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Jonas MM, Romero R, Rosenthal P, Lin CH, Verucchi G, Wen J, Balistreri WF, Whitworth S, Bansal S, Leung DH, Narkewicz MR, Gonzalez-Peralta RP, Mangia A, Karnsakul W, Rao GS, Shao J, de Jong J, Parhy B, Osinusi A, Kersey K, Murray KF, Sokal EM, Schwarz KB. Sofosbuvir-velpatasvir in children 3-17 years old with hepatitis C virus infection. J Pediatr Gastroenterol Nutr 2024. [PMID: 38644678 DOI: 10.1002/jpn3.12045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 02/20/2023] [Accepted: 03/13/2023] [Indexed: 04/23/2024]
Abstract
BACKGROUND The safety and efficacy of sofosbuvir-velpatasvir in children aged 3-17 years with chronic hepatitis C virus (HCV) infection of any genotype were evaluated. METHODS In this Phase 2, multicenter, open-label study, patients received once daily for 12 weeks either sofosbuvir-velpatasvir 400/100 mg tablet (12-17 years), 200/50 mg low dose tablet or oral granules (3-11 years and ≥17 kg), or 150/37.5 mg oral granules (3-5 years and <17 kg). The efficacy endpoint was sustained virologic response 12 weeks after therapy (SVR12). Dose appropriateness was confirmed by intensive pharmacokinetics in each age group. FINDINGS Among 216 patients treated, 76% had HCV genotype 1% and 12% had genotype 3. Rates of SVR12 were 83% (34/41) among 3-5-year-olds, 93% (68/73) among 6-11-year-olds, and 95% (97/102) among 12-17-year-olds. Only two patients experienced virologic failure. The most common adverse events were headache, fatigue, and nausea in 12-17-year-olds; vomiting, cough, and headache in 6-11-year-olds; and vomiting in 3-5-year-olds. Three patients discontinued treatment because of adverse events. Four patients had serious adverse events; all except auditory hallucination (n = 1) were considered unrelated to study drug. Exposures of sofosbuvir, its metabolite GS-331007, and velpatasvir were comparable to those in adults in prior Phase 2/3 studies. Population pharmacokinetic simulations supported weight-based dosing for children in this age range. INTERPRETATION The pangenotypic regimen of sofosbuvir-velpatasvir is highly effective and safe in treating children 3-17 years with chronic HCV infection.
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Affiliation(s)
| | - Rene Romero
- Children's Healthcare of Atlanta and Emory University School of Medicine, Atlanta, Georgia, USA
| | - Philip Rosenthal
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California San Francisco, Benioff Children's Hospital, San Francisco, California, USA
| | - Chuan-Hao Lin
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | - Jessica Wen
- University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | | | | | - Daniel H Leung
- Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Michael R Narkewicz
- School of Medicine and Children's Hospital of Colorado, University of Colorado, Aurora, Colorado, USA
| | | | - Alessandra Mangia
- Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Wikrom Karnsakul
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Girish S Rao
- Riley Hospital for Children, Indiana University School of Medicine, Indiana, Indianapolis, USA
| | - Jiang Shao
- Gilead Sciences Inc., Foster City, California, USA
| | - Jan de Jong
- Gilead Sciences Inc., Foster City, California, USA
| | | | - Anu Osinusi
- Gilead Sciences Inc., Foster City, California, USA
| | | | - Karen F Murray
- Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA
| | - Etienne M Sokal
- Cliniques Universitaires Saint-Luc, Service de Gastroentérologie Hépatologie Pédiatrique, Université Catholique de Louvain, Bruxelles, Belgique
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Kondili LA, Zanetto A, Quaranta MG, Ferrigno L, Panetta V, Calvaruso V, Zignego AL, Brunetto MR, Raimondo G, Biliotti E, Ieluzzi D, Iannone A, Madonia S, Chemello L, Cavalletto L, Coppola C, Morisco F, Barbaro F, Licata A, Federico A, Cerini F, Persico M, Pompili M, Ciancio A, Piscaglia F, Chessa L, Giacometti A, Invernizzi P, Brancaccio G, Benedetti A, Baiocchi L, Gentile I, Coppola N, Nardone G, Craxì A, Russo FP. Predicting de-novo portal vein thrombosis after HCV eradication: A long-term competing risk analysis in the ongoing PITER cohort. United European Gastroenterol J 2024; 12:352-363. [PMID: 38032175 DOI: 10.1002/ueg2.