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Telaprevir versus simeprevir for the treatment of recurrent hepatitis C after living donor liver transplantation
Author(s) -
Ikegami Toru,
Yoshizumi Tomoharu,
Yoshida Yoshihro,
Kurihara Takeshi,
Harimoto Norifumi,
Itoh Shinji,
Shimokawa Masahiro,
Fukuhara Takasuke,
Shirabe Ken,
Maehara Yoshihiko
Publication year - 2016
Publication title -
hepatology research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.123
H-Index - 75
eISSN - 1872-034X
pISSN - 1386-6346
DOI - 10.1111/hepr.12546
Subject(s) - simeprevir , medicine , telaprevir , ribavirin , gastroenterology , pegylated interferon , hepatitis c , adverse effect , transplantation , viral load , liver transplantation , immunology , hepatitis c virus , human immunodeficiency virus (hiv) , virus
Aim Our aim was to evaluate the clinical outcomes of telaprevir (TVR)‐ or simeprevir (SMV)‐based triple therapy for recurrent hepatitis C after living donor liver transplantation. Methods Twenty‐six patients received antiviral therapy, consisting of either TVR ( n = 12) or SMV ( n = 14) in combination with pegylated interferon and ribavirin, plus cyclosporin. Results More patients had a dose reduction of the direct‐acting agent (36.3% vs 0.0%, P = 0.02) or required blood transfusion for anemia (58.3% vs 7.1%, P < 0.01) in the TVR group. The cyclosporin trough/dose ratio increased significantly from week 0 to week 4 in the TVR group (1.6 ± 0.4 to 5.1 ± 2.0, P < 0.01), but not in the SMV group (1.2 ± 0.3 to 1.3 ± 0.2, P = 0.68). The 24‐week cumulative viral clearance rate was 91.7% and 85.7% in the TVR and in SMV groups, respectively. The early viral response and sustained viral response rates were 91.7% and 83.3%, respectively, in the TVR group, compared with 85.7% and 64.3%, respectively, in the SMV group. Interferon‐mediated graft dysfunction occurred in four and five patients in the TVR and SMV groups, respectively; two patients were treated by oral steroids, five by steroid pulse and two by thymoglobulin, resulting in viral breakthrough in one case. Conclusion SMV‐based triple therapy was associated with fewer adverse events and drug interactions with cyclosporin, and possibly less antiviral properties to TVR. Interferon‐mediated graft dysfunction is a significant clinical problem that warrants particular caution following living donor liver transplantation.