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Erdafitinib (Balversa) for urothelial carcinoma. Med Lett Drugs Ther 2024; 66:e83-4. [PMID: 38696316 DOI: 10.58347/tml.2024.1702g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
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Paris A, Bodaghi B, Touhami S. Pan fibroblast growth factor receptor inhibitor associated retinopathy. Eur J Ophthalmol 2024; 34:NP66-NP71. [PMID: 38086757 DOI: 10.1177/11206721231220334] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024]
Abstract
PURPOSE To report a case of Fibroblast Growth Factor Receptor inhibitor (FGFRi) associated retinopathy in a patient treated with Erdafitinib. CASE REPORT A patient with a history of non-muscle invasive urothelial carcinoma treated with Erdafitinib developed symptomatic unifocal bilateral serous retinal detachments (SRD) eight weeks after starting this new treatment. Six months after discontinuing the drug, the SRDs resolved and visual acuity recovered to baseline. However, hyper and hypo auto fluorescent lesions were still visible on fundus autofluorescence, suggesting a still ongoing retinal pigment epithelium (RPE) impairment. CONCLUSIONS Cancer treatments using FGFRi are showing promising results but their ocular toxicity is not well reported nor fully understood. Oncologists should be aware of the potential risks associated with FGFRi and involve ophthalmologists for the follow-up of their patients. The toxicity of FGFRi seems to resolve after drug continuation, but a certain degree of infra clinical RPE impairment may persist. Longer term follow-ups are warranted to further understand the effects of FGFRi on the RPE.
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Affiliation(s)
- Arianna Paris
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
- Clinic of Ophthalmology, Institute of Clinical Neurosciences of Southern Switzerland (INSI), Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Bahram Bodaghi
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
| | - Sara Touhami
- Department of Ophthalmology, Pitié-Salpêtrière University Hospital, Sorbonne Université, Paris, France
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De Santi O, Orellana M, Di Niro CA, Greco V. Evaluation of the effectiveness of cytisine for the treatment of smoking cessation: A systematic review and meta-analysis. Addiction 2024; 119:649-663. [PMID: 38161271 DOI: 10.1111/add.16399] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND AND AIMS Smoking is considered the main cause of preventable death world-wide. This study aimed to review the efficacy and safety of cytisine for smoking cessation. METHODS This review included an exhaustive search of databases to identify randomized controlled trials (RCTs) in health centers of any level with smokers of any age or gender investigating the effects of cytisine at standard dosage versus placebo, varenicline or nicotine replacement therapy (NRT). RESULTS We identified 12 RCTs. Eight RCTs compared cytisine with placebo at the standard dose covering 5922 patients, 2996 of whom took cytisine, delivering a risk ratio (RR) of 2.25 [95% confidence interval (CI) = 1.42-3.56; I2 = 88%; moderate-quality evidence]. The greater intensity of behavioral therapy was associated directly with the efficacy findings (moderate-quality evidence). The confirmed efficacy of cytisine was not evidenced in trials conducted in low- and middle-income countries. We estimate a number needed to treat (NNT) of 11. Two trials compared the efficacy of cytisine versus NRT, and the combination of both studies yields modest results in favor of cytisine. Three trials compared cytisine with varenicline, without a clear benefit for cytisine. Meta-analyses of all non-serious adverse events in the cytisine group versus placebo groups yielded a RR of 1.24 (95% CI = 1.11-1.39; participants = 5895; studies = 8; I2 = 0%; high-quality evidence). CONCLUSIONS Cytisine increases the chances of successful smoking cessation by more than twofold compared with placebo and has a benign safety profile, with no evidence of serious safety concerns. Limited evidence suggests that cytisine may be more effective than nicotine replacement therapy, with modest cessation rates.
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Affiliation(s)
- Omar De Santi
- Toxicology, Hospital Nacional Professor Alejandro Posadas, Centro Nacional de Intoxicaciones, (CNI), Buenos Aires, Argentina
| | - Marcelo Orellana
- Toxicology, Hospital Nacional Professor Alejandro Posadas, Centro Nacional de Intoxicaciones, (CNI), Buenos Aires, Argentina
| | | | - Vanina Greco
- Toxicology, Hospital Nacional Professor Alejandro Posadas, Centro Nacional de Intoxicaciones, (CNI), Buenos Aires, Argentina
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Pozzi P, Boffi R, Veronese C, Trussardo S, Valsecchi C, Sabia F, Pastorino U, Apolone G, Cardani E, Tarantini F, Munarini E. Cytisine as a smoking cessation aid: Preliminary observations with a modified therapeutic scheme in real life. Tumori 2024; 110:124-131. [PMID: 38149659 PMCID: PMC11005299 DOI: 10.1177/03008916231216906] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 11/06/2023] [Accepted: 11/09/2023] [Indexed: 12/28/2023]
Abstract
INTRODUCTION Cigarette smoke accounts for over 90,000 deaths each year in Italy. Tobacco dependence treatment guidelines suggest adopting an integrated pharmacological-behavioral model of intervention. Cytisine is a partial agonist of nicotinic receptors. Trials conducted to date have demonstrated its good efficacy in promoting smoking cessation. The cytisine scheme of treatment consists of 25 days of treatment. A 40-day regimen, with an escalating dose and an extended duration of the treatment, has been in use in many anti-smoking centers in Italy for several years, but to date there are no reports on the use of cytisine with this scheme. METHODS A retrospective, real-life, observational study was conducted between January 2016 and September 2022. The 300 patients who had received at least one dose of study medication were selected. Continuous variables were compared by the Wilcoxon-Mann-Whitney test. Univariate and multivariate logistic regression models were implemented for self-reported seven-day point prevalence for abstinence at three, six and 12 months. RESULTS The median age of the patients was 59 years, 57% were women. The median smoking exposure was 33.8 pack-years. Self-reported smoking abstinence at three, six and 12 months was 68.7%, 56.3% and 47.3% respectively. 84% completed the cytisine treatment, 31.3% reported adverse events and in 8.3% these led to dropping out of the treatment. CONCLUSION Cytisine, administered with a novel therapeutic scheme in the real-life setting of a specialized anti-smoking center, significantly promotes smoking abstinence. However, more studies are needed to assess the tolerability and efficacy of this new regimen.
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Affiliation(s)
- Paolo Pozzi
- Pulmonology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Roberto Boffi
- Pulmonology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Chiara Veronese
- Pulmonology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Sara Trussardo
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Camilla Valsecchi
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Federica Sabia
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Ugo Pastorino
- Department of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Giovanni Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elisa Cardani
- Pulmonology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Francesco Tarantini
- Pulmonology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | - Elena Munarini
- Pulmonology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
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Sicker KM, Secic M, Graham A, Auciello SE. Patient interest in acupuncture for smoking cessation: a survey. Acupunct Med 2024; 42:44-49. [PMID: 37909713 DOI: 10.1177/09645284231206145] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND/OBJECTIVE Tobacco use remains the leading cause of preventable death in the United States. The most widely available treatment options to assist patients in smoking cessation are limited by side effects and moderate efficacy at best. Acupuncture may be an effective option for smoking cessation. The goal of this study was to establish the need for and interest in acupuncture therapy to potentially assist with smoking cessation from a patient perspective. METHODS We conducted a cross-sectional survey study among patients aged 18 years or older whose medical record reported current tobacco use with English as their preferred language. REDCap surveys were administered to patients during office visits and included questions regarding opinions and use of all treatments available for smoking cessation (including acupuncture) as well as perceived barriers to acupuncture treatment. RESULTS A total of 57 surveys were distributed, and 42 (74%) were completed. Most patients reported previous attempts at quitting (76%) and had tried a variety of treatments including nicotine replacement (45%), Chantix (varenicline; 23%), Wellbutrin (bupriopion; 19%), "cold turkey" (65%) and hypnosis (3%). No respondents reported having tried acupuncture for smoking cessation. CONCLUSION When comparing treatment options, patients reported more interest in acupuncture than other treatment options with a statistically significant difference in the level of interest between acupuncture and bupropion. All barriers (cost, time and effectiveness) were equally rated on a Likert-type scale with a median of 50 on a 101-point scale.
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Wani A, Prabhakar B, Shende P. Competitive inhibition of nicotine acetylcholine receptors using microneedles of nicotine and varenicline for smoking withdrawal therapy. Eur J Pharm Biopharm 2024; 195:114171. [PMID: 38159871 DOI: 10.1016/j.ejpb.2023.114171] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/25/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
Current strategies for smoking withdrawal conditions involve monotherapy of nicotine and combinational therapy of nicotine with varenicline or bupropion as per the CDC and FDA. The available dosage forms for nicotine are patches, gums, inhalers and nasal sprays, bupropion and varenicline are available in tablet form. This research work focused on developing a microneedle delivery system to deliver combination drug for overcoming the obstacles encountered by oral route of administration of varenicline such as severe side effects (mood swings, agitation, depressed behaviour, seizures, etc), and nicotine therapy challenges such as short half-life, repeated dosing, nausea, and vomiting. The nanoparticles of nicotine prepared by nanoprecipitation method showed particle size PTZ (356.6 ± 65.98), percentage entrapment efficiency (35.55 % ± 0.007), in-vitro drug release (47.89 % ± 0.7) for 72 h. Microneedles showed height (600 μm), width (350 μm), and tip diameter (10 μm). The nanoparticles encapsulated in microneedles showed in-vitro sustained delivery of nicotine (67.00 % ± 4.92) and varenicline (79.78 % ± 1.09) in 48 h. Nicotine released in a sustained manner attaches to the nicotine acetylcholine receptors (nAchR) to release dopamine for controlling the withdrawal challenges such as anxiety, irritability, cravings, disturbed sleep pattern, etc. The varenicline released from microneedles binds to the nAchR and inhibits dopamine release responsible for the euphoric effect induced by nicotine, and thus assists in curbing the nicotine withdrawal symptoms. This combination microneedle system offers prolonged treatment in a single application for smoking withdrawal conditions wherein patients are not in stage of oral dosing because of repeated dosing resulting in adverse effects like seizures, hypertension, sleep disturbances, insomnia, and nausea.
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Affiliation(s)
- Ashwini Wani
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM'S NMIMS, V. L. Mehta Road, Vile Parle (W), Mumbai, India
| | - Bala Prabhakar
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM'S NMIMS, V. L. Mehta Road, Vile Parle (W), Mumbai, India
| | - Pravin Shende
- Shobhaben Pratapbhai Patel School of Pharmacy and Technology Management, SVKM'S NMIMS, V. L. Mehta Road, Vile Parle (W), Mumbai, India.
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Lu M, Rupp LB, Melkonian C, Trudeau S, Daida YG, Schmidt MA, Gordon SC. Real-World Safety and Effectiveness of an 8-Week Regimen of Glecaprevir/Pibrentasvir in Patients with Hepatitis C and Cirrhosis. Adv Ther 2024; 41:744-758. [PMID: 38169058 PMCID: PMC11006752 DOI: 10.1007/s12325-023-02748-y] [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] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/21/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION In 2019, an 8-week regimen of glecaprevir/ pibrentasvir (GLE/PIB) was FDA-approved for treatment of chronic hepatitis C (HCV) in patients with cirrhosis. We used data from the Chronic Hepatitis Cohort Study (CHeCS) to evaluate treatment response and adverse events among patients with HCV and cirrhosis under routine clinical care. METHODS Using an intention-to-treat (ITT)/modified ITT (mITT) approach, endpoints were (1) sustained virological response (SVR) at 12 weeks (SVR12) post-treatment; and (2) adverse events (AEs)/serious AEs during treatment. Patients with cirrhosis from two CHeCS sites were included if they were prescribed GLE/PIB from August 2017 to June 2020. Detailed treatment and clinical data were collected. Patient baseline characteristics were described with mean/standard deviation (std) for continuous variables, and proportions for categorical variables. Analyses were propensity score adjusted. The final model retained variables that were significant with p value < 0.05. RESULTS The ITT sample included 166 patients, with 43, 116, and 7 patients in the 8-week, 12-week, and > 12-week planned treatment groups. Among them, 159 had confirmed SVR (95.8%, LCL 93.2%). The mITT analysis included 160 patients after excluding 6 with unknown HCV RNA results; 159 achieved SVR (99.4%, LCL 98.3%). There were no significant differences in rates of SVR between the 8-week and 12-week regimens in either analysis, nor any association with patient characteristics. SAEs were experienced by 1 patient (2%) in the 8-week group, 7 (5%) in the 12-week group (including one death), and 2 (29%) in the > 12-week group; 4 patients (from the 12-week group) experienced serious AEs or hepatic events that were "likely attributable" to GLE/PIB treatment. CONCLUSION An 8-week regimen of GLE/PIB is well tolerated and highly effective among US patients with HCV and cirrhosis receiving routine clinical care.
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Affiliation(s)
- Mei Lu
- Department of Public Health Sciences, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA.
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Loralee B Rupp
- Department of Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Christina Melkonian
- Department of Public Health Sciences, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Sheri Trudeau
- Department of Public Health Sciences, Henry Ford Health, One Ford Place, Detroit, MI, 48202, USA
| | - Yihe G Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA
| | - Mark A Schmidt
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Stuart C Gordon
- Department of Gastroenterology and Hepatology, Henry Ford Health, Detroit, MI, USA
- School of Medicine, Wayne State University, Detroit, MI, USA
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Ruwayni AA, AlObary EE, Alyahya KM. Efficacy and safety of glecaprevir and pibrentasvir in Saudi patients with chronic hepatitis C virus infection at a major tertiary hospital. Saudi Med J 2024; 45:34-39. [PMID: 38220241 PMCID: PMC10807674 DOI: 10.15537/smj.2024.45.1.20230236] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 11/07/2023] [Indexed: 01/16/2024] Open
Abstract
OBJECTIVES To evaluate the effectiveness and safety of glecaprevir/pibrentasvir (GLE/PIB) in chronic hepatitis C (HCV) patients, and to assess the prescribers' adherence to Food and Drug Administration recommendations on treatment duration. METHODS A retrospective cohort study was carried out on chronic HCV patients of ≥18 years, with or without cirrhosis, naive or experienced, and with normal kidney function or chronic kidney disease (including dialysis patients) at Prince Sultan Military Medical City in Riyadh, Saudi Arabia, between February 2020 and March 2021. The primary effectiveness end-point was the number and percentage of patients who achieved a sustained virologic response (SVR12), virologic failure, and non-response. Safety was determined considering both serious and non-serious adverse events. RESULTS A total of 92 patients were enrolled in this study. Among patients, 52 (56.5%) were female, 84 (91.3%) were naive, and 45 (48.9 %) had HCV genotype 4. The SVR12 was achieved in 91 (98.9%, 95% CI: [94-99.8]) patients. Only one patient (1.1%, 95% CI: [0.2-5.9]) developed virologic non-response and there were missing data on virologic failure. Overall, non-serious adverse events were observed in 26 (28.5%) patients, and none of them had serious adverse events that led to treatment discontinuation. Approximately 75% of the patients received an inappropriate treatment duration (12 weeks vs. the recommended 8 weeks) and most (n=40, 58%; p<0.022) of the exceedingly long treatments were prescribed by registrars. CONCLUSION The GLE/PIB was highly effective and safe in chronic HCV Saudi patients.
