Sofosbuvir/Ledipasvir Without Ribavirin Achieved High Sustained Virologic Response for Hepatitis C Recurrence After Liver Transplantation

Elfeki, Mohamed A.; Mrad, Rachel Abou; Esfeh, Jamak Modaresi; Zein, Nizar N.; Eghtesad, Bijan; Zervos, Xaralambos; Hanouneh, Ibrahim A.; O’Shea, Robert; Carey, William D.; Alkhouri, Naim

doi:10.1097/tp.0000000000001467

Cited by 22 publications

(24 citation statements)

References 27 publications

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“…We observed a remarkable SVR12 of 100% for pretransplant use and SVR12 of 94% for post-transplant use. Our results are comparable to previously reported rates in practice [101112]. The combination of DAAs was well tolerated with a low rate of adverse events.…”

Section: Discussionsupporting

confidence: 89%

“…Real-world studies have supported high SVR rates and excellent tolerability of DAA regimens in LT recipients with recurrent hepatitis C and mild to moderate fibrosis including combination regimens of SOF/LDV and SOF plus DCV [1011121516]. …”

Section: Discussionmentioning

confidence: 99%

“…Because of hematologic abnormalities associated with RBV, a RBV-free regimen may be considered effective. Limited real-world experiences with SOF-based therapy without RBV suggest similar SVR rates to an RBV-containing regimen [101115]. Avoidance of ribavirin is desirable given the reduction in renal perfusion after liver transplantation due to the use of calcineurin inhibitors and reduced hemoglobin levels.…”

Section: Discussionmentioning

confidence: 99%

“…Since the introduction of DAA agents, multiple non-IFN regimens represent an important achievement in HCV treatment, with higher rates of HCV cure and fewer adverse events [7891011]. Three recent observational studies using sofosbuvir-based therapy reported 100% SVR12 rates after completion of therapy [101112].…”

Section: Introductionmentioning

confidence: 99%

“…Three recent observational studies using sofosbuvir-based therapy reported 100% SVR12 rates after completion of therapy [101112]. However, limited data are available on the efficacy and safety of DAAs in liver recipients in Asia.…”

Section: Introductionmentioning

confidence: 99%

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Use of direct antiviral agents in liver transplant recipients with hepatitis C virus in Korea: 2-center experience

et al. 2018

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PurposeThe proportion of liver recipients with HCV is gradually increasing in Korea. Limited data are available regarding the efficacy of direct antiviral agents (DAAs) in liver transplant recipients in Asia. We aimed to assess the efficacy and safety of DAAs in HCV-infected liver recipients in Korea.MethodsForty HCV-infected patients from 2 centers received DAAs in the pretransplant or posttransplant period between May 2015 and November 2016.ResultsDAA was administered in the pretransplant period in 6 patients and the posttransplant period in 34 patients. Dalastavir and asunaprevir (n = 2) and sofosbuvir/ledipasvir and ribvarin (n = 4) were used in the pretransplant period. HCV RNA was not detected before liver transplantation in all patients. Sustained virological response (SVR) at 12 and 24 weeks after liver transplantation was 100%. In the posttransplant period, 33 of 34 patients received sofosfovir-based therapy. SVR at 12 weeks in those patients was 94%. Recurrent virologic relapse developed in 2 patients because of HCC recurrence or treatment failure. Adverse events included anemia (n = 2) and abdominal discomfort (n = 1).ConclusionDAAs are an effective and well-tolerated treatment for HCV-infected recipients in Korea.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Use of direct antiviral agents in liver transplant recipients with hepatitis C virus in Korea: 2-center experience

et al. 2018

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12 Weeks of a Ribavirin‐Free Sofosbuvir and Nonstructural Protein 5A Inhibitor Regimen Is Enough to Treat Recurrence of Hepatitis C After Liver Transplantation

Houssel‐Debry¹,

Coilly

Fougerou‐Leurent

et al. 2018

Hepatology

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Impact of Sofosbuvir‐Based Therapy on Liver Transplant Candidates with Hepatitis C Virus Infection

et al. 2019

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BACKGROUND Sofosbuvir use in patients with decompensated cirrhosis may be associated with reduced liver transplant waitlist mortality and reduced need for transplant. METHODS Data from the Scientific Registry of Transplant Recipients were linked with a national database of pharmacy claims. All adult patients on the liver transplant waitlist on January 1, 2014, or added to the list during 2014, with hepatitis C virus as reason for listing were identified (2009 patients). A subgroup of 1093 unique patients had consistent pharmacy claim capture and observations. We compared patients who were and were not treated with all sofosbuvir-based regimens. RESULTS During the study period, 154 patients received sofosbuvir-based regimens. These patients had lower model for end-stage liver disease scores and significantly longer waiting times. We found a trend toward significance for more sofosbuvir-treated than untreated patients being removed from the waitlist due to improved condition (4.54% vs 3.19%, p=0.03). In a propensity score-adjusted analysis, sofosbuvir-treated patients were less likely to undergo transplant (hazard ratio 0.57, 95% confidence interval 0.37-0.89, p=0.01). CONCLUSION During the study period reflecting early sofosbuvir use, few liver transplant candidates received sofosbuvir. Use was associated with lower incidence of transplant and a trend toward more waitlist removals due to improved condition.Hepatitis C virus (HCV) is a leading cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC), and a common indication for liver transplant worldwide. 1 Despite recent advances in direct-acting antivirals (DAAs), the number of patients on the transplant waitlist is projected to remain substantial. Liver transplant is the only lifesaving option for patients who develop decompensated cirrhosis. 2 Before 2011, the standard regimen of anti-HCV therapy was dual therapy with pegylated interferon alpha plus ribavirin for 24-48 weeks, which produced cure rates of 70-80% for HCV genotypes 2 and 3, and 45-60% for genotypes 1

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Sofosbuvir/Ledipasvir Without Ribavirin Achieved High Sustained Virologic Response for Hepatitis C Recurrence After Liver Transplantation

Abstract: The combination of SOF/LDV without RBV for 12 or 24 weeks produced 100% SVR 12 in patients with HCV recurrence after liver transplantation. The use of RBV may not be necessary to achieve SVR in this patient population.

Cited by 22 publications

References 27 publications

Use of direct antiviral agents in liver transplant recipients with hepatitis C virus in Korea: 2-center experience

Use of direct antiviral agents in liver transplant recipients with hepatitis C virus in Korea: 2-center experience

12 Weeks of a Ribavirin‐Free Sofosbuvir and Nonstructural Protein 5A Inhibitor Regimen Is Enough to Treat Recurrence of Hepatitis C After Liver Transplantation

Impact of Sofosbuvir‐Based Therapy on Liver Transplant Candidates with Hepatitis C Virus Infection

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