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Ali RA, Awadalla EA, Amin YA, Fouad SS, Ahmed MAEB, Hassan MH, Abdel-Kahaar E, Abdel-Aziz RH. The deleterious effects of sofosbuvir and ribavirin (antiviral drugs against hepatitis C virus) on different body systems in male albino rats regarding reproductive, hematological, biochemical, hepatic, and renal profiles and histopathological changes. Sci Rep 2024; 14:5682. [PMID: 38453980 PMCID: PMC10920821 DOI: 10.1038/s41598-024-55950-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/29/2024] [Indexed: 03/09/2024] Open
Abstract
Sofosbuvir is one of the crucial drugs used in the treatment of chronic hepatitis C virus (HCV) in adults and children with compensated liver disease, including cirrhosis. It may be used alone or with other drugs. Ribavirin is an antiviral medication used to treat HCV infection. It is not effective when used alone and must be used in combination with other medications, such as sofosbuvir. This study pertains to a comprehensive assessment of the deleterious effects of sofosbuvir (an antiviral drug against chronic HCV) or sofosbuvir combined with ribavirin (an antiviral drug against RNA and DNA viruses) on several biological activities of the body, including hematological, hormonal, biochemical, histological, and immunohistochemical examinations during a long-standing period on male healthy rats. In addition, fertility assessments were performed, including sperm collections and semen parameter investigations. This study was conducted on 21 male rats divided into three equal groups. Group I (control group) received distilled water; group II (sofosbuvir group) received sofosbuvir (4 mg/kg); and group III (sofosbuvir + ribavirin) received sofosbuvir (4 mg/kg) plus ribavirin (30 ml/kg). All groups received the specific drug for six months. Blood and tissue samples were collected for hematological, hormonal, biochemical, histological, and immunohistochemical examinations. In addition, sperm collection and assessments of semen parameters were performed. Results revealed that sofosbuvir causes a highly significant decrease in the mean of most hematological, immunological, hormonal, and biochemical parameters, except for a few numbers of parameters such as neutrophils, monocytes, basophils, cortisol, GOT, and lipase, which exhibit a significant increase. The same occurred in the sofosbuvir + ribavirin group, but at much higher levels, as most hematological, immunological, hormonal, and biochemical parameters exhibit a highly significant decrease except for monocytes, triglyceride, and lipase, which exhibit a significant increase. When compared to the sofosbuvir group alone, the sofosbuvir + ribavirin group demonstrated a highly significant decline in the mean of most hematological, immunological, hormonal, and biochemical parameters except lymphocytes and triglycerides, which exhibit a substantial increase. For the reproductive parameters, both groups exhibit a significant decrease in the total sperm motility percentage. Finally, it can be concluded that sofosbuvir causes acute pancreatitis and combined immunodeficiency. Ribavirin is associated with hormonal deficiency, which indicates the occurrence of hypopituitarism. Moreover, sofosbuvir and ribavirin synergistically affect myelosuppression and cause iron-deficiency anemia. However, sofosbuvir, or its combination with ribavirin, is associated with a reduced risk of hepatocellular carcinoma. Besides, adding ribavirin to be combined with sofosbuvir improved the immunodeficiency caused by sofosbuvir; this confirms that using ribavirin with sofosbuvir reduces the side effects of both alone.
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Affiliation(s)
- Rana A Ali
- Zoology Department, Faculty of Science, South Valley University, Qena, Egypt
| | | | - Yahia A Amin
- Department of Theriogenology, Faculty of Veterinary Medicine, Aswan University, Aswan, Egypt.
