PMID- 27943544
OWN - NLM
STAT- MEDLINE
DCOM- 20170807
LR  - 20170807
IS  - 1399-3062 (Electronic)
IS  - 1398-2273 (Linking)
VI  - 19
IP  - 1
DP  - 2017 Feb
TI  - Treatment of hepatitis C virus recurrence after transplantation with 
      sofosbuvir/ledipasvir: The role of ribavirin.
LID - 10.1111/tid.12647 [doi]
AB  - BACKGROUND: Hepatitis C virus (HCV) recurrence after liver transplantation (LT) 
      used to be a serious problem in the era of interferon-based treatment. Since the 
      introduction of modern directly acting antivirals, treatment has become easier 
      and shorter. According to published data, in the natural course of hepatitis C 
      infection the duration of antiviral treatment with sofosbuvir (SOF) and 
      ledipasvir (LDV) may be shortened to 12 instead of 24 weeks, using ribavirin 
      (RBV) in addition. Furthermore, the question of whether or not RBV is really 
      necessary, in a 12-week SOF/LDV treatment in the post-transplant setting, is 
      still unanswered. PATIENTS AND METHODS: At our institution, 100 liver transplant 
      patients with HCV recurrence underwent interferon-free SOF-based treatment. A 
      total of 51 patients received SOF/LDV with or without RBV. Twenty-nine HCV 
      genotype 1 or 4 patients with histologically proven stage 0-2 fibrosis were 
      treated with SOF/LDV for 12 weeks; another 22 patients with advanced fibrosis 
      (stage 3-4) either received SOF/LDV plus weight-adjusted RBV or prolonged 
      treatment for 24 weeks. RESULTS: End of treatment response and sustained 
      virological response (SVR) were achieved in 100% of the 51 patients, irrespective 
      of the treatment group. Patients with prolonged treatment duration or with RBV 
      developed significantly more adverse events (AEs) compared to the SOF/LDV group: 
      19 (86.4%) vs 8 (27.6%), P<.001. One of the predominant and most relevant AEs was 
      the development of anemia in 43.1% of 10 patients receiving RBV, which was a 
      significant result (P<.001). RBV co-medication had to be reduced in 11 (55%) 
      patients and then stopped in 8 (40%) patients because of AEs. No significant 
      difference was observed among the groups regarding kidney function. CONCLUSION: 
      The SOF/LDV combination is a reliable therapy of recurrent HCV infection after 
      LT. It is easy to administer and to achieve SVR in immunocompromised patients 
      without interactions with immunosuppressive medications. Considering the high 
      rate of AEs, frequent discontinuation of RBV treatment, and the 100% SVR, the use 
      of RBV as co-medication in a 12-week SOF/LDV regimen does not seem to be 
      justified after LT.
CI  - (c) 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
FAU - Globke, Brigitta
AU  - Globke B
AD  - General, Visceral and Transplant Surgery, Charite Campus Virchow, Berlin, 
      Germany.
FAU - Raschzok, Nathanael
AU  - Raschzok N
AD  - General, Visceral and Transplant Surgery, Charite Campus Virchow, Berlin, 
      Germany.
FAU - Teegen, Eva-Maria
AU  - Teegen EM
AD  - General, Visceral and Transplant Surgery, Charite Campus Virchow, Berlin, 
      Germany.
FAU - Pratschke, Johann
AU  - Pratschke J
AD  - General, Visceral and Transplant Surgery, Charite Campus Virchow, Berlin, 
      Germany.
AD  - General, Visceral, Thoracic and Vascular Surgery, Charite Campus Mitte, Berlin, 
      Germany.
FAU - Schott, Eckart
AU  - Schott E
AD  - Gastroenterology and Hepatology, Charite Campus Virchow, Berlin, Germany.
FAU - Eurich, Dennis
AU  - Eurich D
AD  - General, Visceral and Transplant Surgery, Charite Campus Virchow, Berlin, 
      Germany.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20170111
PL  - Denmark
TA  - Transpl Infect Dis
JT  - Transplant infectious disease : an official journal of the Transplantation 
      Society
JID - 100883688
RN  - 0 (Antiviral Agents)
RN  - 0 (Benzimidazoles)
RN  - 0 (Fluorenes)
RN  - 0 (Immunosuppressive Agents)
RN  - 013TE6E4WV (ledipasvir)
RN  - 49717AWG6K (Ribavirin)
RN  - WJ6CA3ZU8B (Sofosbuvir)
SB  - IM
MH  - Aged
MH  - Antiviral Agents/pharmacology/*therapeutic use
MH  - Benzimidazoles/pharmacology/*therapeutic use
MH  - Drug Interactions
MH  - Drug Therapy, Combination
MH  - Female
MH  - Fluorenes/pharmacology/*therapeutic use
MH  - Hepacivirus/*drug effects/isolation & purification
MH  - Hepatitis C, Chronic/*drug therapy
MH  - Humans
MH  - Immunocompromised Host
MH  - Immunosuppressive Agents/pharmacology/therapeutic use
MH  - Liver Transplantation/*adverse effects
MH  - Male
MH  - Middle Aged
MH  - Recurrence
MH  - Retrospective Studies
MH  - Ribavirin/pharmacology/*therapeutic use
MH  - Sofosbuvir/pharmacology/*therapeutic use
OTO - NOTNLM
OT  - DAAs
OT  - HCV recurrence
OT  - ledipasvir
OT  - liver transplantation
OT  - sofosbuvir
EDAT- 2016/12/13 06:00
MHDA- 2017/08/08 06:00
CRDT- 2016/12/13 06:00
PHST- 2016/07/09 00:00 [received]
PHST- 2016/08/27 00:00 [revised]
PHST- 2016/09/12 00:00 [accepted]
PHST- 2016/12/13 06:00 [pubmed]
PHST- 2017/08/08 06:00 [medline]
PHST- 2016/12/13 06:00 [entrez]
AID - 10.1111/tid.12647 [doi]
PST - ppublish
SO  - Transpl Infect Dis. 2017 Feb;19(1). doi: 10.1111/tid.12647. Epub 2017 Jan 11.