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Gheorghe L, Preda C, Trifan A, Manuc M, Stanciu C, Istratescu D, Popescu CP, Diculescu MM, Tieranu CG, Manuc T, Stroie TG, Iacob SM, Iliescu L. Real World Efficacy and Safety of Sofosbuvir + Velpatasvir + Voxilaprevir in Romanian Patients with Genotype 1b HCV Infection Non-reponders to DAAs Therapy. J Gastrointestin Liver Dis 2022; 31:437-443. [PMID: 36535062 DOI: 10.15403/jgld-4472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS The sofosbuvir (SOF) / velpatasvir (VEL) / voxilaprevir (VOX) combination has been evaluated in more than 800 patients enrolled in phase II and phase III studies, where it demonstrated excellent safety and efficacy, achieving overall sustained viral response (SVR) rates of more than 95%. We aimed to assess the efficacy and safety of SOF/VEL/VOX in a real-world study, including patients previously treated for genotype 1b hepatitis C virus (HCV) infection that did not obtain a sustained viral response with previous direct-acting antivirals (DAAs) therapy. METHODS In Romania, through a nationwide government-funded program in 2019-2020, 213 patients with chronic hepatitis C non-responders to previous DAAs therapy, received treatment with SOF/VEL/ VOX 400/100/100 mg/day for 12 weeks. We performed a retrospective longitudinal study that included 143 individuals who were treated in Bucharest, Iași, Craiova and Constanța clinics, all with genotype 1b HCV infection. Efficacy was assessed by the percentage of patients achieving SVR 12 weeks post-treatment (SVR12). Serious adverse events (SAE) were registered. RESULTS Our cohort comprised 53% males with a median age of 60 years (27÷77); 47% were pre-treated with ombitasvir/paritaprevir/ritonavir+dasabuvir ± ribavirin, 40% with ledipasvir/SOF, 13% with elbasvir/ grazoprevir. 42% of patients associated co-morbidities, 45% had compensated liver cirrhosis, 2% had treated hepatocellular carcinoma (HCC) and 1% had hepatitis B virus co-infection. SVR by intention to treat was reported in 139/143 (97.2%) and per protocol in 141/143 (98.6%). No predictive factors for SVR were identified. Rate of liver decompensation in patients with cirrhosis was 6% and was statistically associated in multivariate analysis with Child-Pugh score (p<0.01) and with severe steatosis (p=0.004). Occurrence of new HCC was reported in 3.6% of all patients with cirrhosis and was associated with poor liver function [higher Child-Pugh score (p=0.001) and low albumin levels (p=0.02)]. Serious adverse events related to therapy were reported in 1/143(0.7%). CONCLUSIONS SOF/VEL/VOX was highly efficient in our population of patients with a 97.2% SVR. Liver decompensation occurred in 6% of cirrhotic patients at SVR, related to hepatic dysfunction.
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Affiliation(s)
- Liana Gheorghe
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania. .
| | - Carmen Preda
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania. .
| | - Anca Trifan
- Gr. T Popa University of Medicine and Pharmacy Iasi, Gastroenterology and Hepatology Department, Gastroenterology and Hepatology Institute, Iași, Romania.
| | - Mircea Manuc
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Carol Stanciu
- Gr. T Popa University of Medicine and Pharmacy Iasi, Gastroenterology and Hepatology Department, Gastroenterology and Hepatology Institute, Iași, Romania.
| | - Doina Istratescu
- Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Corneliu Petru Popescu
- Carol Davila University of Medicine and Pharmacy, Virology Department, Victor Babes Hospital, Bucharest, Romania.
| | - Mircea Mihai Diculescu
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Cristian George Tieranu
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Elias Emergency Hospital, Bucharest, Romania.
| | - Teodora Manuc
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Tudor Gheorghe Stroie
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Speranta Maria Iacob
- Carol Davila University of Medicine and Pharmacy, Gastroenterology and Hepatology Department, Clinic Fundeni Institute, Bucharest, Romania.
| | - Laura Iliescu
- Carol Davila University of Medicine and Pharmacy, Internal Medicine Department, Clinic Fundeni Institute, Bucharest, Romania.
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Florescu MM, Costache A, Iacob SM, Pietrareanu C, Ester C, Cerban R, Dumitru R, Grasu M, Lupescu I, Gheorghe L. Anticoagulation Therapy for Portal Vein Thrombosis in Patients with Cirrhosis in a Tertiary Center Experience. J Gastrointestin Liver Dis 2021; 30:374-379. [PMID: 34551038 DOI: 10.15403/jgld-3392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/14/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS The evidence regarding the use of anticoagulant (AC) agents in portal vein thrombosis (PVT) is increasing and, most patients undergo chronic treatment with low molecular weight heparin (LMWH) or vitamin K antagonists (VKA). Nevertheless, there are no clear data about who should receive antithrombotic therapy, when to initiate it, how long and what dose should be used for this set of patients. The aim of the study was to assess the outcome of patients with cirrhosis and portal vein thrombosis who received AC therapy, in terms of thrombus regression, bleeding events and survival rates. METHODS This observational and retrospective study included 107 cirrhotic patients diagnosed with PVT in a single tertiary center between 2010-2019. 54 received low molecular weight heparin or vitamin K antagonist (AC treatment group) and 53 were untreated. All patients were periodically follow-up to assess the evolution of PVT (regression, progression, stable thrombus) and potential occurrence of bleeding events. RESULTS The regression of portal vein thrombosis was significantly higher in the AC treatment group (OR=2.430; 95% CI=1.11-6.167; p=0.026), more than 50% of on-treatment patients experiencing regression of the thrombus. However, bleeding events were significantly more frequent in the AC treatment group (18.5% vs. 7.5%) and the risk of bleeding was associated with thrombocytes less than 50x103/mm3 (OR=8.266; 95%CI: 2.310-39.211; p=0.002). Survival was better in the AC treatment group (68.4% vs 48.7% at 5 years and 92.7% vs 77.8% at 1 year, p=0.038) and was lower in patients that experienced bleeding events (37.22% survival at 5 years, mean time survival 44 months, p=0.008). CONCLUSIONS In our cohort of cirrhotic patients with PVT more than 50% of patients receiving AC therapy presented regression of the thrombus; most of them obtained partial recanalization. The bleeding complication rate was higher than expected, reaching 18%. The overall mortality was lower in the treated group.
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Affiliation(s)
| | - Adrian Costache
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Dr. Ioan Cantacuzino Clinical Hospital, Bucharest; 4) Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Speranta Maria Iacob
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Corina Pietrareanu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Carmen Ester
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Razvan Cerban
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
| | - Radu Dumitru
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Radiology and Imaging Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Mugur Grasu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Radiology and Imaging Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Ioana Lupescu
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Radiology and Imaging Department, Fundeni Clinical Institute, Bucharest, Romania.
| | - Liana Gheorghe
- Carol Davila University of Medicine and Pharmacy, Faculty of Medicine, Bucharest; Centre for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania.
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