| | - Samer S Fouad
- Qena University Hospital, South Valley University, Qena, Egypt
| | | | - Mohammed H Hassan
- Department of Medical Biochemistry, Faculty of Medicine, South Valley University, Qena, Egypt
| | - Emaad Abdel-Kahaar
- Department of Medical Pharmacology, Faculty of Medicine, South Valley University, Qena, Egypt
- Institute of Clinical Pharmacology, Medical Faculty Mannheim, Ruprecht-Karls-University, Heidelberg, Germany
| | - Rehab H Abdel-Aziz
- Department of Medical Physiology, Faculty of Medicine, South Valley University, Qena, Egypt
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Inhibition of cardiomyocyte differentiation of human induced pluripotent stem cells by Ribavirin: Implication for its cardiac developmental toxicity. Toxicology 2020; 435:152422. [PMID: 32112805 DOI: 10.1016/j.tox.2020.152422] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 02/16/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
Ribavirin has been proven to be an antiviral treatment, whereas there are still risks of hemolysis and congenital malformation. Abnormal cardiac development contributes to the occurrence and development of many heart diseases. However, there is so far no evidence that ribavirin induces human cardiac developmental toxicity. Herein, we employed the cardiac differentiation model of human induced pluripotent stem cells (hiPSCs) to determine the impact of ribavirin on heart development. Our data showed that ribavirin at clinically high concentrations (5 and 10 μM) significantly inhibited the proliferation and differentiation of hiPSCs from mesoderm to cardiac progenitor cells and cardiac progenitor cells to cardiomyocytes, but not from pluripotent status to mesoderm. Meanwhile, DCFH-DA staining revealed that ribavirin could increase ROS content in the mid-phase of differentiation. In addition, ribavirin treatment (1, 5 and 10 μM) remarkably caused DNA damage which was shown by the increase of γH2AX-positive cells and upregulation of the p53 during the differentiation of hiPSCs from mesoderm to cardiac progenitor cells. Moreover, exposuring to ribavirin (5 and 10 μM) markedly upregulated the expression of lncRNAs Gas5 in both mid-phase and late phase of differentiation and HBL1 in the mid-phase. In conclusion, our results suggest that ribavirin is detrimental in cardiac differentiation of hiPSCs, which may be associated with DNA damage, upregulated p53 and increased Gas5. It may provide the evidence for the rational clinical application of ribavirin.
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Handala L, Domange B, Ouled-Haddou H, Garçon L, Nguyen-Khac E, Helle F, Bodeau S, Duverlie G, Brochot E. DHEA prevents ribavirin-induced anemia via inhibition of glucose-6-phosphate dehydrogenase. Antiviral Res 2017; 146:153-160. [PMID: 28890388 DOI: 10.1016/j.antiviral.2017.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 08/22/2017] [Accepted: 09/01/2017] [Indexed: 12/29/2022]
Abstract
Ribavirin has been widely used for antiviral therapy. Unfortunately, ribavirin-induced anemia is often a cause of limiting or interrupting treatment. Our team has observed that dehydroepiandrosterone (DHEA) has a protective effect against in vitro and in vivo ribavirin-induced hemolysis. The aim of this study was to better understand this effect as well as the underlying mechanism(s). DHEA was able to reduce in vitro intraerythrocytic ATP depletion induced by ribavirin. Only 1% of ATP remained after incubation with ribavirin (2 mM) at 37 °C for 24 h vs. 37% if DHEA (200 μM) was added (p < 0.01). DHEA also helped erythrocytes conserve their size, with a shrinkage of only 10% vs 40% at 24 h with ribavirin alone (p < 0.01), and reduced phosphatidylserine exposure at the outer membrane, i.e. 27% vs 40% at 48 h, (p < 0.05). DHEA also inhibits ribavirin-induced hemolysis, i.e. 34% vs 46.5% at 72 h (p < 0.01). DHEA is an inhibitor of glucose-6-phosphate dehydrogenase (G6PD), a key enzyme in the hexose monophosphate shunt connected to the glycolytic pathway which is the only energy supplier of the red blood cell in the form of ATP. We have confirmed this inhibitory effect in the presence of ribavirin. All these observations suggest that ribavirin-induced hemolysis was initiated by ATP depletion, and that the inhibitory effect of DHEA on G6PD was able to rescue enough ATP to limit this hemolysis. This mechanism could be important for improving the therapeutic management of patients treated with ribavirin.
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Affiliation(s)
- Lynda Handala
- Laboratoire de Virologie EA4294, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Barbara Domange
- Laboratoire de Virologie EA4294, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Hakim Ouled-Haddou
- Laboratoire d'Hématologie EA4666, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Loïc Garçon
- Laboratoire d'Hématologie EA4666, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Eric Nguyen-Khac
- Service d'Hépato-Gastroentérologie, ERI24, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Francois Helle
- Laboratoire de Virologie EA4294, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Sandra Bodeau
- Laboratoire de Pharmacologie-Toxicologie, U1088, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Gilles Duverlie
- Laboratoire de Virologie EA4294, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France
| | - Etienne Brochot
- Laboratoire de Virologie EA4294, Université de Picardie Jules Verne, Centre Hospitalier Universitaire, 80054, Amiens, France.
