HCV potential. Treatment of HCV-infected cells with G-Rg3 increased HCV core protein-mediated reduction in the expression level of cytosolic p21, required for increasing cyclin-dependent kinase 1 activity, which catalyzes Ser616 phosphorylation of dynamin-related protein 1. The HCV-induced mitophagy, which follows mitochondrial fission, was also rescued by G-Rg3 treatment. CONCLUSION G-Rg3 inhibits HCV propagation. Its antiviral mechanism involves restoring the HCV-induced dynamin-related protein 1-mediated aberrant mitochondrial fission process, thereby resulting in suppression of persistent HCV infection. (Hepatology 2017;66:758-771).
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Affiliation(s)
- Seong-Jun Kim
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Yuseong, Daejeon 34114, South Korea,Corresponding authors: Jae Young Jang, MD, PhD, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Yongsan-gu, Seoul 04401, South Korea, Phone: +82-2-7099863; Fax: +82-2-7099696; ; Seong-Jun Kim, PhD, Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Yuseong, Daejeon 34114, South Korea, Phone: +82-42-860-7477; Fax: +82-42-861-4246;
| | - Jae Young Jang
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul 04401, South Korea,Corresponding authors: Jae Young Jang, MD, PhD, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Yongsan-gu, Seoul 04401, South Korea, Phone: +82-2-7099863; Fax: +82-2-7099696; ; Seong-Jun Kim, PhD, Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Yuseong, Daejeon 34114, South Korea, Phone: +82-42-860-7477; Fax: +82-42-861-4246;
| | - Eun-Jung Kim
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Yuseong, Daejeon 34114, South Korea
| | - Eun Kyung Cho
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul 04401, South Korea
| | - Dae Gyun Ahn
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Yuseong, Daejeon 34114, South Korea
| | - Chonsaeng Kim
- Center for Convergent Research of Emerging Virus Infection, Korea Research Institute of Chemical Technology, Yuseong, Daejeon 34114, South Korea
| | - Han Seul Park
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul 04401, South Korea
| | - Soung Won Jeong
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul 04401, South Korea
| | - Sae Hwan Lee
- Department of Internal Medicine, College of Medicine, Soonchunhyang University, Cheonan 31151, South Korea
| | - Sang Gyune Kim
- Department of Internal Medicine, College of Medicine, Soonchunhyang University, Bucheon 14584, South Korea
| | - Young Seok Kim
- Department of Internal Medicine, College of Medicine, Soonchunhyang University, Bucheon 14584, South Korea
| | - Hong Soo Kim
- Department of Internal Medicine, College of Medicine, Soonchunhyang University, Cheonan 31151, South Korea
| | - Boo Sung Kim
- Institute for Digestive Research, Digestive Disease Center, Department of Internal Medicine, College of Medicine, Soonchunhyang University, Seoul 04401, South Korea
| | - Ji-Hyung Lee
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
| | - Aleem Siddiqui
- Department of Medicine, University of California, San Diego, La Jolla, CA 92093, USA,Division of Infectious Diseases, University of California, San Diego, La Jolla, CA 92093, USA
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Mehta R, Kabrawala M, Nandwani S, Tekriwal R, Nandania P. Early Experience of Sofosbuvir based Combination Therapy in "Real-Life" Cohort with Chronic Hepatitis-C Infection. J Clin Diagn Res 2017; 11:OC05-OC08. [PMID: 28511425 DOI: 10.7860/jcdr/2017/23184.9335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Accepted: 10/21/2016] [Indexed: 12/18/2022]
Abstract
INTRODUCTION There is scarcity of data in literature regarding the treatment response with Sofosbuvir (SOF) based therapy in Indian patients with chronic Hepatitis-C Virus (HCV) infection. AIM This study was designed to observe initial treatment response to SOF based therapy in a "real-life" cohort of Indian patients with HCV infection. MATERIALS AND METHODS This is a prospective, observational and single center study. A total of 107 patients who were diagnosed with chronic HCV infection and received SOF based treatment between March 2015 and December 2015 were included. The patients were treated with either triple drug regimen [SOF, Ribavirin (RBV) and Pegylated Interferon-α (Peg IFN-α)] or dual drug regimen (SOF and RBV) for either 12 or 24 weeks. The virological responses were obtained at baseline and thereafter weekly (up to four weeks) till viral load became undetected during treatment. RESULTS A total of 107 patients who received SOF based therapy for chronic HCV infection were included in the study. Mean age of the patients was 48.7±10.7 years. Among included patients, 24 (22.4%) patients were treatment-experienced. Majority of the patients (n=69; 64.5%) were infected with HCV genotype-3. Except one patient, all the included patients achieved virological response up to week-4 of the treatment. There was statistically insignificant association between virological response (up to four week of the treatment) and severity of the disease (cirrhosis and non-cirrhosis) or treatment status (treatment-naïve and treatment-experienced), or HCV genotype (genotype-1 and 3). CONCLUSION The results of this observational study demonstrated rapid initial virological response of SOF based therapy in "real-life" cohort of Indian patients with chronic HCV infection. However, long-term follow-up data are needed to ensure the sustained antiviral efficacy of SOF based therapy.
