Premium
All‐oral direct‐acting antiviral therapy in HCV ‐advanced liver disease is effective in real‐world practice: observations through HCV ‐ TARGET database
Author(s) -
Reddy K. R.,
Lim J. K.,
Kuo A.,
Di Bisceglie A. M.,
Galati J. S.,
Morelli G.,
Everson G. T.,
Kwo P. Y.,
Brown R. S.,
Sulkowski M. S.,
Akuschevich L.,
Lok A. S.,
Pockros P. J.,
Vainorius M.,
Terrault N. A.,
Nelson D. R.,
Fried M. W.,
Manns M. P.
Publication year - 2017
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.13823
Subject(s) - medicine , antiviral therapy , virology , immunology , virus , chronic hepatitis
Summary Background Chronic hepatitis C virus therapy in patients with advanced liver disease remains a clinical challenge. HCV ‐ TARGET collects data in patients treated at tertiary academic and community centres. Aim To assess efficacy of all‐oral HCV therapy in advanced liver disease. Methods Between December 2013 and October 2014, 240 patients with a MELD score of ≥10 initiated HCV treatment with an all‐oral regimen. Data from the 220 patients who completed 12‐week follow‐up were analysed. Results Genotype 1 ( GT 1) patients had higher sustained virological response ( SVR ) when treated with sofosbuvir plus simeprevir ± ribavirin than with sofosbuvir plus ribavirin (66–74% vs. 54%); GT 1b vs GT 1a (84% vs. 64%). SVR for GT 2 was 72% with sofosbuvir plus ribavirin, while GT 3 patients had a substantially lower response (35%). A decrease in MELD score was not clearly related to SVR over the short course of follow‐up although some had improvements in MELD score, serum bilirubin and albumin. A predictor of virological response was albumin level while negative predictors were elevated bilirubin level and GT 1a. Most patients with GT 1 were treated with approximately 12‐week duration of sofosbuvir and simeprevir ± ribavirin therapy while GT 2 and GT 3 patients were treated with approximately 12 and 24 weeks of sofosbuvir plus ribavirin respectively. Conclusions All‐oral therapies are effective among patients with advanced liver disease with high levels of success in GT 2 and GT 1b, and may serve to reduce the severity of liver disease after SVR . Treatment for GT 3 patients remains an unmet need. Clinical trial number: NCT01474811