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Wu LS, Jimmerson LC, MacBrayne CE, Kiser JJ, D'Argenio DZ. Modeling Ribavirin-Induced Anemia in Patients with Chronic Hepatitis C Virus. CPT Pharmacometrics Syst Pharmacol 2016; 5:65-73. [PMID: 26933517 PMCID: PMC4761234 DOI: 10.1002/psp4.12058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 12/30/2015] [Indexed: 12/17/2022] Open
Abstract
Ribavirin remains an important component of hepatitis C treatment in certain clinical scenarios, but it causes hemolytic anemia. A quantitative understanding of the ribavirin exposure-anemia relationship is important in dose individualization/optimization. We developed a model relating ribavirin triphosphate (RTP) exposure in red blood cells (RBCs), RBC lifespan, feedback regulation of RBC production when anemia occurs, and the resulting hemoglobin decline. Inosine triphosphatase (ITPA) and interleukin 28B (IL28B) genetics were found to be significant covariates. Clinical trial simulations predicted that anemia is least severe in IL28B non-CC (rs12979860, CT or TT), ITPA variant subjects, followed by IL28B non-CC, ITPA wild-type, IL28B CC, ITPA variant, and IL28B CC, ITPA wild-type subjects (most severe). Reducing the ribavirin dose from 1,200/1,000 mg to 800/600 mg could reduce the proportions of grade 2 anemia by about half. The resulting model framework will aid the development of dosing strategies that minimize the incidence of anemia in treatment regimens that include ribavirin.
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Affiliation(s)
- LS Wu
- University of Southern California, Biomedical EngineeringLos AngelesCaliforniaUSA
| | - LC Jimmerson
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Pharmaceutical SciencesAuroraColoradoUSA
| | - CE MacBrayne
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Pharmaceutical SciencesAuroraColoradoUSA
| | - JJ Kiser
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Pharmaceutical SciencesAuroraColoradoUSA
| | - DZ D'Argenio
- University of Southern California, Biomedical EngineeringLos AngelesCaliforniaUSA
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Lupo F, Russo R, Iolascon A, Ieluzzi D, Siciliano A, Toniutto P, Matté A, Piovesan S, Raffetti E, Turrini F, Dissegna D, Donato F, Alberti A, Zuliani V, Fattovich G, De Franceschi L. Protease inhibitors-based therapy induces acquired spherocytic-like anaemia and ineffective erythropoiesis in chronic hepatitis C virus patients. Liver Int 2016; 36:49-58. [PMID: 26104535 DOI: 10.1111/liv.12900] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/09/2015] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS The addition of protease inhibitors, boceprevir (BOC) or telaprevir (TRV), to peg-interferon and ribavirin (PR) increases the incidence of anaemia in patients with chronic hepatitis C virus (HCV) infection. Although genetic variants in inosine triphosphatase (ITPA) gene have been linked to the haemolytic anaemia induced by PR, the mechanism sustaining severe anaemia during triple therapy is still unknown. This study aims to elucidate the molecular mechanisms underlying anaemia in chronic HCV patients with combined therapy. METHODS We studied 59 patients with chronic HCV genotype-1: 29 treated with TRV/PR and 30 with BOC/PR. We evaluated biochemical and haematological parameters, red cell index at baseline, 4, 12, 16 and 24 weeks of treatment; in a subgroup, we performed functional studies: osmotic fragility, red cell membrane protein separation, mass spectrometry analysis, quantification of erythroid microparticles release. IL28B and ITPA polymorphisms were also evaluated. RESULTS We found early acute normochromic normocytic haemolytic anaemia (4-8 weeks) followed by a late macrocytic hypo-regenerative anaemia with inappropriate low reticulocyte count (12-24 weeks). Studies on red cells revealed: (i) presence of spherocytes; (ii) increased osmotic fragility; (iii) abnormalities in red cell membrane protein composition; (iv) reduced membrane-cytoskeleton stability; (v) increased release of erythroid microparticles. ITPA polymorphisms impacted only the early phase of anaemia. CONCLUSIONS The bimodal pattern of anaemia in chronic HCV patients on triple therapy might be because of acquired spherocytic-like anaemia in the early phase, followed by hyporegenerative anaemia, most likely related to the combined effects of PR and TRV or BOC on erythropoiesis.