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Affiliation(s)
- Rajiv Mehta
- Consultant Gastroenterologist, Department of Gastroenterology, Surat Institute of Digestive Sciences (SIDS), Surat, Gujarat, India
| | - Mayank Kabrawala
- Consultant Gastroenterologist, Department of Gastroenterology, Surat Institute of Digestive Sciences (SIDS), Surat, Gujarat, India
| | - Subhash Nandwani
- Consultant Gastroenterologist, Department of Gastroenterology, Surat Institute of Digestive Sciences (SIDS), Surat, Gujarat, India
| | - Rini Tekriwal
- Research Scholar, Department of Physiology, Government College, Surat, Gujarat, India
| | - Payal Nandania
- Research Scholar, Department of Physiology, Government College, Surat, Gujarat, India
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Weiler N, Zeuzem S, Welker MW. Concise review: Interferon-free treatment of hepatitis C virus-associated cirrhosis and liver graft infection. World J Gastroenterol 2016; 22:9044-9056. [PMID: 27895394 PMCID: PMC5107588 DOI: 10.3748/wjg.v22.i41.9044] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/09/2016] [Accepted: 10/19/2016] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis C is a major reason for development of cirrhosis and hepatocellular carcinoma and a leading cause for liver transplantation. The development of direct-acting antiviral agents lead to (pegylated) interferon-alfa free antiviral therapy regimens with a remarkable increase in sustained virologic response (SVR) rates and opened therapeutic options for patients with advanced cirrhosis and liver graft recipients. This concise review gives an overview about most current prospective trials and cohort analyses for treatment of patients with liver cirrhosis and liver graft recipients. In patients with compensated cirrhosis Child-Pugh-Turcotte (CTP) class A, all approved agents are safe and SVR rates do not significantly differ from patients without cirrhosis in general. In patients with decompensated cirrhosis CTP class B or C, daclastasvir, ledipasvir, velpatasvir, and sofosbuvir are approved, and SVR rates higher than 90% can be achieved. Especially for patients with a model of end stage liver disease score higher than 15 and therefore eligible for liver transplantation, data is scarce. Reported SVR rates in patients with cirrhosis CTP class C are lower compared to patients with a less severe liver disease. In liver transplant recipients with a maximum of CTP class A, SVR rates are comparable to patients without LT. Patients with decompensated graft cirrhosis should be treated on an individual basis.
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Mehta R, Kabrawala M, Nandwani S, Tekriwal R, Nandaniya P, Shah M, Bhayani V. Efficacy and safety of sofosbuvir-based therapy for chronic hepatitis C infection in "real-life" cohort. Indian J Gastroenterol 2016; 35:459-464. [PMID: 27822881 DOI: 10.1007/s12664-016-0713-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 10/16/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The safety and efficacy of sofosbuvir-based treatment (sofosbuvir and ribavirin with or without pegylated interferon-α) for hepatitis C virus (HCV) infection has been established in clinical trials. However, there is limited data regarding safety and efficacy of sofosbuvir-based treatment for HCV infection in a "real-life" cohort. We describe our experience with sofosbuvir-based treatment for HCV infection in a real-life cohort. METHODS This was a prospective, nonrandomized and observational study at a tertiary care centre in Surat, India. The primary end-point was proportion of the study patients who achieved a sustained virological response 12 weeks after cessation of treatment (SVR 12). Secondary end-points of the study include SVR 4, virological relapse and appearance of adverse events. RESULTS A total of 107 patients with chronic HCV who received sofosbuvir-based treatment were included in the study. During study period, two patients died due to severity of liver complications. Hence, overall rate of SVR 4 and SVR 12 was 98.1 % (n = 103/105) and 94.3 % (n = 99/105), respectively. Among 67 patients with HCV genotype-3 infection, the SVR 12 rate was 92.5 % (n = 62/67), and among 38 patients with HCV genotype-1 infection, the rate of SVR 12 was 97.4 % (n=37/38). A total of 32 (29.9 %) patients reported adverse events during the course of sofosbuvir-based treatment. None of the patient discontinued treatment due to adverse event. CONCLUSIONS Sofosbuvir-based treatment is safe and efficacious in clinical practice in Indian patients with HCV genotype-1 and genotype-3 infection.