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND & AIMS Sustained virological response (SVR) by direct-acting antivirals (DAAs) may reverse the hypercoagulable state of HCV cirrhosis and the portal vein thrombosis (PVT) risk. We evaluated the incidence and predictive factors of de novo, non-tumoral PVT in patients with cirrhosis after HCV eradication. METHODS Patients with HCV-related cirrhosis, consecutively enrolled in the multi-center ongoing PITER cohort, who achieved the SVR using DAAs, were prospectively evaluated. Kaplan-Meier and competing risk regression analyses were performed. RESULTS During a median time of 38.3 months (IQR: 25.1-48.7 months) after the end of treatment (EOT), among 1609 SVR patients, 32 (2.0%) developed de novo PVT. A platelet count ≤120,000/μL, albumin levels ≤3.5 mg/dL, bilirubin >1.1 mg/dL, a previous liver decompensation, ALBI, Baveno, FIB-4, and RESIST scores were significantly different (p < 0.001), among patients who developed PVT versus those who did not. Considering death and liver transplantation as competing risk events, esophageal varices (subHR: 10.40; CI 95% 4.33-24.99) and pre-treatment ALBI grade ≥2 (subHR: 4.32; CI 95% 1.36-13.74) were independent predictors of PVT. After HCV eradication, a significant variation in PLT count, albumin, and bilirubin (p < 0.001) versus pre-treatment values was observed in patients who did not develop PVT, whereas no significant differences were observed in those who developed PVT (p > 0.05). After the EOT, esophageal varices and ALBI grade ≥2, remained associated with de novo PVT (subHR: 9.32; CI 95% 3.16-27.53 and subHR: 5.50; CI 95% 1.67-18.13, respectively). CONCLUSIONS In patients with HCV-related cirrhosis, a more advanced liver disease and significant portal hypertension are independently associated with the de novo PVT risk after SVR.
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Affiliation(s)
- Loreta A Kondili
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
- UniCamillus-Saint Camillus International University of Health Sciences, Rome, Italy
| | - Alberto Zanetto
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale - Università Padova, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | | | - Luigina Ferrigno
- Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Valentina Panetta
- L'altrastatistica srl, Consultancy & Training, Biostatistics Office, Rome, Italy
| | - Vincenza Calvaruso
- Gastroenterology and Hepatology Unit, PROMISE, University of Palermo, Palermo, Italy
| | - Anna Linda Zignego
- Center for Systemic Manifestations of Hepatitis Viruses, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maurizia R Brunetto
- Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy
| | - Giovanni Raimondo
- Department of Internal Medicine, University Hospital of Messina, Messina, Italy
| | - Elisa Biliotti
- Department of Public Health and Infectious Diseases, "Policlinico Umberto I" Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Andrea Iannone
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Salvatore Madonia
- Department of Internal Medicine, Villa Sofia-Cervello Hospital, Palermo, Italy
| | - Liliana Chemello
- Department of Medicine, Unit of Internal Medicine & Hepatology, University of Padova, Padova, Italy
| | - Luisa Cavalletto
- Department of Medicine, Unit of Internal Medicine & Hepatology, University of Padova, Padova, Italy
| | - Carmine Coppola
- Department of Hepatology, Gragnano Hospital, Gragnano, Italy
| | - Filomena Morisco
- Liver and Biliary System Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Francesco Barbaro
- Department of Medicine, Infectious Diseases Unit, University Hospital of Padova, Padova, Italy
| | - Anna Licata
- Infectious Diseases Clinic, Department of Biomedical Sciences and Public Health, DIBIMIS, University of Palermo, Palermo, Italy
| | - Alessandro Federico
- Department of Hepato-Gastroenterology, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Marcello Persico
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Maurizio Pompili
- Internal Medicine and Gastroenterology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alessia Ciancio
- Gastroenterology Unit, Città della Salute e della Scienza of Turin, University Hospital, Turin, Italy
| | - Fabio Piscaglia
- Division of Internal Medicine Unit, Sant'Orsola Malpighi Hospital, Bologna, Italy
| | - Luchino Chessa
- Liver Unit, University Hospital, Monserrato, Cagliari, Italy
| | - Andrea Giacometti