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Affiliation(s)
- Ali A. Ruwayni
- From the Department of Pharmaceutical Care (Ruwayni), Armed Forces Hospital, Jazan, and from the Department of Pharmaceutical Care (Ruwayni, AlObary, Alyahya), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Eman E. AlObary
- From the Department of Pharmaceutical Care (Ruwayni), Armed Forces Hospital, Jazan, and from the Department of Pharmaceutical Care (Ruwayni, AlObary, Alyahya), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Khalid M. Alyahya
- From the Department of Pharmaceutical Care (Ruwayni), Armed Forces Hospital, Jazan, and from the Department of Pharmaceutical Care (Ruwayni, AlObary, Alyahya), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
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Patel S, Moser A, Domingo H. Sustained virologic response in DAA-treated HCV patients on anti-epileptic drugs. J Hepatol 2023; 79:e121-e123. [PMID: 37271373 DOI: 10.1016/j.jhep.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
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Shiner B, Park JA, Rozema L, Hoyt JE, Watts BV, Gradus JL. Safety of Glecaprevir/Pibrentasvir for hepatitis C in patients with posttraumatic stress disorder: A post-marketing surveillance study. Gen Hosp Psychiatry 2023; 84:268-270. [PMID: 37380536 DOI: 10.1016/j.genhosppsych.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Brian Shiner
- Veterans Affairs Medical Center, White River Junction, Vermont, United States of America; National Center for Posttraumatic Stress Disorder, White River Junction, Vermont, United States of America; Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America.
| | - Jenna A Park
- Veterans Affairs Medical Center, White River Junction, Vermont, United States of America; Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Luke Rozema
- Veterans Affairs Medical Center, White River Junction, Vermont, United States of America
| | - Jessica E Hoyt
- Veterans Affairs Medical Center, White River Junction, Vermont, United States of America
| | - Bradley V Watts
- Veterans Affairs Medical Center, White River Junction, Vermont, United States of America; Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Jaimie L Gradus
- Boston University School of Public Health, Boston, MA, United States of America; Boston University School of Medicine, Boston, MA, United States of America
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Castaldelli-Maia JM, Camargos de Oliveira V, Irber FM, Blaas IK, Angerville B, Sousa Martins-da-Silva A, Koch Gimenes G, Waisman Campos M, Torales J, Ventriglio A, Guillois C, El Ouazzani H, Gazaix L, Favré P, Dervaux A, Apter G. Psychopharmacology of smoking cessation medications: focus on patients with mental health disorders. Int Rev Psychiatry 2023; 35:397-417. [PMID: 38299651 DOI: 10.1080/09540261.2023.2249084] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/14/2023] [Indexed: 02/02/2024]
Abstract
The adverse effects of smoking cessation in individuals with mental health disorders have been a point of concern, and progress in the development of treatment has been slow. The primary first-line treatments for smoking cessation are Nicotine Replacement Therapy, Bupropion, Varenicline, and behavioural support. Nortriptyline and Clonidine are second-line treatments used when the first-line treatments are not effective or are contraindicated. Smoking cessation medications have been shown to be effective in reducing nicotine cravings and withdrawal symptoms and promoting smoking cessation among patients living with mental disorders. However, these medications may have implications for patients' mental health and need to be monitored closely. The efficacy and side effects of these medications may vary depending on the patient's psychiatric condition, medication regimen, substance use, or medical comorbidities. The purpose of this review is to synthesise the pharmacokinetics, pharmacodynamics, therapeutic effects, adverse effects, and pharmacological interactions of first- and second-line smoking cessation drugs, with an emphasis on patients suffering from mental illnesses. Careful consideration of the risks and benefits of using smoking cessation medications is necessary, and treatment plans must be tailored to individual patients' needs. Monitoring symptoms and medication regimens is essential to ensure optimal treatment outcomes.
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Affiliation(s)
- João Mauricio Castaldelli-Maia
- Cellule de Recherche Clinique, Groupe Hospitalier du Havre, Le Havre, France
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | - Israel K Blaas
- Perdizes Institute (IPer), Clinics Hospital (HCFMUSP), Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | - Gislaine Koch Gimenes
- Perdizes Institute (IPer), Clinics Hospital (HCFMUSP), Medical School, University of São Paulo, São Paulo, Brazil
| | - Marcela Waisman Campos
- Department of Cognitive Neurology, Neuropsychiatry, and Neuropsychology, FLENI, Buenos Aires, Argentina
| | - Julio Torales
- Department of Psychiatry, National University of Asuncion, San Lorenzo, Paraguay
- Regional Institute of Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay
- School of Health Sciences, Universidad Sudamericana, Pedro Juan Caballero, Paraguay
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carine Guillois
- Cellule de Recherche Clinique, Groupe Hospitalier du Havre, Le Havre, France
| | - Houria El Ouazzani
- Cellule de Recherche Clinique, Groupe Hospitalier du Havre, Le Havre, France
| | - Léna Gazaix
- Cellule de Recherche Clinique, Groupe Hospitalier du Havre, Le Havre, France
| | - Pascal Favré
- Établissement Public de Santé Mentale, Neuilly sur Marne, France
| | - Alain Dervaux
- Établissement Public de Santé Barthélémy Durand, Étampes, France
- Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Gisèle Apter
- Cellule de Recherche Clinique, Groupe Hospitalier du Havre, Le Havre, France
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
- Établissement Public de Santé Mentale, Neuilly sur Marne, France
- Societé de l'Information Psychiatrique, Bron, France
- University of Rouen Normandy, Rouen, France
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Tanihara H, Yamamoto T, Aihara M, Koizumi N, Minami H, Kojima S, Isobe T, Kanazawa M, Suganami H. Crossover Randomized Study of Pharmacologic Effects of Ripasudil-Brimonidine Fixed-Dose Combination Versus Ripasudil or Brimonidine. Adv Ther 2023; 40:3559-3573. [PMID: 37330927 PMCID: PMC10329961 DOI: 10.1007/s12325-023-02534-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/27/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Multidrug regimens for glaucoma treatment often result in adherence issues due to inconvenience; these issues may be improved with fixed-dose combination drugs. The ophthalmic solution of ripasudil-brimonidine fixed-dose combination (RBFC; K-232) is the first treatment combining a Rho kinase inhibitor and an α2-adrenoceptor agonist, and has demonstrated ability to lower intraocular pressure (IOP) and have various effects on conjunctival hyperemia and corneal endothelial cell morphology. This study evaluates the pharmacologic effects of RBFC treatment versus its separate components-ripasudil or brimonidine. METHODS This single-center, prospective, randomized, open-label, blinded endpoint study with 3 × 3 crossover design randomly assigned healthy adult men to three groups (1:1:1) to undergo consecutive 8-day administration phases (with drug-free intervals of at least 5 days). Subjects received twice-daily instillation of RBFC → ripasudil → brimonidine (group A), ripasudil → brimonidine → RBFC (group B), or brimonidine → RBFC → ripasudil (group C). Endpoints included change in IOP, severity of conjunctival hyperemia, corneal endothelial cell morphology, pupil diameter, and pharmacokinetics. RESULTS Eighteen subjects were assigned in total (six to each group). RBFC significantly reduced IOP from baseline at 1 h post-instillation on days 1 and 8 (12.7 vs. 9.1 and 9.0 mmHg, respectively; both P < 0.001), and provided significantly greater IOP reductions than ripasudil or brimonidine at several time points. The most common adverse drug reaction with all three treatments was mild conjunctival hyperemia, which transiently increased in severity with RBFC or ripasudil, peaking at 15 min post-instillation. In post hoc analyses, conjunctival hyperemia scores were lower with RBFC than with ripasudil at several time points. Transient morphologic changes in corneal endothelial cells occurred for up to several hours with RBFC or ripasudil, but not with brimonidine. Pupil diameter did not change with RBFC. CONCLUSION RBFC significantly reduced IOP compared with each agent alone. A combination of each agent's pharmacologic profile was observed in that of RBFC. TRIAL REGISTRATION Japan Registry of Clinical Trials; Registration No. jRCT2080225220.
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Affiliation(s)
- Hidenobu Tanihara
- Department of Ophthalmology, Biei Municipal Hospital, 3-8-35 Naka-machi, Biei Town, Kamikawa-gun, Hokkaido, 071-0207, Japan.
| | - Tetsuya Yamamoto
- Prof. Kazuo Iwata Memorial Kaijin Glaucoma Center, Kaiya Eye Clinic, Shizuoka, Japan
| | - Makoto Aihara
- Department of Ophthalmology, The University of Tokyo, Tokyo, Japan
| | - Noriko Koizumi
- Department of Biomedical Engineering, Faculty of Life and Medical Sciences, Doshisha University, Kyoto, Japan
| | - Hiroomi Minami
- Pharmaceutical Clinical Development Management Department, Kowa Company, Ltd., Tokyo, Japan
| | - Satoshi Kojima
- Pharmaceutical Clinical Development Management Department, Kowa Company, Ltd., Tokyo, Japan
| | - Tomoyuki Isobe
- Tokyo New Drug Research Laboratories, Kowa Company, Ltd., Tokyo, Japan
| | - Mizuho Kanazawa
- Medical Affairs Department, Kowa Company, Ltd., Tokyo, Japan
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13
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Gonzalez-Peralta RP, Wirth S, Squires RH, Mutschler F, Lang T, Pawlowska M, Sluzewski W, Majda-Stanislawska E, Fischler B, Balistreri WF, Jonas MM, Blondet N, Rosenthal P, Alkhouri N, Romero R, Grandhi A, Castronuovo P, Caro L, Du L, Rosenbloom DI, Haber BA. Elbasvir/grazoprevir in children aged 3-18 years with chronic HCV genotype 1 or 4 infection: a pharmacokinetic modeling study. Hepatol Commun 2023; 7:e0031. [PMID: 36790337 PMCID: PMC9931032 DOI: 10.1097/hc9.0000000000000031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/15/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Approximately 3.5 million children and adolescents worldwide are chronically infected with HCV. This study uses pharmacokinetic modeling to identify pediatric doses of elbasvir/grazoprevir (EBR/GZR) that achieve plasma concentrations similar to those seen in adults receiving the approved fixed-dose combination regimen of EBR/GZR. PATIENTS AND METHODS We conducted a nonrandomized, single-arm, multicenter, open-label phase 2b trial in children and adolescents aged 3 to <18 years with chronic HCV genotype 1 or 4 infection (NCT03379506). Pharmacokinetic data were used to bridge efficacy and safety data from adults to children in a stepwise (oldest to youngest) manner. A total of 57 participants were enrolled: cohort 1 (aged 12 to <18 y), n=22; cohort 2 (aged 7 to <12 y), n=17; and cohort 3 (aged 3 to <7 y), n=18. RESULTS Steady-state plasma exposures were achieved by week 4 for EBR and GZR in all cohorts and daily dosing achieved geometric mean steady-state area under the concentration-time curve at 0-24 hours that fell within comparability bounds established for adults. All participants achieved sustained virologic response 12 weeks after completing treatment (ie, undetectable HCV RNA 12 wk following completion of treatment). Headache (n=4), fatigue (n=4), and nausea (n=2) were the most common treatment-related adverse events (all mild or moderate); no participant discontinued because of an adverse event. CONCLUSIONS Pediatric EBR/GZR pharmacokinetic models were successfully developed based on complex adult population pharmacokinetic models. At appropriate age-related doses, EBR/GZR is safe and effective in pediatric and adolescent participants with HCV infection.
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Affiliation(s)
| | - Stefan Wirth
- Helios University Hospital Wuppertal, Witten Herdecke University, Wuppertal, Germany
| | - Robert H. Squires
- University of Pittsburgh School of Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Frauke Mutschler
- Department of Pediatric Gastroenterology and Hepatology Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Bjorn Fischler
- Karolinska Institutet CLINTEC and Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Niviann Blondet
- Seattle Children’s Hospital and the University of Washington, Seattle, Washington, USA
| | - Philip Rosenthal
- University of California, San Francisco, San Francisco, California, USA
| | - Naim Alkhouri
- Texas Liver Institute, University of Texas Health, San Antonio, Texas, USA
| | - Rene Romero
- Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia, USA
| | | | | | | | - Lihong Du
- Merck & Co. Inc., Rahway, New Jersey, USA
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14
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Correia C, Fernandes S, Correia T, Soares-de-Almeida L, Filipe P. Varenicline-induced drug eruption: case and review of the literature. Dermatol Online J 2023; 29. [PMID: 37040914 DOI: 10.5070/d329160217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023] Open
Abstract
Cutaneous side-effects of varenicline, a selective partial agonist of the a4B2 nicotinic acetylcholine receptor used to treat smoking addiction, are relatively rare and mainly consist of acute generalized exanthematous pustulosis. We describe an atypical clinical presentation of a varenicline-induced drug eruption, which occurred one day after drug initiation. We report this case since we believe no drug reaction to varenicline has had this clinical presentation or rapidity of onset. Clinicians should be aware of this potential adverse cutaneous reaction in patients taking varenicline for smoking cessation.