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Affiliation(s)
- Rajiv Mehta
- Department of Gastroenterology, Surat Institute of Digestive Sciences, Ring Road, Surat, 395 002, India.
| | - Mayank Kabrawala
- Department of Gastroenterology, Surat Institute of Digestive Sciences, Ring Road, Surat, 395 002, India
| | - Subhash Nandwani
- Department of Gastroenterology, Surat Institute of Digestive Sciences, Ring Road, Surat, 395 002, India
| | - Rini Tekriwal
- Department of Physiology, Government Medical College, Majuragate, Surat, 395 001, India
| | - Payal Nandaniya
- Department of Physiology, Government Medical College, Majuragate, Surat, 395 001, India
| | - Mrunal Shah
- Department of Gastroenterology, Surat Institute of Digestive Sciences, Ring Road, Surat, 395 002, India
| | - Vishwa Bhayani
- Department of Gastroenterology, Surat Institute of Digestive Sciences, Ring Road, Surat, 395 002, India
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Sugimoto K, Kim SK, Kim SR, Kobayashi M, Kato A, Morimoto E, Imoto S, Kim CW, Tanaka Y, Kudo M, Yano Y, Hayashi Y. Efficacy and Safety of Sofosbuvir Plus Ribavirin Treatment for Patients with Chronic Hepatitis C Genotype 2. Dig Dis 2016; 34:627-631. [PMID: 27750229 DOI: 10.1159/000448823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The efficacy of sofosbuvir plus ribavirin (RBV) treatment for hepatitis C virus (HCV) genotype 2 focusing on virological response was compared with that of pegylated interferon (peg-IFN) plus RBV treatment. Safety of the former focusing on the decline in hemoglobin levels was compared with that of the latter and assessed in terms of age and inosine triphosphatase (ITPA). METHODS Patients (n = 17) receiving sofosbuvir plus RBV and those (n = 24) receiving peg-IFN plus RBV diagnosed with chronic HCV genotype 2 were enrolled in this study, and the efficacy and safety of both treatments were assessed. RESULTS Rapid virological response was attained with sofosbuvir plus RBV treatment compared with peg-IFN plus RBV treatment. All patients under sofosbuvir plus RBV treatment achieved end-of-treatment response compared with 70% who sustained viral response under the peg-IFN plus RBV treatment, with the former demonstrating greater virological response. The decline in hemoglobin levels under the former treatment was greater than that under the latter and in patients over 65 years of age with ITPA gene major. CONCLUSION Efficacy and safety of sofosbuvir plus RBV treatment were clearly demonstrated compared with those of peg-IFN plus RBV treatment. The decline in hemoglobin levels was not related to the discontinuation of the former treatment, irrespective of age or the effect of the ITPA gene.
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Yan XB. Anti-HCV therapy: Whether it comes into the age of DAA-based specific therapy? Shijie Huaren Xiaohua Zazhi 2016; 24:1943-1951. [DOI: 10.11569/wcjd.v24.i13.1943] [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] [Indexed: 02/06/2023] Open
Abstract
Hepatitis C virus (HCV) infection is one of the main causes of chronic liver diseases. Direct-acting antiviral (DAA) agents undoubtedly bring hope for patients who cannot tolerate or are not suitable for interferon therapy. There have been six foreign guidelines for anti-HCV therapy in 2014, and in October this year, China also updated its guideline for the diagnosis and treatment of HCV infection. In this paper I review the current status and future perspectives of HCV treatment.
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