Sofosbuvir Add-on to Ribavirin Treatment for Chronic Hepatitis E Virus Infection in Solid Organ Transplant Recipients Does Not Result in Sustained Virological Response

Wezel, Esther M. van; Bruijne, Joep de; Damman, Kevin; Bijmolen, M; Berg, A. P. van den; Verschuuren, Erik; Ruigrok, G A; Riezebos‐Brilman, Annelies; Knoester, Marjolein

doi:10.1093/ofid/ofz346

Cited by 25 publications

(13 citation statements)

References 20 publications

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“…Sofosbuvir has been proposed as an alternative treatment method for chronic hepatitis E. Although it seems to have some efficacy in vitro, 78 only two out of seven patients described in case reports achieved a SVR 79‐86 . Combination of peg‐IFN and RBV has been described in three patients, resulting in SVR in one patient 87‐89 .…”

Section: Discussionmentioning

confidence: 99%

Treatment for chronic hepatitis E virus infection: A systematic review and meta‐analysis

Gorris

Lecq

Erpecum

et al. 2020

Journal of Viral Hepatitis

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Hepatitis E virus infection can cause chronic hepatitis in immunocompromised patients with significant chance of progressive fibrosis and possibly cirrhosis. The aim of this systematic review was to summarize the efficacy and safety of the various treatment options for chronic hepatitis E. We performed a systematic literature search. The primary outcome measure was a sustained virological response (SVR). Secondary end points were rapid virological response (RVR), relapse rates, side effects and adverse events. Forty‐four articles were included with a total of 582 patients. Reduction of immunosuppressive medication induced viral clearance in 55/174 (32%) of the patients. Meta‐analysis of 395 patients showed a pooled SVR rate of 78% (95‐CI 72%–84%) after ribavirin treatment. Twenty‐five per cent of the patients obtained a RVR, whereas a relapse occurred in 18% of the patients. Anaemia during treatment led to dose reduction, use of erythropoietin and/or blood transfusion in 37% of the patients. A second treatment attempt with ribavirin led to a SVR in 39/51 (76%) of the patients. Pegylated interferon‐alpha was administered to 13 patients and SVR was obtained in 85%. Two patients (15%) suffered from acute transplant rejection during treatment with interferon. In conclusion, reduction of immunosuppressive medication and treatment with ribavirin is safe, generally well tolerated and induced viral clearance in 32% and 78% of patients, respectively. Therefore, ribavirin should be considered as first treatment step for chronic hepatitis E. Treatment with pegylated interferon‐alpha increases the risk of transplant rejection and should therefore be administered with great caution.

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Section: Discussionmentioning

confidence: 99%

Treatment for chronic hepatitis E virus infection: A systematic review and meta‐analysis

Gorris

Lecq

Erpecum

et al. 2020

Journal of Viral Hepatitis

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“…On the other hand, the use of SOF monotherapy in those patients who are not eligible for RBV use has demonstrated a lack of efficacy [66]. Furthermore, the lack of efficacy also has been reported in the second-line treatment approach in transplant-recipient patients [67]. Consequently, the use of SOF is not recommended for the therapy of HEV infection.…”

Section: Discussionmentioning

confidence: 99%

Ribavirin as a First Treatment Approach for Hepatitis E Virus Infection in Transplant Recipient Patients

et al. 2019

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The hepatitis E virus (HEV) is the major cause of acute hepatitis of viral origin worldwide. Despite its usual course as an asymptomatic self-limited hepatitis, there are highly susceptible populations, such as those with underlying immunosuppression, which could develop chronic hepatitis. In this situation, implementation of therapy is mandatory in the sense to facilitate viral clearance. Currently, there are no specific drugs approved for HEV infection, but ribavirin (RBV), the drug of choice, is used for off-label treatment. Here, we present two cases of chronic HEV infection in transplant patients, reviewing and discussing the therapeutic approach available in the literature. The use of RBV for the treatment of an HEV infection in organ transplant patients seems to be effective. The recommendation of 12 weeks of therapy is adequate in terms of efficacy. Nevertheless, there are important issues that urgently need to be assessed, such as optimal duration of therapy and drug dosage.

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“…No other antiviral therapy is presently known to be effective against a chronic HEV infection. Sofosbuvir was shown to have antiviral activity against HEV in vitro [192] but had limited efficacy in HEV-infected patients [193][194][195][196][197][198][199][200]. A recent pilot study of nine patients (seven for whom ribavirin had previously failed) given sofosbuvir (400 mg/day) for 24 weeks found that their HEV viremia decreased, but was not cleared.…”

Section: Treatmentmentioning

confidence: 99%

Clinical Manifestations, Pathogenesis and Treatment of Hepatitis E Virus Infections

Lhomme

Marion

Abravanel

et al. 2020

JCM

102

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Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis throughout the world. Most infections are acute but they can become chronic in immunocompromised patients, such as solid organ transplant patients, patients with hematologic malignancy undergoing chemotherapy and those with a human immunodeficiency virus (HIV) infection. Extra-hepatic manifestations, especially neurological and renal diseases, have also been described. To date, four main genotypes of HEV (HEV1-4) were described. HEV1 and HEV2 only infect humans, while HEV3 and HEV4 can infect both humans and animals, like pigs, wild boar, deer and rabbits. The real epidemiology of HEV has been underestimated because most infections are asymptomatic. This review focuses on the recent advances in our understanding of the pathophysiology of acute HEV infections, including severe hepatitis in patients with pre-existing liver disease and pregnant women. It also examines the mechanisms leading to chronic infection in immunocompromised patients and extra-hepatic manifestations. Acute infections are usually self-limiting and do not require antiviral treatment. Conversely, a chronic HEV infection can be cleared by decreasing the dose of immunosuppressive drugs or by treating with ribavirin for 3 months. Nevertheless, new drugs are needed for those cases in which ribavirin treatment fails.

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Sofosbuvir Add-on to Ribavirin Treatment for Chronic Hepatitis E Virus Infection in Solid Organ Transplant Recipients Does Not Result in Sustained Virological Response

Cited by 25 publications

References 20 publications

Treatment for chronic hepatitis E virus infection: A systematic review and meta‐analysis

Treatment for chronic hepatitis E virus infection: A systematic review and meta‐analysis

Ribavirin as a First Treatment Approach for Hepatitis E Virus Infection in Transplant Recipient Patients

Clinical Manifestations, Pathogenesis and Treatment of Hepatitis E Virus Infections

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