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Affiliation(s)
- Catarina Correia
- Dermatology Department, Hospital de Santa Maria, Centro Hospitalar Universitario Lisboa Norte (CHULN), Lisbon, Portugal
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15
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Lu YH, Lu CK, Chen CH, Hsieh YY, Tung SY, Chen YH, Yen CW, Tung WL, Chang KC, Chen WM, Lu SN, Hung CH, Chang TS. Comparison of 8- versus 12-weeks of glecaprevir/pibrentasvir for Taiwanese patients with hepatitis C and compensated cirrhosis in a real-world setting. PLoS One 2022; 17:e0272567. [PMID: 35980912 PMCID: PMC9387785 DOI: 10.1371/journal.pone.0272567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Real-world data on the effectiveness of glecaprevir/pibrentasvir (GLE/PIB) for patients with HCV infection and compensated cirrhosis is limited, especially for the 8-week regimen and in an Asian population. This retrospective study enrolled 159 consecutive patients with HCV and compensated cirrhosis who were treated with GLE/PIB at a single center in Taiwan. Sustained virological response (SVR) and adverse events (AEs) were evaluated. Among the 159 patients, 91 and 68 were treated with GLE/PIB for 8 and 12 weeks, respectively. In the per protocol analysis, both the 8- and 12-week groups achieved 100% SVR (87/87 vs. 64/64); and in the evaluable population analysis, 95.6% (87/91) of the 8-week group and 94.1% (64/68) of the 12-week group achieved SVR. The most commonly reported AEs, which included pruritus (15.4% vs. 26.5%), abdominal discomfort (9.9% vs. 5.9%), and skin rash (5.5% vs. 5.9%), were mild for the 8- and 12-week groups. Two patients in the 8-week group exhibited total bilirubin elevation over three times the upper normal limit. One of these two patients discontinued GLE/PIB treatment after 2 weeks but still achieved SVR. Both 8- and 12-week GLE/PIB treatments are safe and effective for patients of Taiwanese ethnicity with HCV and compensated cirrhosis.
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Affiliation(s)
- Yung-Hsin Lu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chung-Kuang Lu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chun-Hsien Chen
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yung-Yu Hsieh
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shui-Yi Tung
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsing Chen
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chih-Wei Yen
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Lin Tung
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Kao-Chi Chang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Ming Chen
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Sheng-Nan Lu
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chao-Hung Hung
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Te-Sheng Chang
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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16
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Kramer JR, Puenpatom A, Cao Y, Yu X, El-Serag HB, Kanwal F. Treatment of hepatitis C virus infection in people with opioid use disorder: a real-world study of elbasvir/grazoprevir in a US Department of Veterans Affairs population. Am J Drug Alcohol Abuse 2022; 48:445-453. [PMID: 35077656 DOI: 10.1080/00952990.2021.1983821] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/13/2021] [Accepted: 09/17/2021] [Indexed: 06/14/2023]
Abstract
Background: Hepatitis C virus (HCV) infections in the United States have increased in recent years, with the most rapid rise among people who inject drugs (PWIDs). Historically, there have been concerns regarding treatment adherence among PWIDs with HCV infection, leading to undertreatment of this population and increased HCV transmission. Elbasvir (EBR)/grazoprevir (GZR) has demonstrated high rates of virologic cure (sustained virologic response [SVR]) in clinical trials enrolling PWIDs with HCV infection. Objective: To evaluate the real-world effectiveness of EBR/GZR in HCV genotype (GT) 1-infected patients with a diagnosis of opioid use disorder. Methods: A retrospective analysis of electronic medical records from the US Department of Veterans Affairs Corporate Data Warehouse. Adults with chronic HCV GT1 infection, ≥1 prescription for EBR/GZR, and ≥1 clinic visit were included. All patients had ≥1 ICD-9/10 code of opioid use disorder. SVR was the primary outcome. Results: 419 patients were included; 97.1% had a history of any illicit drug use and 40.8% were receiving medication for opioid use disorder (MOUD). SVR was achieved by 96.9% (406/419) of all patients, 97.0% (350/361) of those receiving EBR/GZR for 12 weeks, and 95.3% (163/171) of those receiving MOUD. SVR in patients receiving psychiatric medications ranged from 96.1% (221/230) in those taking antidepressant medications to 98.5% (128/130) in those taking mood stabilizers. Conclusion: In this real-world setting, high rates of virologic cure were achieved in patients with HCV GT1 infection on MOUD receiving EBR/GZR for 12 weeks, including patients with multiple comorbidities and high rate of psychiatric medication use.
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Affiliation(s)
- Jennifer R Kramer
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Amy Puenpatom
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Yumei Cao
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Xian Yu
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Hashem B El-Serag
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Fasiha Kanwal
- Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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17
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Papachristou C, Humair JP. [Tobacco cessation treatment for people with schizophrenia]. Rev Med Suisse 2022; 18:1275-1278. [PMID: 35735153 DOI: 10.53738/revmed.2022.18.787.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Among patients suffering from schizophrenia, tobacco smoking prevalence is extremely high and represents a major burden in terms of morbidity and mortality. Tobacco smoking is under-diagnosed and under-treated by mental health professionals, mostly due to an overestimated risk of jeopardizing the patient's mental condition, but also due to a lack of expertise on tobacco cessation treatment. Despite the extent of this problem, pharmacological approaches haven't been studied enough. However, treatments such as varenicline, bupropion and nicotine replacement are effective and well tolerated and their prescription should be recommended for tobacco withdrawal among these patients.
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Affiliation(s)
| | - Jean-Paul Humair
- Service de médecine de premier recours, Hôpitaux universitaires de Genève, 1211 Genève 14
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18
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Dosne AG, Valade E, Goeyvaerts N, De Porre P, Avadhani A, O'Hagan A, Li LY, Ouellet D, Perez Ruixo JJ. Exposure-response analyses of erdafitinib in patients with locally advanced or metastatic urothelial carcinoma. Cancer Chemother Pharmacol 2022; 89:151-164. [PMID: 34977972 PMCID: PMC8807442 DOI: 10.1007/s00280-021-04381-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
Background Exposure–response analyses were conducted to explore the relationship between selected efficacy and safety endpoints and serum phosphate (PO4) concentrations, a potential biomarker of efficacy and safety, in locally advanced or metastatic urothelial carcinoma patients with FGFR alterations treated with erdafitinib. Methods Data from two dosing regimens of erdafitinib in a phase 2 study (NCT02365597), 6 and 8-mg/day with provision for pharmacodynamically guided titration per serum PO4 levels, were analyzed using Cox proportional hazard or logistic regression models. Efficacy endpoints were overall survival (OS), progression-free survival (PFS), and objective response rate (ORR). Safety endpoints were adverse events typical for FGFR inhibitors. Results Exposure-efficacy analyses on 156 patients (6-mg = 68; 8-mg = 88) showed that patients with higher serum PO4 levels within the first 6 weeks showed better OS (hazard ratio 0.57 [95% CI 0.46–0.72] per mg/dL of PO4; p = 0.01), PFS (hazard ratio 0.80 [0.67–0.94] per mg/dL of PO4; p = 0.01), and ORR (odds ratio 1.38 [1.02–1.86] per mg/dL of PO4; p = 0.04). Exposure-safety analyses on 177 patients (6-mg = 78; 8-mg = 99) showed that the incidence of selected adverse events associated with on-target off-tumor effects significantly rose with higher PO4. Conclusions The exploratory relationship between serum PO4 levels and efficacy/safety outcomes supported the use of pharmacodynamically guided dose titration to optimize erdafitinib’s therapeutic benefit/risk ratio. Clinical trial registration number NCT02365597. Supplementary Information The online version contains supplementary material available at 10.1007/s00280-021-04381-4.
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Affiliation(s)
| | | | | | | | | | - Anne O'Hagan
- Janssen Research and Development, Spring House, PA, USA
| | - Lilian Y Li
- Janssen Research and Development, Spring House, PA, USA
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19
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Jonas MM, Rhee S, Kelly DA, Del Valle‐Segarra A, Feiterna‐Sperling C, Gilmour S, Gonzalez‐Peralta RP, Hierro L, Leung DH, Ling SC, Lobzin Y, Lobritto S, Mizuochi T, Narkewicz MR, Sabharwal V, Wen J, Kei Lon H, Marcinak J, Topp A, Tripathi R, Sokal E. Pharmacokinetics, Safety, and Efficacy of Glecaprevir/Pibrentasvir in Children With Chronic HCV: Part 2 of the DORA Study. Hepatology 2021; 74:19-27. [PMID: 33811356 PMCID: PMC8548879 DOI: 10.1002/hep.31841] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND AIMS Glecaprevir/pibrentasvir (GLE/PIB) has shown high efficacy and safety in chronic HCV-infected adults and adolescents; data in children were limited. DORA part 2 is a phase 2/3, nonrandomized, open-label study evaluating the pharmacokinetics, efficacy, and safety of a pediatric formulation of GLE and PIB in children ages 3 to < 12 years. APPROACH AND RESULTS Children with chronic HCV infection, genotype 1-6, with or without compensated cirrhosis, were divided into three cohorts by age-cohort 2 (9 to < 12 years), cohort 3 (6 to < 9 years), and cohort 4 (3 to < 6 years)-and given weight-based doses of GLE and PIB for 8, 12, or 16 weeks. Primary endpoints were sustained virologic response at posttreatment week 12 (SVR12) and steady-state exposure; secondary endpoints were rates of persistent viremia, relapse, and reinfection. Safety and laboratory abnormalities were assessed. Final pediatric dosages determined to be efficacious were 250 mg GLE + 100 mg PIB (in children weighing ≥ 30 to < 45 kg), 200 mg GLE + 80 mg PIB (≥ 20 to < 30 kg), and 150 mg GLE + 60 mg PIB (12 to < 20 kg). Of 80 participants enrolled and dosed, 96% (77/80) achieved SVR12. One participant, on the initial dose ratio, relapsed by posttreatment week 4; no participants had virologic failures on the final dose ratio of GLE 50 mg/PIB 20 mg. Two nonresponders prematurely discontinued the study. Most adverse events (AEs) were mild; no drug-related serious AEs occurred. Pharmacokinetic exposures were comparable to those of adults. CONCLUSIONS A pediatric formulation of GLE/PIB was highly efficacious and well tolerated in chronic HCV-infected children 3 to < 12 years old.
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Affiliation(s)
- Maureen M. Jonas
- Division of Gastroenterology, Hepatology, and NutritionBoston Children’s HospitalBostonMA
- Department of PediatricsHarvard Medical SchoolBostonMA
| | | | - Deirdre A. Kelly
- The Liver UnitBirmingham Women’s & Children’s Hospital and University of BirminghamBirminghamUnited Kingdom
| | | | - Cornelia Feiterna‐Sperling
- Department of Pediatric Pulmonology, Immunology, and Intensive Care MedicineCharité–Universitätsmedizin BerlinBerlinGermany
| | - Susan Gilmour
- Stollery Children’s Hospital and University of AlbertaEdmontonABCanada
| | | | | | - Daniel H. Leung
- Division of Gastroenterology, Hepatology, and NutritionTexas Children’s HospitalHoustonTX
- Department of PediatricsBaylor College of MedicineHoustonTX
| | - Simon C. Ling
- Division of Gastroenterology, Hepatology, and NutritionThe Hospital for Sick ChildrenTorontoONCanada
- Department of PaediatricsUniversity of TorontoTorontoONCanada
| | - Yuri Lobzin
- Pediatric Research and Clinical Center for Infectious Diseases and North‐Western State Medical University named after I.I. MechnikovRussian FederationSt. PetersburgRussia
| | - Steven Lobritto
- Morgan Stanley Children’s Hospital of New YorkColumbia University Irving Medical CenterNew YorkNY
| | - Tatsuki Mizuochi
- Department of Pediatrics and Child HealthKurume University School of MedicineKurumeJapan
| | - Michael R. Narkewicz
- Digestive Health InstituteChildren’s Hospital ColoradoSection of Pediatric GastroenterologyHepatology, and NutritionDepartment of Pediatrics University of Colorado School of MedicineAuroraCO
| | - Vishakha Sabharwal
- Division of Pediatric Infectious DiseasesDepartment of PediatricsBoston University Medical CenterBostonMA
| | - Jessica Wen
- The Children’s Hospital Philadelphia and University of PennsylvaniaPhiladelphiaPA
| | | | | | | | | | - Etienne Sokal
- Division of Pediatric Gastroenterology and HepatologyUniversité Catholique de LouvainCliniques Universitaires Saint LucBrusselsBelgium
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20
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Forns X, Feld JJ, Dylla DE, Pol S, Chayama K, Hou J, Heo J, Lampertico P, Brown A, Bondin M, Tatsch F, Burroughs M, Marcinak J, Zhang Z, Emmett A, Gordon SC, Jacobson IM. Safety of Patients with Hepatitis C Virus Treated with Glecaprevir/Pibrentasvir from Clinical Trials and Real-World Cohorts. Adv Ther 2021; 38:3409-3426. [PMID: 34021887 PMCID: PMC8189955 DOI: 10.1007/s12325-021-01753-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/18/2021] [Indexed: 12/24/2022]
Abstract
Introduction More than 70 million people are estimated to be infected with hepatitis C virus (HCV) globally. If left untreated, HCV infection can lead to complications such as extensive liver fibrosis, cirrhosis, and hepatocellular carcinoma (HCC). Evolution of treatments has resulted in highly effective and well-tolerated all-oral direct-acting antivirals. The pangenotypic regimen of glecaprevir/pibrentasvir is approved for treating HCV for patients without cirrhosis or with compensated cirrhosis (CC). Guidelines have evolved to simplify treatment to enable non-specialists to manage and treat HCV-infected patients. Simultaneously, such treatment algorithms provide guidance on the pretreatment identification of small subsets of patients who may require specialist treatment and long-term follow-up for advanced liver disease, including those at risk of developing HCC. This study describes the safety profile of glecaprevir/pibrentasvir in patients identified using previously described noninvasive laboratory measures who may be eligible for treatment by non-liver specialists. Methods This post hoc analysis of glecaprevir/pibrentasvir in patients, identified by noninvasive laboratory measures, intended to exclude patients with advanced liver disease and severe renal impairment, who can be managed within non-liver specialist settings. Patients were included from clinical trials and real-world studies of glecaprevir/pibrentasvir for HCV treatment. Baseline demographics, clinical characteristics, and safety assessments, including adverse events and laboratory abnormalities, were summarized. Results Data across these large-scale studies confirm that glecaprevir/pibrentasvir is well tolerated across different patient populations, with fewer than 0.1% of patients experiencing a serious adverse event related to treatment drugs, and few patients developing HCC during or after treatment. Conclusion The safety profile of glecaprevir/pibrentasvir enhances the confidence of non-liver specialists to treat the majority of HCV-infected patients, and provides an opportunity to expand the treater pool, potentially increasing diagnosis and treatment rates for HCV, contributing to elimination of HCV. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01753-3.