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Affiliation(s)
- Francesca Lupo
- Department of Medicine, University of Verona and AOUI-Verona, Verona, Italy
| | - Roberta Russo
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy.,CEINGE Biotecnologie Avanzate, Napoli, Italy
| | - Achille Iolascon
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, Università degli Studi di Napoli Federico II, Napoli, Italy.,CEINGE Biotecnologie Avanzate, Napoli, Italy
| | - Donatella Ieluzzi
- Clinical Unit of Gastroenterology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Angela Siciliano
- Department of Medicine, University of Verona and AOUI-Verona, Verona, Italy
| | - Pierluigi Toniutto
- Department of Medicine and Pathology Clinical and Experimental, Medical Liver Transplantation Unit, Internal Medicine, University of Udine, Udine, Italy
| | - Alessandro Matté
- Department of Medicine, University of Verona and AOUI-Verona, Verona, Italy
| | - Sara Piovesan
- Department of Molecular Medicine, University of Padova, Padova, Italy.,Clinical Unit of General Medicine, Azienda Ospedaliera Universitaria Integrata Padova, Padova, Italy
| | - Elena Raffetti
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | | | - Denis Dissegna
- Department of Medicine and Pathology Clinical and Experimental, Medical Liver Transplantation Unit, Internal Medicine, University of Udine, Udine, Italy
| | - Francesco Donato
- Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy
| | - Alfredo Alberti
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Valeria Zuliani
- Department of Medicine, University of Verona and AOUI-Verona, Verona, Italy
| | - Giovanna Fattovich
- Department of Medicine, University of Verona and AOUI-Verona, Verona, Italy.,Clinical Unit of Gastroenterology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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Boccaccio V, Russo ML, Carbone M, Bruno S. Treatment discontinuation with peg-interferon: what to consider. Expert Rev Clin Pharmacol 2015; 8:761-8. [PMID: 26437265 DOI: 10.1586/17512433.2015.1090872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Eradication of chronic hepatitis C virus infection improves the outcome of both liver and extrahepatic-related diseases and interferon-based regimens represented, for years, the standard of care to achieve this goal. Several baseline and on-treatment predictors of response, associated with a lower chance to achieve sustained virological response after interferon-based treatment, were developed. In the past few years, the advent of direct acting antivirals has dramatically modified the landscape of antiviral therapy, leading to an evolution from interferon-based to interferon-free therapies. This review will focus on the usefulness of futility stopping rules that allow the discontinuation of therapy in patients with a reduced chance to obtain sustained virological response if treated with interferon-containing regimens.
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Affiliation(s)
- Vincenzo Boccaccio
- a 1 Internal Medicine and Hepatology Unit, Humanitas Research Hospital , Rozzano, Italy
| | - Maria Luisa Russo
- a 1 Internal Medicine and Hepatology Unit, Humanitas Research Hospital , Rozzano, Italy
| | - Marco Carbone
- a 1 Internal Medicine and Hepatology Unit, Humanitas Research Hospital , Rozzano, Italy
| | - Savino Bruno
- a 1 Internal Medicine and Hepatology Unit, Humanitas Research Hospital , Rozzano, Italy.,b 2 Department of Internal Medicine, Humanitas University Medicine , Rozzano, Italy
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Kumada H, Chayama K, Rodrigues L, Suzuki F, Ikeda K, Toyoda H, Sato K, Karino Y, Matsuzaki Y, Kioka K, Setze C, Pilot‐Matias T, Patwardhan M, Vilchez RA, Burroughs M, Redman R. Randomized phase 3 trial of ombitasvir/paritaprevir/ritonavir for hepatitis C virus genotype 1b-infected Japanese patients with or without cirrhosis. Hepatology 2015; 62:1037-46. [PMID: 26147154 PMCID: PMC5049673 DOI: 10.1002/hep.27972] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/27/2015] [Indexed: 12/15/2022]
Abstract
UNLABELLED GIFT-I is a phase 3 trial evaluating the efficacy and safety of a 12-week regimen of coformulated ombitasvir (OBV)/paritaprevir (PTV)/ritonavir (r) for treatment of Japanese hepatitis C virus genotype 1b-infected patients. It consists of a double-blind, placebo-controlled substudy of patients without cirrhosis and an open-label substudy of patients with compensated cirrhosis. Patients without cirrhosis were randomized 2:1 to once-daily OBV/PTV/r (25 mg/150 mg/100 mg; group A) or placebo (group B). Patients with cirrhosis received open-label OBV/PTV/r (group C). The primary efficacy endpoint was the rate of sustained virological response 12 weeks posttreatment in interferon-eligible, treatment-naive patients without cirrhosis and hepatitis C virus RNA ≥100,000 IU/mL in group A. A total of 321 patients without cirrhosis were randomized and dosed with double-blind study drug (106 received double-blind placebo and later received open-label OBV/PTV/r), and 42 patients with cirrhosis were enrolled and dosed with open-label OBV/PTV/r. In the primary efficacy population, the rate of sustained virological response 12 weeks posttreatment was 94.6% (106/112, 95% confidence interval 90.5-98.8). Sustained virological response 12 weeks posttreatment rates were 94.9% (204/215) in group A, 98.1% (104/106) in group B (open-label), and 90.5% (38/42) in group C. Overall, virological failure occurred in 3.0% (11/363) of patients who received OBV/PTV/r. The rate of discontinuation due to adverse events was 0%-2.4% in the three patient groups receiving OBV/PTV/r. The most frequent adverse event in patients in any group was nasopharyngitis. CONCLUSION In this broad hepatitis C virus genotype 1b-infected Japanese patient population with or without cirrhosis, treatment with OBV/PTV/r for 12 weeks was highly effective and demonstrated a favorable safety profile.
