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Interferon‐free therapy for genotype 1 hepatitis C in liver transplant recipients: Real‐world experience from the hepatitis C therapeutic registry and research network
- Source :
- Liver Transplantation. 22:24-33
- Publication Year :
- 2015
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2015.
-
Abstract
- Recurrent infection with the hepatitis C virus (HCV) after liver transplantation (LT) is associated with decreased graft and patient survival. Achieving sustained virological response (SVR) with antiviral therapy improves survival. Because interferon (IFN)-based therapy has limited efficacy and is poorly tolerated, there has been rapid transition to IFN-free direct-acting antiviral (DAA) regimens. This article describes the experience with DAAs in the treatment of posttransplant genotype (GT) 1 HCV from a consortium of community and academic centers (Hepatitis C Therapeutic Registry and Research Network [HCV-TARGET]). Twenty-one of the 54 centers contributing to the HCV-TARGET consortium participated in this study. Enrollment criteria included positive posttransplant HCV RNA before treatment, HCV GT 1, and documentation of use of a simeprevir (SMV)/sofosbuvir (SOF) containing DAA regimen. Safety and efficacy were assessed. SVR was defined as undetectable HCV RNA 64 days or later after cessation of treatment. A total of 162 patients enrolled in HCV-TARGET started treatment with SMV+SOF with or without ribavirin (RBV) following LT. The study population included 151 patients treated with these regimens for whom outcomes and safety data were available. The majority of the 151 patients were treated with SOF and SMV alone (n = 119; 79%) or with RBV (n = 32; 21%), The duration of therapy was 12 weeks for most patients, although 15 patients received 24 weeks of treatment. Of all patients receiving SOF/SMV with or without RBV, 133/151 (88%) achieved sustained virological response at 12 weeks after therapy and 11 relapsed (7%). One patient had virological breakthrough (n = 1), and 6 patients were lost to posttreatment follow-up. Serious adverse events occurred in 11.9%; 3 patients (all cirrhotic) died due to aspiration pneumonia, suicide, and multiorgan failure. One experienced LT rejection. IFN-free DAA treatment represents a major improvement over prior IFN-based therapy. Broader application of these and other emerging DAA regimens in the treatment of posttransplant hepatitis C is warranted.
- Subjects :
- Male
Simeprevir
medicine.medical_specialty
Pathology
Sofosbuvir
Hepatitis C virus
medicine.medical_treatment
Hepacivirus
030230 surgery
Liver transplantation
medicine.disease_cause
Antiviral Agents
Article
03 medical and health sciences
chemistry.chemical_compound
Postoperative Complications
0302 clinical medicine
Recurrence
Internal medicine
medicine
Humans
Longitudinal Studies
Registries
Adverse effect
Aged
Immunosuppression Therapy
Transplantation
Hepatology
business.industry
Ribavirin
Hepatitis C
Middle Aged
medicine.disease
Liver Transplantation
Regimen
Treatment Outcome
chemistry
Female
030211 gastroenterology & hepatology
Surgery
business
medicine.drug
Subjects
Details
- ISSN :
- 15276473 and 15276465
- Volume :
- 22
- Database :
- OpenAIRE
- Journal :
- Liver Transplantation
- Accession number :
- edsair.doi.dedup.....5b86eb28a7fd061d9bd5fcfa8cebe842