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Affiliation(s)
- Xavier Forns
- Liver Unit, Hospital Clinic de Barcelona, IDIBAPS and CIBEREHD, University of Barcelona, Barcelona, Spain.
| | - Jordan J Feld
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Stanislas Pol
- Liver Unit, Cochin Hospital, APHP, Inserm U-1223, Institut Pasteur, Université de Paris, Paris, France
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jinlin Hou
- Department of Infectious Diseases, State Key Laboratory of Organ Failure Research, Guangdong Provincial Key Laboratory of Viral Hepatitis Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jeong Heo
- Department of Internal Medicine, College of Medicine, Pusan National University and Medical Research Institute, Busan, Republic of Korea
| | - Pietro Lampertico
- Division of Gastroenterology and Hepatology, CRC "A.M. and A. Migliavacca" Center for Liver Disease, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Ashley Brown
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | | | | | - Stuart C Gordon
- Division of Gastroenterology and Hepatology, Henry Ford Health System and Wayne State University School of Medicine, Detroit, MI, USA
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21
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Li C, Liang J, Xiang H, Chen H, Tian J. Effectiveness of direct-acting antivirals in maintenance hemodialysis patients complicated with chronic hepatitis C. Medicine (Baltimore) 2020; 99:e23384. [PMID: 33235113 PMCID: PMC7710190 DOI: 10.1097/md.0000000000023384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/21/2020] [Accepted: 10/29/2020] [Indexed: 11/28/2022] Open
Abstract
Hepatitis C virus (HCV) infection is very common in maintenance hemodialysis patients, causing high morbidity and mortality. This study aimed to evaluate the effectiveness and adverse events of direct-acting antivirals (DAAs) in maintenance hemodialysis patients complicated with chronic hepatitis C in real-world clinical practice.In this retrospective observational study, hemodialysis patients with chronic hepatitis C infection in the Third Central Hospital of Tianjin outpatient were screened, and appropriate treatment plans were selected accordingly. Totally 25 patients diagnosed with chronic hepatitis C and treated with DAAs for 12 weeks or 24 weeks were included. The sustained virologic response (SVR) rate obtained 12 weeks post-treatment (SVR12) was evaluated. Laboratory indexes and adverse reactions during the treatment process were also assessed.A total of 25 cases met the eligibility criteria and provided informed consent. Except for 1 patient who discontinued the treatment due to gastrointestinal bleeding, the remaining 24 cases completed the treatment cycle with 100% rapid virologic response (RVR) and 100% SVR12, with no serious adverse reactions recorded.Maintenance hemodialysis patients complicated with chronic hepatitis C in Chinese real-world setting tolerate DAAs very well, with a viral response rate reaching 100%.
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Affiliation(s)
- Chunhong Li
- Depatrment of Nephrology, The Third Central Clinical College of Tianjin Medical University
- Department of Nephrology, The Third Central Hospital of Tianjin
| | - Jing Liang
- Depatrment of Nephrology, The Third Central Clinical College of Tianjin Medical University
- Department of Nephrology, The Third Central Hospital of Tianjin
| | - Huiling Xiang
- Department of Nephrology, The Third Central Hospital of Tianjin
| | - Haiyan Chen
- Department of Blood Purification Center, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Jie Tian
- Department of Nephrology, The Third Central Hospital of Tianjin
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Laguno Centeno M, Alvarez B, Martínez-Rebollar M, de la Mora L, Prieto L, de Lazzari E, González-Cordón A, Torres B, Cabello A, Gorgolas M, Mallolas J. Efficacy of Elbasvir/Grazoprevir in Early Chronic G1/G4 Hepatitis C infection in HIV/HCV co-infected patients with mild fibrosis. Gastroenterol Hepatol 2020; 44:191-197. [PMID: 33041087 DOI: 10.1016/j.gastrohep.2020.06.019] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 06/02/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Acute hepatitis C virus (AHC) infection is increasingly common among HIV+ men who have sex with men (MSM). Until 2017, the guidelines recommended therapy with pegylated-interferon plus ribavirin with a mild sustained virological response (SVR). This prompted many patients to reject that treatment, at that time, waiting to be treated with better and safer options with new Direct-Acting-Antivirals (DAA). OBJECTIVES Assess the efficacy and safety of Elbasvir/Grazoprevir to treat recent chronic hepatitis C infection, genotype 1 or 4, in HIV+ MSM patients. METHODS Prospective, open-labeled, two center, pilot study. SVR is analyzed for treatment with Elbasvir/Grazoprevir (8 weeks in GT1b or 12 in GT1a or GT4) in patients with a recent chronic HCV infection, defined as HCV infection lasting less than 4 years and mild liver fibrosis (liver stiffness <8kPa). RESULTS Forty-eight patients were included (May 2017-March 2018): 2 GT1b, 24 GT1a and 22 GT4. HCV-RNA>800000UI in 63% and medium liver stiffness 4.9kPa. The SVR was 98%, one patient failed due to poor adherence. 67% of patients had adverse effects, but only 16% treatment related. The most frequent side effects were gastrointestinal (19%), related with the central nervous system (18%), respiratory (16%) and systemic symptoms (15%). During one year of follow-up post-therapy, 4 AHC and 18 patients with sexually transmitted diseases (STD) were diagnosed. CONCLUSIONS Treatment with Elbasvir/Grazoprevir in this scenario is highly effective and safe. Patients with risky sexual practices must remain linked to the medical care system to detect new STD and HCV reinfection.
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Affiliation(s)
| | - Beatriz Alvarez
- Servicio de Infecciones, Fundación Jímenez Díaz, Madrid, Spain
| | | | | | - Laura Prieto
- Servicio de Infecciones, Fundación Jímenez Díaz, Madrid, Spain
| | | | | | - Berta Torres
- Unidad de VIH, Hospital Clinic, Barcelona, Spain
| | - Alfonso Cabello
- Servicio de Infecciones, Fundación Jímenez Díaz, Madrid, Spain
| | - Miguel Gorgolas
- Servicio de Infecciones, Fundación Jímenez Díaz, Madrid, Spain
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Liu YC, Jeng WJ, Cheng YT, Hsieh YC, Teng W, Chen YC, Lin CY, Chien RN, Sheen IS. Incidence and predictors for abnormal liver function during direct-acting antiviral agents in chronic hepatitis C patients. Medicine (Baltimore) 2020; 99:e21898. [PMID: 32925725 PMCID: PMC7489670 DOI: 10.1097/md.0000000000021898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abrupt alanine aminotransferase (ALT) elevation during direct-acting antiviral agents (DAA) treatment is an uncommon but noticeable adverse event in chronic hepatitis C (CHC) patients, which may lead to early termination of treatment. This study aims to investigate the incidence, outcome and predictors of the on-treatment ALT elevation during DAA therapy.CHC patients treated with DAA regimen in Chang Gung Memorial Hospital, Linkou branch during March 2015 to March 2019 were recruited. Prospective scheduled ALT assessment at baseline, 2nd, 4th, 8th, and 12th/24th weeks were recorded. Pretherapy host and viral factors were compared between patients with and without on-treatment ALT elevation. Multivariate logistic regression was used for independent factors for on-treatment ALT elevation.A total of 1563 CHC patients treated with grazoprevir/elbasvir, glecaprevir/pibrentasvir and sofosbuvir-based regimen were analyzed. On-treatment ALT elevation occurred in 10.9% patients while those treated with glecaprevir/pibrentasvir had the least possibility (5.4%). Only 1.4% patients had ≥grade 3 ALT elevation events. The presence of such events had no impact on sustained virological response 12 rates. Hepatitis B virus coinfection (aOR: 3.599, P < 0.001) and higher pretherapy ALT (1-5x, ≥5x upper limit of normal: aOR: 2.632, P = 0.024, aOR: 4.702, P = .011, respectively) were significant predictors for ALT elevation.On-treatment ALT elevation occurred in one-tenth CHC patients treated with preferred DAAs but had no impact on sustained virological response rate.
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Affiliation(s)
- Yen-Chun Liu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch
- College of Medicine, Chang Gung University, Taiwan
| | - Wen-Juei Jeng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch
- College of Medicine, Chang Gung University, Taiwan
| | - Ya-Ting Cheng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch
- College of Medicine, Chang Gung University, Taiwan
| | - Yi-Chung Hsieh
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch
- College of Medicine, Chang Gung University, Taiwan
| | - Wei Teng
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch
- College of Medicine, Chang Gung University, Taiwan
| | - Yi-Cheng Chen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch
- College of Medicine, Chang Gung University, Taiwan
| | - Chun-Yen Lin
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch
- College of Medicine, Chang Gung University, Taiwan
| | - Rong-Nan Chien
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch
- College of Medicine, Chang Gung University, Taiwan
| | - I-Shyan Sheen
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou branch
- College of Medicine, Chang Gung University, Taiwan
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Asselah T, Zeuzem S, Reau N, Hwang P, Long J, Talwani R, Robertson MN, Haber BA. Efficacy and safety of elbasvir/grazoprevir for 12 weeks in people with hepatitis C virus infection aged 35 years or younger compared with older people: a retrospective integrated analysis. Curr Med Res Opin 2020; 36:1325-1332. [PMID: 32459122 DOI: 10.1080/03007995.2020.1775075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: In the United States, the number of new cases of hepatitis C virus infection has risen in recent years, driven largely by transmission among young white adults in their 20s and 30s. Herein, we report an integrated analysis of participants with hepatitis C virus infection aged ≤35 years from 12 phase II/III clinical trials of elbasvir/grazoprevir.Methods: Treatment-naive and -experienced adults with hepatitis C virus genotype 1 or 4 infection received elbasvir (50 mg/day)/grazoprevir (100 mg/day) for 12 weeks without ribavirin. Analyses were stratified according to participant age (≤35 years vs >35 years). The primary endpoint was sustained virologic response (hepatitis C virus RNA < lower limit of quantitation at 12 weeks after completion of therapy).Results: Sustained virologic response was achieved by 98.9% (271/274) of participants aged ≤35 years and by 96.9% (2093/2160) aged >35 years. Three participants aged ≤35 years with genotype 1b infection relapsed. Eight participants with genotype 1a infection and baseline non-structural protein 5 A resistance-associated substitutions achieved sustained virologic response. Similarly, all 85 participants aged ≤35 years with genotype 1a infection and no baseline non-structural protein 5 A resistance-associated substitutions achieved sustained virologic response. Safety was favorable, with the incidence of drug-related adverse events similar in younger and older participants (30.1% vs 30.6%). One participant (0.4%) aged ≤35 years and 15 participants (0.7%) aged >35 years discontinued treatment owing to adverse events.Conclusions: Elbasvir/grazoprevir for 12 weeks was safe and highly effective in participants aged ≤35 years with hepatitis C virus genotype 1 or 4 infection.
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Affiliation(s)
- Tarik Asselah
- Department of Hepatology, INSERM UMR1149, University Paris Diderot, Hôpital Beaujon, Clichy, France
| | - Stefan Zeuzem
- Department of Medicine, Goethe University Hospital, Frankfurt, Germany
| | - Nancy Reau
- Department of Hepatology, Rush University Medical Center, Chicago, IL, USA
| | - Peggy Hwang
- Department of Infectious Disease, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Jianmin Long
- Department of Infectious Disease, Merck & Co. Inc., Kenilworth, NJ, USA
| | - Rohit Talwani
- Department of Infectious Disease, Merck & Co. Inc., Kenilworth, NJ, USA
| | | | - Barbara A Haber
- Department of Infectious Disease, Merck & Co. Inc., Kenilworth, NJ, USA
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Feld JJ, Cypel M, Kumar D, Dahari H, Pinto Ribeiro RV, Marks N, Kamkar N, Bahinskaya I, Onofrio FQ, Zahoor MA, Cerrochi O, Tinckam K, Kim SJ, Schiff J, Reichman TW, McDonald M, Alba C, Waddell TK, Sapisochin G, Selzner M, Keshavjee S, Janssen HLA, Hansen BE, Singer LG, Humar A. Short-course, direct-acting antivirals and ezetimibe to prevent HCV infection in recipients of organs from HCV-infected donors: a phase 3, single-centre, open-label study. Lancet Gastroenterol Hepatol 2020; 5:649-657. [PMID: 32389183 PMCID: PMC7391837 DOI: 10.1016/s2468-1253(20)30081-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [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: 01/13/2020] [Revised: 02/28/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND An increasing percentage of potential organ donors are infected with hepatitis C virus (HCV). After transplantation from an infected donor, establishment of HCV infection in uninfected recipients is near-universal, with the requirement for post-transplant antiviral treatment. The aim of this study was to determine if antiviral drugs combined with an HCV entry blocker given before and for 7 days after transplant would be safe and reduce the likelihood of HCV infection in recipients of organs from HCV-infected donors. METHODS HCV-uninfected organ recipients without pre-existing liver disease were treated with ezetimibe (10 mg; an HCV entry inhibitor) and glecaprevir-pibrentasvir (300 mg/120 mg) before and after transplantation from HCV-infected donors aged younger than 70 years without co-infection with HIV, hepatitis B virus, or human T-cell leukaemia virus 1 or 2. Recipients received a single dose 6-12 h before transplant and once a day for 7 days after surgery (eight doses in total). HCV RNA was assessed once a day for 14 days and then once a week until 12 weeks post-transplant. The primary endpoint was prevention of chronic HCV infection, as evidenced by undetectable serum HCV RNA at 12 weeks after transplant, and assessed in the intention-to-treat population. Safety monitoring was according to routine post-transplant practice. 12-week data are reported for the first 30 patients. The trial is registered on ClinicalTrials.gov, NCT04017338. The trial is closed to recruitment but follow-up is ongoing. FINDINGS 30 patients (23 men and seven women; median age 61 years (IQR 48-66) received transplants (13 lung, ten kidney, six heart, and one kidney-pancreas) from 18 HCV-infected donors. The median donor viral load was 5·11 log10IU/mL (IQR 4·55-5·63) and at least three HCV genotypes were represented (nine [50%] donors with genotype 1, two [11%] with genotype 2, five [28%] with genotype 3, and two [11%] with unknown genotype). All 30 (100%) transplant recipients met the primary endpoint of undetectable HCV RNA at 12 weeks post-transplant, and were HCV RNA-negative at last follow-up (median 36 weeks post-transplant [IQR 25-47]). Low-level viraemia was transiently detectable in 21 (67%) of 30 recipients in the early post-transplant period but not after day 14. Treatment was well tolerated with no dose reductions or treatment discontinuations; 32 serious adverse events occurred in 20 (67%) recipients, with one grade 3 elevation in alanine aminotransferase (ALT) possibly related to treatment. Non-serious transient elevations in ALT and creatine kinase during the study dosing period resolved with treatment completion. Among the serious adverse events were two recipient deaths due to causes unrelated to study drug treatment (sepsis at 49 days and subarachnoid haemorrhage at 109 days post-transplant), with neither patient ever being viraemic for HCV. INTERPRETATION Ezetimibe combined with glecaprevir-pibrentasvir given one dose before and for 7 days after transplant prevented the establishment of chronic HCV infection in recipients of different organs from HCV-infected donors. This study shows that an ultra-short course of direct-acting antivirals and ezetimibe can prevent the establishment of chronic HCV infection in the recipient, alleviating many of the concerns with transplanting organs from HCV-infected donors. FUNDING Canadian Institutes of Health Research; the Organ Transplant Program, University Health Network.