- Department of Biomedical Sciences & Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy San Gerardo Hospital, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Giuseppina Brancaccio
- Department of Molecular Medicine, Infectious Diseases, University of Padova, Padova, Italy
| | - Antonio Benedetti
- Clinic of Gastroenterology and Hepatology, Polytechnic University of Marche, Ancona, Italy
| | | | - Ivan Gentile
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gerardo Nardone
- Hepato-Gastroenterology Unit, University of Naples Federico II, Naples, Italy
| | - Antonio Craxì
- Gastroenterology and Hepatology Unit, PROMISE, University of Palermo, Palermo, Italy
| | - Francesco Paolo Russo
- Gastroenterology and Multivisceral Transplant Unit, Azienda Ospedale - Università Padova, Padova, Italy
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
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Tada T, Kurosaki M, Tamaki N, Yasui Y, Mori N, Tsuji K, Hasebe C, Joko K, Akahane T, Furuta K, Kobashi H, Kimura H, Yagisawa H, Marusawa H, Kondo M, Kojima Y, Yoshida H, Uchida Y, Nakamura S, Izumi N. A validation study of after direct-acting antivirals recommendation for surveillance score for the development of hepatocellular carcinoma in patients with hepatitis C virus infection who had received direct-acting antiviral therapy and achieved sustained virological response. JGH Open 2022; 6:20-28. [PMID: 35071784 PMCID: PMC8762616 DOI: 10.1002/jgh3.12690] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/25/2021] [Accepted: 11/28/2021] [Indexed: 12/19/2022]
Abstract
Background and Aim The pathogenic process underlying the development of hepatocellular carcinoma (HCC) is not yet clear in patients with hepatitis C virus (HCV) who have received direct-acting antiviral (DAA) therapy and achieved sustained virological response (SVR). This study validated a composite predictive model for HCC in these patients. Methods This study included 3058 patients in whom HCV was eradicated with DAA therapy. After DAAs recommendation for surveillance (ADRES) score, which is based on sex, FIB-4 index, and α-fetoprotein, was used as a composite predictive model for HCC development. Results The 1-, 3-, and 5-year cumulative incidence rates of HCC were 0.9, 4.5, and 15.2%, respectively. Multivariate analysis with Cox proportional hazards models showed that male sex (hazard ratio [HR], 2.646; 95% confidence interval [CI], 1.790-3.911), FIB-4 index >3.25 (HR, 2.891; 95% CI, 1.947-4.293), and α-fetoprotein >5 ng/mL (HR, 2.835; 95% CI, 1.914-4.200) are independently associated with HCC development. The incidence of HCC differed significantly by ADRES score (P < 0.001). Cox proportional hazards models showed that compared to the ADRES score 0 group, the HR for HCC development was 2.947 (95% CI, 1.367-6.354) in the ADRES score 1 group, 9.171 (95% CI, 4.339-19.380) in the ADRES score 2 group, and 20.630 (95% CI, 8.641-49.230) in the ADRES score 3 group. ADRES score had superior predictive power for HCC development compared with the FIB-4 index and α-fetoprotein according to time-dependent receiver operating characteristic analysis. Conclusion The ADRES score is useful for predicting HCC development after SVR.
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Affiliation(s)
- Toshifumi Tada
- Department of Internal Medicine Japanese Red Cross Society Himeji Hospital Himeji Japan
| | - Masayuki Kurosaki
- Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan
| | - Nobuharu Tamaki
- Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan
| | - Yutaka Yasui
- Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan
| | - Nami Mori
- Department of Gastroenterology Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital Hiroshima Hiroshima Japan
| | - Keiji Tsuji
- Department of Gastroenterology Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital Hiroshima Hiroshima Japan
| | - Chitomi Hasebe
- Department of Gastroenterology Japanese Red Cross Asahikawa Hospital Asahikawa Hokkaido Japan
| | - Koji Joko
- Center for Liver-Biliary-Pancreatic Disease Matsuyama Red Cross Hospital Matsuyama Ehime Japan
| | - Takehiro Akahane
- Department of Gastroenterology Japanese Red Cross Ishinomaki Hospital Ishinomaki Miyagi Japan
| | - Koichiro Furuta
- Department of Gastroenterology Masuda Red Cross Hospital Masuda Shimane Japan
| | - Haruhiko Kobashi
