Effectiveness and safety of sofosbuvir-based regimens plus an NS5A inhibitor for patients with HCV genotype 3 infection and cirrhosis. Results of a multicenter real-life cohort
Effectiveness and safety of sofosbuvir-based regimens plus an NS5A inhibitor for patients with HCV genotype 3 infection and cirrhosis. Results of a multicenter real-life cohort
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DOI：
10.1111/jvh.12648
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发表时间：
2017-04-01
影响因子：
2.5
通讯作者：
Fernandez-Rodriguez, C. M.
中科院分区：
文献类型：
--
作者：
Alonso, S.;Riveiro-Barciela, M.;Fernandez-Rodriguez, C. M.
HCV基因型3 （GT3）感染和肝硬化患者目前是最难治愈的。我们报告了在该人群中使用索非布韦+daclatasvir （SOF+DCV）或索非布韦/ledipasvir (SOF/LDV)，加或不加利巴韦林（RBV）的临床实践经验。这是一项多中心观察性研究，纳入了感染HCV GT3的肝硬化患者，接受sofosbuvir加NS5A抑制剂治疗（2014年5月- 2015年10月）。总共纳入208例患者：98例（47%）有治疗经验，42例（20%）失代偿，55例（27%）MELD评分为bb10。131例（63%）采用SOF+DCV治疗，77例（37%）采用SOF/LDV治疗。总体而言，86%的患者获得了RBV。SOF/LDV组RBV增加和延长至24周的比例更高（分别为95%对80%，P= 0.002和83%对72%，P= 0.044）。与LDV相比，DCV治疗失代偿患者的比例更高（25% vs 12%， P= 0.013）。总体而言，SVR12为93.8% (195/208)，SOF+DCV为94%，SOF/LDV为93.5%。90.5%的失代偿患者达到了SVR12。治疗失败11例，复发10例，突破1例。RBV的添加没有改善SVR （RR: 1.08； P= 0.919）。无法达到SVR的唯一因素是血小板计数
Patients with HCV genotype 3 (GT3) infection and cirrhosis are currently the most difficult to cure. We report our experience with sofosbuvir+daclatasvir (SOF+DCV) or sofosbuvir/ledipasvir (SOF/LDV), with or without ribavirin (RBV) in clinical practice in this population. This was a multicenter observational study including cirrhotic patients infected by HCV GT3, treated with sofosbuvir plus an NS5A inhibitor (May 2014-October 2015). In total, 208 patients were included: 98 (47%) treatment-experienced, 42 (20%) decompensated and 55 (27%) MELD score >10. In 131 (63%), treatment was SOF+DCV and in 77 (37%), SOF/LDV. Overall, 86% received RBV. RBV addition and extension to 24weeks was higher in the SOF/LDV group (95% vs 80%, P=.002 and 83% vs 72%, P=.044, respectively). A higher percentage of decompensated patients were treated with DCV than LDV (25% vs 12%, P=.013). Overall, SVR12 was 93.8% (195/208): 94% with SOF+DCV and 93.5% with SOF/LDV. SVR12 was achieved in 90.5% of decompensated patients. Eleven treatment failures: 10 relapses and one breakthrough. RBV addition did not improve SVR (RR: 1.08; P=.919). The single factor associated with failure to achieve SVR was platelet count