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Affiliation(s)
- Jordan J Feld
- Toronto Centre for Liver Disease, Toronto, ON, Canada; Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
| | - Marcelo Cypel
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Deepali Kumar
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Harel Dahari
- Program for Experimental and Theoretical Modeling, Division of Hepatology, Department of Medicine, Loyola University Chicago, Chicago, IL, USA
| | | | - Nikki Marks
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Nellie Kamkar
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Ilona Bahinskaya
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Fernanda Q Onofrio
- Toronto Centre for Liver Disease, Toronto, ON, Canada; Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mohamed A Zahoor
- Toronto Centre for Liver Disease, Toronto, ON, Canada; Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Orlando Cerrochi
- Toronto Centre for Liver Disease, Toronto, ON, Canada; Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kathryn Tinckam
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - S Joseph Kim
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Schiff
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Trevor W Reichman
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Michael McDonald
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Carolina Alba
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Thomas K Waddell
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Gonzalo Sapisochin
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Markus Selzner
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Shaf Keshavjee
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Harry L A Janssen
- Toronto Centre for Liver Disease, Toronto, ON, Canada; Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bettina E Hansen
- Toronto Centre for Liver Disease, Toronto, ON, Canada; Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Lianne G Singer
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Atul Humar
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Soham and Shaila Ajmera Family Transplant Centre, University Health Network, University of Toronto, Toronto, ON, Canada
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Affiliation(s)
- Katherine Wong
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexander Podboy
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan Lavezo
- Department of Neuropathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Aparna Goel
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA, USA.
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Fontana RJ, Lens S, McPherson S, Elkhashab M, Ankoma-Sey V, Bondin M, Dos Santos AGP, Xue Z, Trinh R, Porcalla A, Zeuzem S. Efficacy and Safety of 8 Weeks of Glecaprevir/Pibrentasvir in Treatment-Naïve, HCV-Infected Patients with APRI ≤ 1 in a Single-Arm, Open-Label, Multicenter Study. Adv Ther 2019; 36:3458-3470. [PMID: 31646465 PMCID: PMC6860464 DOI: 10.1007/s12325-019-01123-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The presence or absence of cirrhosis in patients with chronic hepatitis C virus (HCV) infection influences the type and duration of antiviral therapy. Non-invasive markers, like serum aspartate aminotransferase (AST) to platelet ratio index (APRI), may help identify appropriate HCV treatment-naive patients for 8-week treatment with the pangenotypic regimen of glecaprevir/pibrentasvir. METHODS This single-arm, open-label, international, prospective study (NCT03212521) evaluated the efficacy and safety of 8-week glecaprevir/pibrentasvir regimen in HCV treatment-naïve adults with chronic HCV genotypes 1-6 infection, APRI ≤ 1, and no prior evidence of cirrhosis. The primary and secondary outcomes were sustained virologic response at 12 weeks post-treatment (SVR12) by modified intent-to-treat (mITT) and intent-to-treat (ITT) analyses, respectively. Additional endpoints included virologic failures, treatment adherence, and genotype-specific SVR12 rates. RESULTS Among the 230 patients enrolled, most were less than 65 years old (90%); 37% and 43% had a history of injection drug use or psychiatric disorders, respectively. SVR12 rates were 100% (222/222; 95% CI 98.3-100%) and 96.5% (222/230; 95% CI 94.2-98.9%) by mITT and ITT analyses, respectively. There were no virologic failures. ITT SVR12 rates were greater than 94% for all HCV genotypes. In patients with available data, treatment adherence was 99% (202/204). There were no grade 3 or higher laboratory abnormalities in alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin, and low rates of serious adverse events (2%). CONCLUSIONS Glecaprevir/pibrentasvir was highly efficacious and well tolerated in HCV treatment-naïve patients with APRI ≤ 1 and no prior evidence of cirrhosis. TRIAL REGISTRATION ClinicalTrials.gov number, NCT03212521. FUNDING AbbVie. Plain language summary available for this article.
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Affiliation(s)
- Robert J Fontana
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.
| | - Sabela Lens
- Liver Unit, Hospital Clinic, IDIBAPS and CIBERehd, University of Barcelona, Barcelona, Spain
| | - Stuart McPherson
- Liver Unit, The Newcastle upon Tyne Hospitals NHS Foundation and Trust and Newcastle University, Newcastle upon Tyne, UK
| | | | - Victor Ankoma-Sey
- Division of Gastroenterology, Sherri and Alan Conover Center for Liver Disease and Transplantation, Houston Methodist, Houston, TX, USA
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Sezaki H, Suzuki F, Hosaka T, Fujiyama S, Kawamura Y, Akuta N, Kobayashi M, Suzuki Y, Saitoh S, Arase Y, Ikeda K, Kobayashi M, Kumada H. Initial- and re-treatment effectiveness of glecaprevir and pibrentasvir for Japanese patients with chronic hepatitis C virus-genotype 1/2/3 infections. J Gastroenterol 2019; 54:916-927. [PMID: 30903385 DOI: 10.1007/s00535-019-01575-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/17/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Glecaprevir and pibrentasvir (GLE/PIB) are potent antiviral agents for hepatitis C virus (HCV) pan-genotypic infections; however, their clinical effectiveness and safety remain limited in the real-world. This study aimed to evaluate viral responses and the safety of GLE/PIB for patients with chronic HCV-1/2/3 infections during both initial- (Arm A) and re-treatment (Arm B) with all-oral direct-acting antiviral agents (DAAs). METHODS This prospective-observational cohort study included Japanese patients with chronic HCV-1/2/3 infections (n = 271: 183 in Arm A and 83 in Arm B), who had started receiving GLE/PIB. Primary end point was a sustained virological response (SVR) rate at week 12 (SVR12) after the end of GLE/PIB treatment (EOT). RESULTS SVR12 was achieved by 99.4% of patients (180/181: modified intention-to-treat (mITT) analysis excluding 2 patients lost to follow-up) in Arm A. One patient with an HCV-3b infection who discontinued at week 8 failed to achieve SVR12. SVR12 was achieved by 97.7% of patients (85/87: mITT excluding 1 patient lost to follow-up) in Arm B. Virological relapse occurred in 2 patients with HCV-1b, presenting common 5 loci of resistance-associated substitutions (RASs) including A92 RASs in the NS5A lesion at baseline. Any adverse events (AEs) (grade ≥ 3) occurred in 8 patients (3.0%). 8 patients (3.0%) discontinued due to AEs, however, all of them achieved SVR12. CONCLUSIONS Initial and re-treatment with GLE/PIB are effective and safe for Japanese patients with HCV-1/2/3 in real-life settings. Further studies are required to elucidate the mechanism underlying treatment failures of GLE/PIB to completely eradicate HCV worldwide.
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Affiliation(s)
- Hitomi Sezaki
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Fumitaka Suzuki
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Tetsuya Hosaka
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Shunichirou Fujiyama
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yusuke Kawamura
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Norio Akuta
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Masahiro Kobayashi
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yoshiyuki Suzuki
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Satoshi Saitoh
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yasuji Arase
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kenji Ikeda
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Mariko Kobayashi
- Research Institute for Hepatology, Toranomon Hospital, Tokyo, Japan
| | - Hiromitsu Kumada
- Department of Hepatology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
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Abstract
RATIONALE Glecaprevir/pibrentasvir, a pan-genotypic and ribavirin-free direct acting antiviral agent regimen, has shown significant efficacy and very few serious complications. However, as the drug metabolizes in the liver, it is not recommended in patients with decompensated liver cirrhosis. Herein, we report the case of a patient with compensated liver cirrhosis who developed severe jaundice after glecaprevir/pibrentasvir medication. PATIENT CONCERNS A 77-year-old man diagnosed with chronic hepatitis C-related compensated liver cirrhosis visited hospital due to severe jaundice after 12 weeks of glecaprevir/pibrentasvir medication. DIAGNOSES On the laboratory work-up, the total/direct bilirubin level was markedly elevated to 21.56/11.68 from 1.81 mg/dL; the alanine aminotransferase and aspartate aminotransferase levels were within the normal range. We checked the plasma drug concentration level of glecaprevir, and 18,500 ng/mL was detected, which was more than 15 times higher than the drug concentration level verified in normal healthy adults. INTERVENTIONS Glecaprevir/pibrentasvir was abruptly stopped and after 6 days, the drug concentration level decreased to 35 ng/mL and the serum total/direct bilirubin decreased to 7.49/4.06 mg/dL. OUTCOMES Three months after drug cessation, the serum total bilirubin level normalized to 1.21 mg/dL and HCV RNA was not detected. LESSONS We report what is likely the first known case of severe jaundice after medication with glecaprevir/pibrentasvir in a patient with compensated liver cirrhosis. Clinicians should bear potential hyperbilirubinemia in mind when treating chronic hepatitis C with this regimen and should monitor the patient closely during follow-up laboratory exams, especially in elderly cirrhotic patients.
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Affiliation(s)
| | - Sun Min Kim
- Department of Gastroenterology and Hepatology
| | | | - Hee Joon Kim
- Department of Surgery, Chonnam National University Hospital and School of Medicine, Gwangju, South Korea
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Loriot Y, Necchi A, Park SH, Garcia-Donas J, Huddart R, Burgess E, Fleming M, Rezazadeh A, Mellado B, Varlamov S, Joshi M, Duran I, Tagawa ST, Zakharia Y, Zhong B, Stuyckens K, Santiago-Walker A, De Porre P, O'Hagan A, Avadhani A, Siefker-Radtke AO. Erdafitinib in Locally Advanced or Metastatic Urothelial Carcinoma. N Engl J Med 2019; 381:338-348. [PMID: 31340094 DOI: 10.1056/nejmoa1817323] [Citation(s) in RCA: 773] [Impact Index Per Article: 154.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Alterations in the gene encoding fibroblast growth factor receptor (FGFR) are common in urothelial carcinoma and may be associated with lower sensitivity to immune interventions. Erdafitinib, a tyrosine kinase inhibitor of FGFR1-4, has shown antitumor activity in preclinical models and in a phase 1 study involving patients with FGFR alterations. METHODS In this open-label, phase 2 study, we enrolled patients who had locally advanced and unresectable or metastatic urothelial carcinoma with prespecified FGFR alterations. All the patients had a history of disease progression during or after at least one course of chemotherapy or within 12 months after neoadjuvant or adjuvant chemotherapy. Prior immunotherapy was allowed. We initially randomly assigned the patients to receive erdafitinib in either an intermittent or a continuous regimen in the dose-selection phase of the study. On the basis of an interim analysis, the starting dose was set at 8 mg per day in a continuous regimen (selected-regimen group), with provision for a pharmacodynamically guided dose escalation to 9 mg. The primary end point was the objective response rate. Key secondary end points included progression-free survival, duration of response, and overall survival. RESULTS A total of 99 patients in the selected-regimen group received a median of five cycles of erdafitinib. Of these patients, 43% had received at least two previous courses of treatment, 79% had visceral metastases, and 53% had a creatinine clearance of less than 60 ml per minute. The rate of confirmed response to erdafitinib therapy was 40% (3% with a complete response and 37% with a partial response). Among the 22 patients who had undergone previous immunotherapy, the confirmed response rate was 59%. The median duration of progression-free survival was 5.5 months, and the median duration of overall survival was 13.8 months. Treatment-related adverse events of grade 3 or higher, which were managed mainly by dose adjustments, were reported in 46% of the patients; 13% of the patients discontinued treatment because of adverse events. There were no treatment-related deaths. CONCLUSIONS The use of erdafitinib was associated with an objective tumor response in 40% of previously treated patients who had locally advanced and unresectable or metastatic urothelial carcinoma with FGFR alterations. Treatment-related grade 3 or higher adverse events were reported in nearly half the patients. (Funded by Janssen Research and Development; BLC2001 ClinicalTrials.gov number, NCT02365597.).
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Affiliation(s)
- Yohann Loriot
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Andrea Necchi
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Se Hoon Park
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Jesus Garcia-Donas
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Robert Huddart
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Earle Burgess
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Mark Fleming
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Arash Rezazadeh
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Begoña Mellado
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Sergey Varlamov
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Monika Joshi
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Ignacio Duran
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Scott T Tagawa
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Yousef Zakharia
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Bob Zhong
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Kim Stuyckens
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Ademi Santiago-Walker
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Peter De Porre
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Anne O'Hagan
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Anjali Avadhani
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
| | - Arlene O Siefker-Radtke
- From Gustave Roussy, INSERM Unité 981, Université Paris-Sud, Université Paris-Saclay, Villejuif, France (Y.L.); Fondazione IRCCS Istituto Nazionale dei Tumori, Milan (A.N.); Sungkyunkwan University Samsung Medical Center, Seoul, South Korea (S.H.P.); Genitourinary and Gynecological Cancer Unit, Centro Integral Oncológico Clara Campal, Madrid (J.G.-D.), Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona (B.M.), and Hospital Universitario Marques de Valdecilla, Santander (I.D.) - all in Spain; the Institute of Cancer Research, Sutton, London (R.H.); the Levine Cancer Institute, Atrium Health, Charlotte, NC (E.B.); Virginia Oncology Associates, US Oncology Research, Norfolk (M.F.); Norton Healthcare, Louisville, KY (A.R.); the Altai Regional Cancer Center, Barnaul, Russia (S.V.); the Penn State Cancer Institute, Hershey (M.J.), and Janssen Research and Development, Spring House (B.Z., A.S.-W., A.O., A.A.) - both in Pennsylvania; Weill Cornell Medical College, New York (S.T.T.); University of Iowa Hospitals and Clinics, Holden Comprehensive Cancer Center, Iowa City (Y.Z.); Janssen Research and Development, Beerse, Belgium (K.S., P.D.P.); and the University of Texas M.D. Anderson Cancer Center, Houston (A.O.S.-R.)
