Sofosbuvir and Simeprevir Therapy for Recurrent Hepatitis C Infection After Liver Transplantation.
Sofosbuvir and Simeprevir Therapy for Recurrent Hepatitis C Infection After Liver Transplantation.
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DOI：
10.1097/txd.0000000000000531
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发表时间：
2015-07
影响因子：
2.3
通讯作者：
Fong TL
中科院分区：
文献类型：
--
作者：
Khemichian S;Lee B;Kahn J;Noureddin M;Kim B;Harper T;Esmailian Y;Fong TL
肝移植受者复发性丙型肝炎的抗病毒治疗与疗效低、耐受性差和药物相互作用有关。最近批准的各种丙型肝炎直接作用的抗病毒药物已导致这些参数的改善。我们评估了索非布韦和西米普韦12周全口服无干扰素和利巴韦林治疗的有效性和安全性。回顾性分析了32例基因1型肝移植受者复发丙型肝炎感染。所有患者均接受12周的索非布韦400 mg和西米普韦150 mg口服每日。主要终点是治疗后12周的持续病毒学应答。治疗后12周，32例患者中有30例（94%; 95%置信区间，79-99%）达到持续病毒学应答。所有患者在治疗期间均出现病毒学应答。复发的两名患者均为既往接受过Q80 K多态性治疗的阿尔茨海默病患者。治疗后12周，碱性磷酸酶、白蛋白、丙氨酸氨基转移酶水平和血小板显著改善。治疗耐受性良好。未观察到3级或4级不良事件。头痛和疲劳是最常见的主诉。索非布韦和西米普韦联合治疗12周，在基因型1型丙型肝炎患者中持续病毒学应答率为94%，耐受性良好。
Antiviral therapy for recurrent hepatitis C in liver transplant recipients has been associated with low efficacy, poor tolerability, and drug-drug interactions. Recent approval of various hepatitis C direct-acting antivirals has resulted in improvement of these parameters. We evaluated the efficacy and safety of 12 week all-oral interferon- and ribavirin-free therapy with sofosbuvir and simeprevir. Thirty-two genotype 1 liver transplant recipients with recurrent hepatitis C infection were retrospectively analyzed. All patients received 12 weeks of sofosbuvir 400 mg and simeprevir 150 mg orally daily. The primary endpoint was sustained virologic response 12 weeks after treatment. Sustained virologic response 12 weeks after treatment was achieved in 30 of 32 (94%; 95% confidence interval, 79-99%) patients. All patients enjoyed on-treatment virological response. Both patients who relapsed were cirrhotic, previously treated with Q80K polymorphism. Significant improvements in alkaline phosphatase, albumin, alanine aminotransferase levels, and platelets were seen at 12-week post therapy. Treatment was well tolerated. No grade 3 or 4 adverse events were noted. Headache and fatigue were the most common complaints. Combination of sofosbuvir and simeprevir for 12 weeks resulted in 94% sustained virological response-12 rates in patients with hepatitis C genotype 1 and was well tolerated.