- Department of Gastroenterology Japanese Red Cross Okayama Hospital Okayama Okayama Japan
| | - Hiroyuki Kimura
- Department of Gastroenterology Japanese Red Cross Kyoto Daiichi Hospital Kyoto Japan
| | - Hitoshi Yagisawa
- Department of Gastroenterology Japanese Red Cross Akita Hospital Akita Akita Japan
| | - Hiroyuki Marusawa
- Department of Gastroenterology and Hepatology Japanese Red Cross Osaka Hospital Osaka Japan
| | - Masahiko Kondo
- Department of Gastroenterology Japanese Red Cross Otsu Hospital Otsu Shiga Japan
| | - Yuji Kojima
- Department of Hepatology Japanese Red Cross Ise Hospital Ise Mie Japan
| | - Hideo Yoshida
- Department of Gastroenterology Japanese Red Cross Medical Center Tokyo Japan
| | - Yasushi Uchida
- Department of Gastroenterology Japanese Red Cross Matsue Hospital Matsue Shimane Japan
| | - Shinichiro Nakamura
- Department of Internal Medicine Japanese Red Cross Society Himeji Hospital Himeji Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology Musashino Red Cross Hospital Tokyo Japan
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Joshita S, Sugiura A, Umemura T, Yamazaki T, Fujimori N, Matsumoto A, Usami Y, Tanaka E. Clinical impact of normal alanine aminotransferase on direct-acting antiviral outcome in patients with chronic hepatitis C virus infection. JGH Open 2019; 4:574-581. [PMID: 32782941 PMCID: PMC7411565 DOI: 10.1002/jgh3.12296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/12/2019] [Accepted: 12/01/2019] [Indexed: 12/27/2022]
Abstract
Background and Aims This study aimed to clarify the clinical picture of hepatitis C virus (HCV) carriers with normal alanine aminotransferase (CNALT) and those with ALT elevation (non‐CNALT) under direct‐acting antivirals (DAAs). Methods We enrolled 1002 patients with HCV (427 men, median age: 69 years) who had received DAAs for comparisons between CNALT (ALT ≤33 U/L in males and ≤25 U/L in females; n = 374) and non‐CNALT (n = 628) groups. Results CNALT patients displayed a higher platelet count (PLT) (170 000 vs 146 000/μL, P < 0.0001) and albumin (4.1 vs 4.1 g/dL, P = 0.0006) but lower AST (25 vs 51 U/L, P < 0.0001), alpha fetoprotein (3.2 vs 5.4 ng/mL, P < 0.0001), and liver fibrosis marker scores (all P < 0.0001). The sustained virologic response rate was comparable between the CNALT and non‐CNALT groups (97.8 vs 95.3%, P = 0.106). The cumulative incidence of hepatocellular carcinoma (HCC) after DAA treatment was comparable between the CNALT and non‐CNALT groups (P = 0.117, log‐rank test). In CNALT patients with HCC history, PLT ≥150 000/μL was an independent risk factor of HCC recurrence (P = 0.019). In non‐CNALT patients without HCC history, male gender (P = 0.021) and albumin <4.0 g/dL (P = 0.007) were independent risk factors, while PLT < 150 000/μL (P = 0.081) was a marginal risk factor of HCC occurrence. Conclusion CNALT patients displayed a milder degree of liver fibrosis. Combinations of CNALT and PLT status might be useful as markers for HCC occurrence or recurrence surveillance.
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Affiliation(s)
- Satoru Joshita
- Department of Medicine, Division of Gastroenterology and Hepatology Shinshu University School of Medicine Matsumoto Japan
| | - Ayumi Sugiura
- Department of Medicine, Division of Gastroenterology and Hepatology Shinshu University School of Medicine Matsumoto Japan
| | - Takeji Umemura
- Department of Medicine, Division of Gastroenterology and Hepatology Shinshu University School of Medicine Matsumoto Japan.,Department of Life Innovation, Institute for Biomedical Sciences Shinshu University Matsumoto Japan
| | - Tomoo Yamazaki
- Department of Medicine, Division of Gastroenterology and Hepatology Shinshu University School of Medicine Matsumoto Japan
| | - Naoyuki Fujimori
- Department of Medicine, Division of Gastroenterology and Hepatology Shinshu University School of Medicine Matsumoto Japan
| | - Akihiro Matsumoto
- Department of Medicine, Division of Gastroenterology and Hepatology Shinshu University School of Medicine Matsumoto Japan.,Consultation Centers for Hepatic Diseases Shinshu University Hospital Matsumoto Japan
| | - Yoko Usami
- Department of Laboratory Medicine Shinshu University Hospital Matsumoto Japan
| | - Eiji Tanaka
- Department of Medicine, Division of Gastroenterology and Hepatology Shinshu University School of Medicine Matsumoto Japan
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