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Schneider A, Ramesh M. Angioedema following initiation of glecaprevir/pibrentasvir while on sitagliptin. J Allergy Clin Immunol Pract 2019; 7:2068-2069. [PMID: 30779957 DOI: 10.1016/j.jaip.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/21/2019] [Accepted: 02/04/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Amanda Schneider
- Division of Allergy and Immunology, Montefiore Medical Center, Bronx, NY
| | - Manish Ramesh
- Division of Allergy and Immunology, Montefiore Medical Center, Bronx, NY.
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Ueda Y, Kobayashi T, Ikegami T, Miuma S, Mizuno S, Akamatsu N, Takaki A, Ishigami M, Takatsuki M, Sugawara Y, Maehara Y, Uemoto S, Seno H. Efficacy and safety of glecaprevir and pibrentasvir treatment for 8 or 12 weeks in patients with recurrent hepatitis C after liver transplantation: a Japanese multicenter experience. J Gastroenterol 2019; 54:660-666. [PMID: 30806783 DOI: 10.1007/s00535-019-01561-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/13/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Efficacy of 8-week regimen with direct-acting antivirals (DAA) for patients with hepatitis C after liver transplantation has not been clarified. This study aimed to clarify the efficacy and safety of glecaprevir and pibrentasvir therapy for 8 and 12 weeks in Japanese patients with recurrent hepatitis C after liver transplantation. METHODS A cohort study of liver transplant recipients with recurrent hepatitis C treated with glecaprevir (300 mg/day) and pibrentasvir (120 mg/day) was performed at nine liver transplant centers in Japan. RESULTS Twenty-five patients with hepatitis C after liver transplantation were treated with glecaprevir and pibrentasvir. Twenty-four patients completed the treatment protocol; treatment was discontinued in one patient who had nausea at 3 days after the initiation of treatment. All the 24 patients who completed the 8- or 12-week treatment protocol achieved a sustained virological response 12 weeks after completion of treatment (SVR12). The SVR12 rates in patients with HCV genotype 1 and 2 were 100% (21 of 21 patients) and 75% (3 of 4 patients), respectively. All patients with prior DAA therapy failure (n = 6), jaundice (n = 4), and liver cirrhosis (n = 4) achieved SVR12. Seven of 8 patients (88%) with severe renal impairment achieved SVR12. Adverse events occurred in 6 of 25 patients (24%), including serious adverse events in 2 patients (8%). Treatment-related adverse events were nausea, pruritus, and mild renal dysfunction. CONCLUSIONS Eight- or 12-week regimen of glecaprevir and pibrentasvir is efficacious and safe in patients with recurrent HCV infection after liver transplantation, even in difficult-to-treat populations, including patients with severe renal impairment, prior DAA experience, liver cirrhosis, or jaundice after liver transplantation.
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Affiliation(s)
- Yoshihide Ueda
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Satoshi Miuma
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University School of Medicine, Mie, Japan
| | - Nobuhisa Akamatsu
- Division of Artificial Organ and Transplantation, Department of Surgery, University of Tokyo, Tokyo, Japan
| | - Akinobu Takaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuhisa Takatsuki
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuhiko Sugawara
- Department of Transplantation and Pediatric Surgery, Postgraduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Foster GR, Asselah T, Kopecky-Bromberg S, Lei Y, Asatryan A, Trinh R, Zadeikis N, Mensa FJ. Safety and efficacy of glecaprevir/pibrentasvir for the treatment of chronic hepatitis C in patients aged 65 years or older. PLoS One 2019; 14:e0208506. [PMID: 30601818 PMCID: PMC6314565 DOI: 10.1371/journal.pone.0208506] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022] Open
Abstract
Finding safe and effective treatments for chronic hepatitis C virus (HCV) infection in the elderly is of clinical interest given the comorbidities and associated polypharmacy in this population. However, the number of patients older than age 65 years enrolled into clinical trials of anti-HCV medications generally have been limited and thus reaching meaningful conclusions for this demographic has been difficult. Glecaprevir/pibrentasvir is a once-daily, all-oral, ribavirin-free, pangenotypic direct-acting antiviral (DAA) combination therapy that has demonstrated high sustained virologic response rates at post-treatment week 12 (SVR12) and a favorable safety profile in patients with chronic HCV infection. This analysis evaluated the safety and efficacy of glecaprevir/pibrentasvir in patients aged ≥65 years. Data were pooled for treatment-naïve and -experienced patients with chronic HCV genotype (GT) 1-6 infections who received glecaprevir/pibrentasvir for 8, 12, or 16 weeks in 9 Phase 2 and 3 trials. SVR12 and adverse events (AEs) were evaluated for patients aged ≥65 versus <65 years. Of the 2369 patients enrolled, 328 (14%) were aged ≥65 years. Among patients aged ≥65 years, 42% and 34% had GT1 and GT2, respectively; 40% were treatment-experienced and 20% had compensated cirrhosis. Glecaprevir/pibrentasvir treatment resulted in SVR12 rates of 97.9% (95% CI, 96.3-99.4; n/N = 321/328) for patients aged ≥65 years and 97.3% (95% CI, 96.6-98.0; n/N = 1986/2041) for patients aged <65 years. The rates were not significantly different between the two age groups (P = 0.555). DAA-related AEs leading to treatment discontinuation, or serious AEs were similarly rare (<0.5%) for patients ≥65 and <65 years old. Glecaprevir/pibrentasvir is an efficacious and well-tolerated treatment option for patients aged ≥65 years with chronic HCV infection.
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Affiliation(s)
- Graham R. Foster
- Barts Liver Centre, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Tarik Asselah
- Hepatology Department, UMR1149, Physiopathology and Treatment of Viral Hepatitis, Centre de Recherche sur l’Inflammation and Université Denis Diderot Paris 7, Beaujon Hospital, AP-HP, Clichy, France
| | | | - Yang Lei
- AbbVie Inc., North Chicago, Illinois, United States of America
| | - Armen Asatryan
- AbbVie Inc., North Chicago, Illinois, United States of America
| | - Roger Trinh
- AbbVie Inc., North Chicago, Illinois, United States of America
| | - Neddie Zadeikis
- AbbVie Inc., North Chicago, Illinois, United States of America
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Matsumoto K, Kikuchi K, Kajiyama Y, Takano Y, Mabuchi M, Doi S, Sato K, Miyakawa H, Yasuda I. Development of Autoimmune Hepatitis during Direct-acting Antiviral Therapy for Chronic Hepatitis C Virus Infection. Intern Med 2018; 57:2669-2673. [PMID: 29709942 PMCID: PMC6191578 DOI: 10.2169/internalmedicine.0613-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
An 81-year-old woman developed liver dysfunction after two months' treatment with direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection. She was positive for serum anti-nuclear antibody, with an elevated immunoglobulin G level. A liver biopsy revealed high-grade interface hepatitis and infiltrate of lymphocytes and plasma cells. DAA-associated drug-induced autoimmune hepatitis (DI-AIH) was considered. Her liver dysfunction improved after discontinuing DAA therapy and starting prednisolone treatment. The differential diagnosis for AIH should include liver injury during DAA therapy for chronic HCV infection.
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Affiliation(s)
- Kotaro Matsumoto
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Japan
| | - Kentaro Kikuchi
- Fourth Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Japan
| | - Yusuke Kajiyama
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Japan
| | - Yuichi Takano
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Japan
| | - Masatoshi Mabuchi
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Japan
| | - Shinpei Doi
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Japan
| | - Koichiro Sato
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Japan
| | - Hiroshi Miyakawa
- Fourth Department of Internal Medicine, Teikyo University Mizonokuchi Hospital, Japan
| | - Ichiro Yasuda
- Department of Gastroenterology, Teikyo University Mizonokuchi Hospital, Japan
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35
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Lin CW, Dutta S, Zhao W, Asatryan A, Campbell A, Liu W. Pharmacokinetic Interactions and Safety of Coadministration of Glecaprevir and Pibrentasvir in Healthy Volunteers. Eur J Drug Metab Pharmacokinet 2018; 43:81-90. [PMID: 28688001 DOI: 10.1007/s13318-017-0428-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Glecaprevir and pibrentasvir are pangenotypic direct-acting antiviral agents for the treatment of chronic hepatitis C virus infection. The aim of the present study was to evaluate the drug-drug interaction and safety of glecaprevir and pibrentasvir coadministration in healthy volunteers. METHODS In this open-label, randomized, multiple-dose, Phase 1 study in 72 subjects, glecaprevir (100-1200 mg once daily) and pibrentasvir (40-200 mg once daily) were administered alone for 7 days and then in combination for another 7 days. Intensive blood sampling was performed on Days 1, 7, 8, and 14, and pharmacokinetic interactions were assessed using a repeated measures analysis of glecaprevir and pibrentasvir maximum plasma concentration (C max) and area under the curve (AUC). RESULTS Coadministration of glecaprevir 400 mg increased pibrentasvir 120 and 40 mg steady-state C max and AUC values to 2.9-6.3-fold, and coadministration of glecaprevir 700 mg increased pibrentasvir 160 mg steady-state C max and AUC24 values to up to sevenfold of the values when pibrentasvir was administered alone. Glecaprevir C max and AUC values during coadministration were less than 1.5-fold of the values when glecaprevir was administered alone. The combination of glecaprevir and pibrentasvir at doses up to 400 mg was well tolerated by the healthy subjects in this study. High glecaprevir exposures at 700 and 1200 mg were associated with grade 2/3 elevations in alanine aminotransferase, aspartate aminotransferase, and/or bilirubin. CONCLUSIONS Coadministration of pibrentasvir 120 mg with glecaprevir doses up to 400 mg resulted in increases in pibrentasvir exposures without significant changes in glecaprevir exposures in the absence of any clinically significant laboratory abnormalities.
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Affiliation(s)
- Chih-Wei Lin
- Clinical Pharmacokinetics and Pharmacodynamics, AbbVie Inc., Department R4PK, Building AP31-3, 1 North Waukegan Road, North Chicago, IL, 60064, USA
| | - Sandeep Dutta
- Clinical Pharmacokinetics and Pharmacodynamics, AbbVie Inc., Department R4PK, Building AP31-3, 1 North Waukegan Road, North Chicago, IL, 60064, USA
| | - Weihan Zhao
- Clinical Pharmacokinetics and Pharmacodynamics, AbbVie Inc., Department R4PK, Building AP31-3, 1 North Waukegan Road, North Chicago, IL, 60064, USA
| | - Armen Asatryan
- Infectious Diseases, AbbVie Inc., Department R48U, Building AP30, 1 North Waukegan Road, North Chicago, IL, 60064, USA
| | - Andrew Campbell
- Infectious Diseases, AbbVie Inc., Department R48U, Building AP30, 1 North Waukegan Road, North Chicago, IL, 60064, USA
| | - Wei Liu
- Clinical Pharmacokinetics and Pharmacodynamics, AbbVie Inc., Department R4PK, Building AP31-3, 1 North Waukegan Road, North Chicago, IL, 60064, USA.
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Abstract
Brimonidine is a selective α2-adrenergic agonist developed for lowering intraocular pressure in glaucoma patients. Since brimonidine will be used in long-term theraphy, the safety of this drug is an important feature for its clinical success. Brimonidine has been evaluated in a number of safety studies using doses much greater than those in humans. In this paper chronic and carcinogenicity studies are presented. The results of the 6-month ocular/systemic study in rabbits and the 1-year ocular/systemic study in monkeys with 0.2, 0.5, and 0.8% brimonidine ophthalmic formulations showed no ocular or organ toxicity. The highest concentration of 0.8% used in rabbits and monkeys resulted in plasma drug concentrations of 95 (Cmax) and 10 (C2hr) times, respectively, higher than those seen in humans following topical dosing. Dose-related transient exaggerated pharmacologic effects of sedation were observed in the 1-year oral study in monkeys without any organ toxicity. The dose that elicited an apparent pharmacologic effect produced a plasma drug concentration that was approximately 115 times higher than that in humans. In 2-year carcinogenicity studies in mice and rats using doses that produced plasma concentrations 77 and 118 times, respectively, higher than those seen in humans, no oncogenic effect was observed. Based on the extensive safety research on brimonidine, it was concluded that this drug has an excellent safety profile.
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Poordad F, Pol S, Asatryan A, Buti M, Shaw D, Hézode C, Felizarta F, Reindollar RW, Gordon SC, Pianko S, Fried MW, Bernstein DE, Gallant J, Lin C, Lei Y, Ng TI, Krishnan P, Kopecky‐Bromberg S, Kort J, Mensa FJ. Glecaprevir/Pibrentasvir in patients with hepatitis C virus genotype 1 or 4 and past direct-acting antiviral treatment failure. Hepatology 2018; 67:1253-1260. [PMID: 29152781 PMCID: PMC5901397 DOI: 10.1002/hep.29671] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/24/2017] [Accepted: 11/14/2017] [Indexed: 12/15/2022]
Abstract
Patients with hepatitis C virus (HCV) who have virological failure (VF) after treatment containing a nonstructural protein 5A (NS5A) inhibitor have limited retreatment options. MAGELLAN-1 Part 2 was a randomized, open-label, phase 3 study to evaluate the efficacy and safety of ribavirin (RBV)-free glecaprevir and pibrentasvir (G/P; 300 mg/120 mg) in patients with chronic HCV and past VF on at least one NS3/4A protease and/or NS5A inhibitor-containing therapy. Patients with compensated liver disease, with or without cirrhosis, and HCV genotype (GT) 1, 4, 5, or 6 were randomized 1:1 to receive 12 or 16 weeks of G/P. The primary endpoint was sustained virological response (SVR) at 12 weeks posttreatment (SVR12). Among 91 patients treated, 87 had GT1 and 4 had GT4 infection. SVR12 was achieved by 89% (39 of 44) and 91% (43 of 47) of patients who received 12 and 16 weeks of G/P, respectively. Virological relapse occurred in 9% (4 of 44) of patients treated with 12 weeks of G/P; there were no relapses with 16 weeks of treatment. Past treatment history with one class of inhibitor (protease or NS5A) had no impact on SVR12, whereas past treatment with both classes of inhibitors was associated with lower SVR12 rate. The most common adverse event (AE) was headache (≥10% of patients), and there were no serious AEs assessed as related to study drugs or AEs leading to discontinuation. CONCLUSION Sixteen weeks of G/P treatment achieved a high SVR12 rate in patients with HCV GT1 infection and past failure to regimens containing either NS5A inhibitors or NS3 protease inhibitors. (Hepatology 2018;67:1253-1260).
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Affiliation(s)
- Fred Poordad
- The Texas Liver InstituteUniversity of Texas HealthSan AntonioTX
| | - Stanislas Pol
- Groupe Hospitalier Cochin‐Saint Vincent De PaulParisFrance
| | | | - Maria Buti
- Vall d'Hebron University Hospital and CiBERHED del Instituto Carlos IIIBarcelonaSpain
| | - David Shaw
- Royal Adelaide HospitalAdelaideAustralia
| | | | | | | | | | - Stephen Pianko
- Monash Health and Monash UniversityCaulfield SouthVictoriaAustralia
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Kumada H, Watanabe T, Suzuki F, Ikeda K, Sato K, Toyoda H, Atsukawa M, Ido A, Takaki A, Enomoto N, Kato K, Alves K, Burroughs M, Redman R, Pugatch D, Pilot-Matias TJ, Krishnan P, Oberoi RK, Xie W, Chayama K. Efficacy and safety of glecaprevir/pibrentasvir in HCV-infected Japanese patients with prior DAA experience, severe renal impairment, or genotype 3 infection. J Gastroenterol 2018; 53:566-575. [PMID: 29052790 PMCID: PMC5866827 DOI: 10.1007/s00535-017-1396-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/23/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND Once-daily, orally administered, co-formulated glecaprevir (NS3/4A protease inhibitor) and pibrentasvir (NS5A inhibitor) (G/P) demonstrated pangenotypic activity and high sustained virologic response (SVR) rates in studies outside Japan. Here we report safety and efficacy in a subset of Japanese patients with chronic HCV infection who received G/P 300/120 mg in a phase 3, open-label, multicenter study (CERTAIN-1). METHODS This analysis focuses on three difficult-to-treat subgroups: HCV GT1/2-infected patients who failed to achieve SVR after treatment with a direct acting antiviral (DAA)-containing regimen; GT1/2-infected patients with severe renal impairment (estimated glomerular filtration rate < 30 mL/min/1.73 m2); and GT3-infected patients. Patients in the renal impairment and GT3 cohorts were treatment-naive or interferon treatment-experienced. Noncirrhotic GT1/2-infected, DAA-naïve patients in the renal impairment cohort received G/P for 8 weeks; all other patients were treated for 12 weeks. Primary outcome was SVR (HCV RNA < 15 IU/mL) 12 weeks post-treatment (SVR12). RESULTS The study enrolled 33 GT1/2-infected patients who failed previous DAA treatment (four with cirrhosis); 12 GT1/2-infected patients with severe renal impairment (two with cirrhosis); and 12 GT3-infected patients (two with cirrhosis). SVR12 was achieved by 31/33 (93.9%), 12/12 (100%), and 10/12 (83.3%) patients, respectively. One serious adverse event (fluid overload, not related to G/P) occurred in a patient on chronic intermittent hemodialysis. CONCLUSIONS G/P achieved high SVR12 rates and was well tolerated in three difficult-to-treat patient subgroups with limited treatment options in Japan (DAA-experienced patients, patients with severe renal impairment, and GT3-infected patients). These results support the potential suitability of this regimen for these special populations in Japan.
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Affiliation(s)
| | - Tsunamasa Watanabe
- Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | | | - Kenji Ikeda
- Department of Hepatology, Toranomon Hospital, Tokyo, Japan
| | - Ken Sato
- Department of Medicine and Molecular Science, Gunma University Hospital, Maebashi, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology, Ogaki Municipal Hospital, Gifu, Japan
| | - Masanori Atsukawa
- Department of Internal Medicine, Nippon Medical School, Tokyo, Japan
| | - Akio Ido
- Department of Human and Environmental Sciences, Kagoshima University Hospital, Kagoshima, Japan
| | - Akinobu Takaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuyuki Enomoto
- The First Department of Internal Medicine, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | | | | | | | | | | | | | | | | | | | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences, Hiroshima University Hospital, Hiroshima, Japan
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Edelman G, Rodon J, Lager J, Castell C, Jiang J, Van Allen EM, Wagle N, Lindeman NI, Sholl LM, Shapiro GI. Phase I Trial of a Tablet Formulation of Pilaralisib, a Pan-Class I PI3K Inhibitor, in Patients with Advanced Solid Tumors. Oncologist 2018; 23:401-e38. [PMID: 29593099 PMCID: PMC5896717 DOI: 10.1634/theoncologist.2017-0691] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 12/12/2017] [Indexed: 11/17/2022] Open
Abstract
Lessons Learned. A phase I study of the pan‐class I phosphoinositide 3‐kinase inhibitor pilaralisib (in capsule formulation) in advanced solid tumors established the maximum tolerated dose as 600 mg once daily. The current study investigated pilaralisib in tablet formulation. Pilaralisib tablets were associated with a favorable safety profile and preliminary antitumor activity. Based on pharmacokinetic data, the recommended phase II dose of pilaralisib tablets was established as 400 mg once daily.
Background. A phase I trial of pilaralisib, an oral pan‐class I phosphoinositide 3‐kinase (PI3K) inhibitor, established the maximum tolerated dose (MTD) of the capsule formulation in patients with advanced solid tumors as 600 mg once daily. This phase I study investigated pilaralisib in tablet formulation. Materials and Methods. Patients with advanced solid tumors received pilaralisib tablets (100–600 mg once daily). Primary endpoints were MTD and safety; secondary and exploratory endpoints included pharmacokinetics (PK), pharmacodynamics, and efficacy. Results. Twenty‐two patients were enrolled. No dose‐limiting toxicities (DLTs) were reported. The most common treatment‐related adverse events were diarrhea (40.9%), fatigue (40.9%), decreased appetite (22.7%), and hyperglycemia (22.7%). Pilaralisib plasma exposure did not appear to increase dose‐proportionally. Steady‐state exposure was higher with pilaralisib tablet formulation at 400 mg than with pilaralisib capsule formulation at 400 or 600 mg (mean area under the curve [AUC0–24] 2,820,000 ng × h/mL vs. 2,653,000 and 1,930,000 ng × h/mL, respectively). Of 18 evaluable patients, 2 (11.1%) had a partial response (PR). Conclusion. Pilaralisib tablets were associated with a favorable safety profile and preliminary antitumor activity. MTD was not determined. The recommended phase II dose for pilaralisib tablets, based on PK data, was 400 mg once daily.
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Affiliation(s)
- Gerald Edelman
- Mary Crowley Medical Research Center, Dallas, Texas, USA
| | - Jordi Rodon
- Vall d'Hebron University Hospital and Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | | | | | - Eliezer M Van Allen
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Nikhil Wagle
- Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Neal I Lindeman
- Center for Advanced Molecular Diagnostics, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lynette M Sholl
- Center for Advanced Molecular Diagnostics, Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Geoffrey I Shapiro
- Early Drug Development Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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40
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Toyoda H, Chayama K, Suzuki F, Sato K, Atarashi T, Watanabe T, Atsukawa M, Naganuma A, Notsumata K, Osaki Y, Nakamuta M, Takaguchi K, Saito S, Kato K, Pugatch D, Burroughs M, Redman R, Alves K, Pilot‐Matias TJ, Oberoi RK, Fu B, Kumada H. Efficacy and safety of glecaprevir/pibrentasvir in Japanese patients with chronic genotype 2 hepatitis C virus infection. Hepatology 2018; 67:505-513. [PMID: 28865152 PMCID: PMC5814891 DOI: 10.1002/hep.29510] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/22/2017] [Accepted: 08/29/2017] [Indexed: 12/14/2022]
Abstract
Glecaprevir (nonstructural protein 3/4A protease inhibitor) and pibrentasvir (nonstructural protein 5A inhibitor) (G/P), a coformulated once-daily, all oral, ribavirin (RBV)-free, direct-acting antiviral regimen, was evaluated for safety and efficacy in hepatitis C virus genotype 2 (GT2)-infected Japanese patients, including those with compensated cirrhosis. CERTAIN-2 is a phase 3, open-label, multicenter study assessing the safety and efficacy of G/P (300/120 mg) once daily in treatment-naive and interferon ± RBV treatment-experienced Japanese patients without cirrhosis but with GT2 infection. Patients were randomized 2:1 to receive 8 weeks of G/P (arm A) or 12 weeks of sofosbuvir (400 mg once daily) + RBV (600-1000 mg weight-based, twice daily) (arm B). The primary endpoint was noninferiority of G/P compared to sofosbuvir + RBV by assessing sustained virologic response at posttreatment week 12 (SVR12) among patients in the intent-to-treat population. SVR12 was also assessed in treatment-naive and interferon ± RBV treatment-experienced patients with GT2 infection and compensated cirrhosis who received G/P for 12 weeks in the CERTAIN-1 study. A total of 136 patients were enrolled in CERTAIN-2. SVR12 was achieved by 88/90 (97.8%) patients in arm A and 43/46 (93.5%) patients in arm B. No patient in arm A experienced virologic failure, while 2 did in arm B. The primary endpoint was achieved. In CERTAIN-1, 100% (18/18) of GT2-infected patients with compensated cirrhosis achieved SVR12. Treatment-emergent serious adverse events were experienced by 2 patients without cirrhosis in each arm and no patient with cirrhosis. Conclusion: The results demonstrate high efficacy and favorable tolerability of G/P in GT2-infected Japanese patients. (Hepatology 2018;67:505-513).
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Affiliation(s)
| | | | | | - Ken Sato
- Gunma University HospitalMaebashiJapan
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- AbbVie Inc.North ChicagoIL
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41
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Wyles D, Poordad F, Wang S, Alric L, Felizarta F, Kwo PY, Maliakkal B, Agarwal K, Hassanein T, Weilert F, Lee SS, Kort J, Lovell SS, Liu R, Lin C, Pilot‐Matias T, Krishnan P, Mensa FJ. Glecaprevir/pibrentasvir for hepatitis C virus genotype 3 patients with cirrhosis and/or prior treatment experience: A partially randomized phase 3 clinical trial. Hepatology 2018; 67:514-523. [PMID: 28926120 PMCID: PMC5817409 DOI: 10.1002/hep.29541] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/14/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022]
Abstract
This study assessed the efficacy and safety of ribavirin-free coformulated glecaprevir/pibrentasvir (G/P) in patients with hepatitis C virus genotype 3 infection with prior treatment experience and/or compensated cirrhosis, a patient population with limited treatment options. SURVEYOR-II, Part 3 was a partially randomized, open-label, multicenter, phase 3 study. Treatment-experienced (prior interferon or pegylated interferon ± ribavirin or sofosbuvir plus ribavirin ± pegylated interferon therapy) patients without cirrhosis were randomized 1:1 to receive 12 or 16 weeks of G/P (300 mg/120 mg) once daily. Treatment-naive or treatment-experienced patients with compensated cirrhosis were treated with G/P for 12 or 16 weeks, respectively. The primary efficacy endpoint was the percentage of patients with sustained virologic response at posttreatment week 12 (SVR12). Safety was evaluated throughout the study. There were 131 patients enrolled and treated. Among treatment-experienced patients without cirrhosis, SVR12 was achieved by 91% (20/22; 95% confidence interval [CI], 72-97) and 95% (21/22; 95% CI, 78-99) of patients treated with G/P for 12 or 16 weeks, respectively. Among those with cirrhosis, SVR12 was achieved by 98% (39/40; 95% CI, 87-99) of treatment-naive patients treated for 12 weeks and 96% (45/47; 95% CI, 86-99) of patients with prior treatment experience treated for 16 weeks. No adverse events led to discontinuation of study drug, and no serious adverse events were related to study drug. Conclusion: Patients with hepatitis C virus genotype 3 infection with prior treatment experience and/or compensated cirrhosis achieved high SVR12 rates following 12 or 16 weeks of treatment with G/P. The regimen was well tolerated. (Hepatology 2018;67:514-523).
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Affiliation(s)
| | - Fred Poordad
- The Texas Liver InstituteUniversity of Texas HealthSan AntonioTX
| | | | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, CHU Purpan, UMR 152IRD Toulouse 3 UniversityToulouseFrance
| | | | - Paul Y. Kwo
- Division of Gastroenterology and HepatologyStanford UniversityPalo AltoCA
| | | | - Kosh Agarwal
- Institute of Liver Studies, Kings College HospitalLondonUK
| | - Tarek Hassanein
- Southern California GI and Liver Centers and Southern California Research CenterCoronadoCA
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42
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Zeuzem S, Foster GR, Wang S, Asatryan A, Gane E, Feld JJ, Asselah T, Bourlière M, Ruane PJ, Wedemeyer H, Pol S, Flisiak R, Poordad F, Chuang WL, Stedman CA, Flamm S, Kwo P, Dore GJ, Sepulveda-Arzola G, Roberts SK, Soto-Malave R, Kaita K, Puoti M, Vierling J, Tam E, Vargas HE, Bruck R, Fuster F, Paik SW, Felizarta F, Kort J, Fu B, Liu R, Ng TI, Pilot-Matias T, Lin CW, Trinh R, Mensa FJ. Glecaprevir-Pibrentasvir for 8 or 12 Weeks in HCV Genotype 1 or 3 Infection. N Engl J Med 2018; 378:354-369. [PMID: 29365309 DOI: 10.1056/nejmoa1702417] [Citation(s) in RCA: 285] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Glecaprevir and pibrentasvir are direct-acting antiviral agents with pangenotypic activity and a high barrier to resistance. We evaluated the efficacy and safety of 8-week and 12-week courses of treatment with 300 mg of glecaprevir plus 120 mg of pibrentasvir in patients without cirrhosis who had hepatitis C virus (HCV) genotype 1 or 3 infection. METHODS We conducted two phase 3, randomized, open-label, multicenter trials. Patients with genotype 1 infection were randomly assigned in a 1:1 ratio to receive once-daily glecaprevir-pibrentasvir for either 8 or 12 weeks. Patients with genotype 3 infection were randomly assigned in a 2:1 ratio to receive 12 weeks of treatment with either glecaprevir-pibrentasvir or sofosbuvir-daclatasvir. Additional patients with genotype 3 infection were subsequently enrolled and nonrandomly assigned to receive 8 weeks of treatment with glecaprevir-pibrentasvir. The primary end point was the rate of sustained virologic response 12 weeks after the end of treatment. RESULTS In total, 1208 patients were treated. The rate of sustained virologic response at 12 weeks among genotype 1-infected patients was 99.1% (95% confidence interval [CI], 98 to 100) in the 8-week group and 99.7% (95% CI, 99 to 100) in the 12-week group. Genotype 3-infected patients who were treated for 12 weeks had a rate of sustained virologic response at 12 weeks of 95% (95% CI, 93 to 98; 222 of 233 patients) with glecaprevir-pibrentasvir and 97% (95% CI, 93 to 99.9; 111 of 115) with sofosbuvir-daclatasvir; 8 weeks of treatment with glecaprevir-pibrentasvir yielded a rate of 95% (95% CI, 91 to 98; 149 of 157 patients). Adverse events led to discontinuation of treatment in no more than 1% of patients in any treatment group. CONCLUSIONS Once-daily treatment with glecaprevir-pibrentasvir for either 8 weeks or 12 weeks achieved high rates of sustained virologic response among patients with HCV genotype 1 or 3 infection who did not have cirrhosis. (Funded by AbbVie; ENDURANCE-1 and ENDURANCE-3 ClinicalTrials.gov numbers, NCT02604017 and NCT02640157 .).
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Affiliation(s)
- Stefan Zeuzem
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Graham R Foster
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Stanley Wang
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Armen Asatryan
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Edward Gane
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Jordan J Feld
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Tarik Asselah
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Marc Bourlière
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Peter J Ruane
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Heiner Wedemeyer
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Stanislas Pol
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Robert Flisiak
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Fred Poordad
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Wan-Long Chuang
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Catherine A Stedman
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Steven Flamm
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Paul Kwo
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Gregory J Dore
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Gladys Sepulveda-Arzola
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Stuart K Roberts
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Ruth Soto-Malave
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Kelly Kaita
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Massimo Puoti
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - John Vierling
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Edward Tam
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Hugo E Vargas
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Rafi Bruck
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Francisco Fuster
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Seung-Woon Paik
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Franco Felizarta
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Jens Kort
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Bo Fu
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Ran Liu
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Teresa I Ng
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Tami Pilot-Matias
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Chih-Wei Lin
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Roger Trinh
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Federico J Mensa
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
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Gane E, Lawitz E, Pugatch D, Papatheodoridis G, Bräu N, Brown A, Pol S, Leroy V, Persico M, Moreno C, Colombo M, Yoshida EM, Nelson DR, Collins C, Lei Y, Kosloski M, Mensa FJ. Glecaprevir and Pibrentasvir in Patients with HCV and Severe Renal Impairment. N Engl J Med 2017; 377:1448-1455. [PMID: 29020583 DOI: 10.1056/nejmoa1704053] [Citation(s) in RCA: 293] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection is more prevalent among patients who have chronic kidney disease than among those who do not have the disease. Patients with chronic kidney disease who also have HCV infection are at higher risk for progression to end-stage renal disease than those who have chronic kidney disease without HCV infection. Patients with both HCV infection and advanced chronic kidney disease have limited treatment options. METHODS We conducted a multicenter, open-label, phase 3 trial to evaluate the efficacy and safety of treatment with the combination of the NS3/4A protease inhibitor glecaprevir and the NS5A inhibitor pibrentasvir for 12 weeks in adults who had HCV genotype 1, 2, 3, 4, 5, or 6 infection and also had compensated liver disease (with or without cirrhosis) with severe renal impairment, dependence on dialysis, or both. Patients had stage 4 or 5 chronic kidney disease and either had received no previous treatment for HCV infection or had received previous treatment with interferon or pegylated interferon, ribavirin, sofosbuvir, or a combination of these medications. The primary end point was a sustained virologic response 12 weeks after the end of treatment. RESULTS Among the 104 patients enrolled in the trial, 52% had genotype 1 infection, 16% had genotype 2 infection, 11% had genotype 3 infection, 19% had genotype 4 infection, and 2% had genotype 5 or 6 infection. The sustained virologic response rate was 98% (102 of 104 patients; 95% confidence interval, 95 to 100). No patients had virologic failure during treatment, and no patients had a virologic relapse after the end of treatment. Adverse events that were reported in at least 10% of the patients were pruritus, fatigue, and nausea. Serious adverse events were reported in 24% of the patients. Four patients discontinued the trial treatment prematurely because of adverse events; three of these patients had a sustained virologic response. CONCLUSIONS Treatment with glecaprevir and pibrentasvir for 12 weeks resulted in a high rate of sustained virologic response in patients with stage 4 or 5 chronic kidney disease and HCV infection. (Funded by AbbVie; ClinicalTrials.gov number, NCT02651194 .).
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Affiliation(s)
- Edward Gane
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Eric Lawitz
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - David Pugatch
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Georgios Papatheodoridis
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Norbert Bräu
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Ashley Brown
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Stanislas Pol
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Vincent Leroy
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Marcello Persico
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Christophe Moreno
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Massimo Colombo
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Eric M Yoshida
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - David R Nelson
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Christine Collins
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Yang Lei
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Matthew Kosloski
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Federico J Mensa
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
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Mavyret and Vosevi--two new combinations for chronic HCV infection. Med Lett Drugs Ther 2017; 59:166-70. [PMID: 28977807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Wheler J, Mutch D, Lager J, Castell C, Liu L, Jiang J, Traynor AM. Phase I Dose-Escalation Study of Pilaralisib (SAR245408, XL147) in Combination with Paclitaxel and Carboplatin in Patients with Solid Tumors. Oncologist 2017; 22:377-e37. [PMID: 28275119 PMCID: PMC5388374 DOI: 10.1634/theoncologist.2016-0257] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 11/29/2016] [Indexed: 11/17/2022] Open
Abstract
Lessons Learned. Despite involvement of PI3K pathway activation in tumorigenesis of solid tumors, single‐agent PI3K inhibitors have shown modest clinical activity. Preclinical evidence suggests that combining PI3K pathway inhibitors and chemotherapy can enhance antitumor effects. In patients with solid tumors, the PI3K inhibitor pilaralisib had a favorable safety profile but did not enhance the antitumor activity of paclitaxel plus carboplatin. Further clinical evaluation is warranted to identify effective combination strategies with PI3K pathway inhibitors.
Background. Pilaralisib (SAR245408) is an oral, pan‐class I phosphoinositide 3‐kinase (PI3K) inhibitor. This phase I dose‐escalation study evaluated the maximum tolerated dose (MTD), safety, pharmacokinetics (PK), and pharmacodynamics of pilaralisib in capsule and tablet formulations, administered in combination with paclitaxel and carboplatin in patients with advanced solid tumors. Methods. A 3 + 3 design was used. Pilaralisib was administered once daily (QD); paclitaxel (up to 175 mg/m2) and carboplatin (up to area under the curve [AUC] of 6) were administered on day 1 of 21‐day cycles. An MTD expansion cohort of patients with endometrial carcinoma was included. Results. Fifty‐eight patients were enrolled. Six patients (10.3%) had dose‐limiting toxicities, of which only rash (two patients, 3.4%) occurred in more than one patient. The MTD of pilaralisib tablets in combination with paclitaxel and carboplatin was determined to be 200 mg QD. The most frequently reported adverse events (AEs) of any grade were neutropenia (67.2%) and thrombocytopenia (67.2%). PK data showed no interaction between pilaralisib and paclitaxel/carboplatin. Tumor tissue showed moderate inhibition of PI3K and mitogen‐activated protein kinase (MAPK) pathways. Seven of 52 evaluable patients had a partial response (PR; 13.5%). Conclusion. Pilaralisib had a favorable safety profile but did not enhance the antitumor activity of paclitaxel plus carboplatin in solid tumors.
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Affiliation(s)
- Jennifer Wheler
- The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - David Mutch
- Washington University, Washington School of Medicine, St Louis, Missouri, USA
| | | | | | - Li Liu
- Sanofi, Bridgewater, New Jersey, USA
| | | | - Anne M Traynor
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
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Elbasha EH, Robertson MN, Nwankwo C. The cost-effectiveness of testing for NS5a resistance-associated polymorphisms at baseline in genotype 1a-infected (treatment-naïve and treatment-experienced) subjects treated with all-oral elbasvir/grazoprevir regimens in the United States. Aliment Pharmacol Ther 2017; 45:455-467. [PMID: 27910116 PMCID: PMC6680317 DOI: 10.1111/apt.13882] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 09/05/2016] [Accepted: 11/08/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND The presence of baseline NS5A resistance-associated variants (RAVs) impacted treatment response in HCV genotype 1a (GT1a)-infected patients treated with elbasvir/grazoprevir (EBR/GZR) for 12 weeks, but not patients treated with EBR/GZR and ribavirin (RBV) for 16 weeks. AIMS To assess the cost-effectiveness of baseline testing for NS5A RAVs in EBR/GZR-treated patients compared without testing, and with current treatments for GT1a patients. METHODS We simulated the course of treatment with EBR/GZR, ledipasvir/sofosbuvir (LDV/SOF) and ombitasvir/paritaprevir/ritonavir+dasabuvir (3D) with or without RBV and natural history of disease of GT1a patients. Treatment-related data from clinical trials were used in a state-transition model of the natural history of chronic HCV GT1a infection and liver disease to project lifetime costs (US$2015) and quality-adjusted life years (QALY). Other clinical and economic inputs were estimated from published sources. We conducted base case and sensitivity analyses. RESULTS RAVs testing-guided treatment with EBR/GZR resulted in more QALYs than EBR/GZR without testing, 3D+RBV, or LDV/SOF8. This strategy was cost-saving relative to 3D+RBV or LDV/SOF8 and was cost-effective compared with EBR/GZR without testing. LDV/SOF12 was not cost-effective compared with the EBR/GZR RAVs testing-based strategy. Treatment with EBR/GZR guided by RAVs testing is the most effective regimen among treatment-experienced patients without cirrhosis and cirrhotic patients. In sensitivity analysis, RAVs testing was cost-effective in 48-55% and 63-85% among noncirrhotic and cirrhotic patients respectively. CONCLUSIONS RAVs testing before treatment with EBR/GZR is likely to be a cost-effective alternative to the use of EBR/GZR without testing, LDV/SOF, or 3D among GT1a treatment-naïve or treatment-experienced patients.
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Ovchinnikov AY, Yeghian SS. [Efficacy of Dioxidine antimicrobial preparation for the treatment of inflammatory diseases of the external and middle ear]. Vestn Otorinolaringol 2016; 81:61-66. [PMID: 27213660 DOI: 10.17116/otorino201681261-66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this article, the comparative analysis of the clinical efficacy of drugs for local therapy in patients with acute external otitis, acute purulent otitis media and exacerbation of chronic suppurative otitis media is presented. The results of the clinical study, dynamic bacteriological investigation confirmed the high efficacy, safety and good tolerance of dioxidine in treatment of external and middle ear infections.
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Affiliation(s)
- A Yu Ovchinnikov
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Russian Ministry of Health, Moscow, 127473
| | - S S Yeghian
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Russian Ministry of Health, Moscow, 127473
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Abstract
Brimonidine gel (Mirvaso-Galderma) became available in February of this year for the symptomatic treatment of facial erythema associated with rosacea in adults.1 Here, we review the evidence on brimonidine gel and consider its place in the management of erythema associated with rosacea.
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Molero Y, Lichtenstein P, Zetterqvist J, Gumpert CH, Fazel S. Varenicline and risk of psychiatric conditions, suicidal behaviour, criminal offending, and transport accidents and offences: population based cohort study. BMJ 2015; 350:h2388. [PMID: 26037950 PMCID: PMC4452930 DOI: 10.1136/bmj.h2388] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To examine associations between varenicline and the incidence of a range of adverse outcomes. DESIGN Population based cohort study using within person analyses to control for confounding by indication. SETTING Whole population of Sweden. PARTICIPANTS 7,917,436 people aged 15 and over, of whom 69,757 were treated with varenicline between 2006 and 2009. MAIN OUTCOME MEASURES Incidence of new psychiatric conditions, suicidal behaviour, suspected and convicted criminal offending, transport accidents, and suspected and convicted traffic offences. RESULTS In the whole population, 337,393 new psychiatric conditions were diagnosed during follow-up. In addition, 507,823 suspected and 338,608 convicted crimes, 40,595 suicidal events, 124,445 transport accidents, and 99,895 suspected and 57,068 convicted traffic crimes were recorded. Within person analyses showed that varenicline was not associated with significant hazards of suicidal behaviour, criminal offending, transport accidents, traffic offences, or psychoses. However, varenicline was associated with a small increase in the risk of anxiety conditions (hazard ratio 1.23, 95% confidence interval 1.01 to 1.51) and mood conditions (1.31, 1.06 to 1.63), which was only seen in people with pre-existing psychiatric disorders. CONCLUSIONS Concerns that varenicline is associated with an increased risk of many adverse outcomes, including suicidality and accidents, are not supported in this observational study. The small increase in risk of two psychiatric conditions in people with pre-existing psychiatric disorders needs to be confirmed using other research designs.
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Affiliation(s)
- Yasmina Molero
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm
| | - Johan Zetterqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 171 77 Stockholm
| | - Clara Hellner Gumpert
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
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Kobayashi M, Takemoto Y, Norioka N, Iguchi T, Shimada K, Maeda M, Morimura M, Fujio Y, Azuma J, Yoshiyama M, Hirohashi K, Shuto T. Vascular Functional and Morphological Alterations in Smokers during Varenicline Therapy. Osaka City Med J 2015; 61:19-30. [PMID: 26434102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Varenicline has been reported to achieve high rates of smoking cessation. It remains undetermined whether varenicline therapy improves vascular function in smokers. METHODS Consecutive Seventy-two smokers (age 57 ± 12 years) who succeeded in complete smoking cessation and 46 normal healthy volunteers (age 24 ± 3 years) with no cardiovascular risk factors were enrolled into this study. Vascular function and structure were assessed by flow-mediated dilation (FMD), nitroglycerin-induced vasodilation, and brachial artery intima-media thickness (baIMT) at baseline and 20 weeks after the initiation of varenicline therapy in smokers. FMD and baIMT were measured simultaneously using a semi-automatic vessel wall-tracking software program. 75 μg dose of a nitroglycerin tablet were sublingually administered for the nitroglycerin-induced vasodilation measurement. RESULTS Exhaled-carbon monoxide concentration decreased significantly (20.0 ± 11.1 ppm at baseline vs 1.9 ± 1.5 ppm after 20 weeks, p < 0.001). FMD was significantly improved after 20 weeks (4.09% ± 1.83% at baseline vs 4.77% ± 2.33% after 20 weeks, p = 0.010), whereas nitroglycerin-induced vasodilation and baIMT were not significantly changed. CONCLUSIONS Smoking cessation with varenicline therapy significantly increased FMD without significant changes of nitroglycerin-induced vasodilation or baIMT from baseline to 20 weeks. It appears to improve vascular function in smokers, which depends on endothelial function rather than on vascular smooth muscle function or changes in vascular structure.
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