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Affiliation(s)
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Institute of Biomedical and Health SciencesHiroshima UniversityHiroshimaJapan
| | | | | | - Kenji Ikeda
- Department of HepatologyToranomon HospitalTokyoJapan
| | - Hidenori Toyoda
- Department of GastroenterologyOgaki Municipal HospitalGifuJapan
| | - Ken Sato
- Department of Medicine and Molecular ScienceGunma University Graduate School of MedicineMaebashiJapan
| | - Yoshiyasu Karino
- Department of GastroenterologySapporo Kosei General HospitalSapporoHokkaidoJapan
| | - Yasushi Matsuzaki
- Department of Gastroenterology, Tokyo Medical UniversityIbaraki Medical CenterIbarakiJapan
| | - Kiyohide Kioka
- Department of Hepatology Osaka City General HospitalOsakaJapan
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D’Ambrosio R, Poggiali E, Cappellini MD. Treating hepatitis C in patients with hemoglobinopathies. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1086333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Guo H, Sun S, Yang Z, Tang X, Wang Y. Strategies for ribavirin prodrugs and delivery systems for reducing the side-effect hemolysis and enhancing their therapeutic effect. J Control Release 2015; 209:27-36. [DOI: 10.1016/j.jconrel.2015.04.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/08/2015] [Accepted: 04/12/2015] [Indexed: 12/16/2022]
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Alqahtani SA, Afdhal N, Zeuzem S, Gordon SC, Mangia A, Kwo P, Fried M, Yang JC, Ding X, Pang PS, McHutchison JG, Pound D, Reddy KR, Marcellin P, Kowdley KV, Sulkowski M. Safety and tolerability of ledipasvir/sofosbuvir with and without ribavirin in patients with chronic hepatitis C virus genotype 1 infection: Analysis of phase III ION trials. Hepatology 2015; 62:25-30. [PMID: 25963890 DOI: 10.1002/hep.27890] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/15/2015] [Accepted: 05/07/2015] [Indexed: 12/11/2022]
Abstract
UNLABELLED In phase III studies, treatment with the once-daily fixed-dose combination tablet of ledipasvir/sofosbuvir (LDV/SOF) with and without ribavirin (RBV) resulted in high rates of sustained virological response (SVR) in patients chronically infected with genotype 1 hepatitis C virus, including those with compensated cirrhosis. We conducted an analysis of data from these trials to compare the safety and tolerability profile of LDV-SOF with and without RBV. We analyzed treatment-emergent adverse events (AEs) and laboratory abnormalities in patients who were randomized to 8, 12, and 24 weeks of LDV/SOF with or without RBV. In total, data from 1,952 patients (of whom 872 received LDV/SOF with RBV and 1,080 received LDV/SOF alone) were analyzed. Overall, 308 patients (16%) were African American, 224 (11%) had compensated cirrhosis, 501 (26%) had a body mass index ≥30 kg/m(2) , and 440 (23%) were treatment experienced. Treatment-related AEs occurred in 71% and 45% of patients treated with and without RBV, respectively, including fatigue, insomnia, irritability, and rash/pruritus. Patients receiving RBV with LDV/SOF were more likely to require dose modification, interruptions of treatment resulting from AEs, or require the use of concomitant medications than those receiving LDV/SOF alone. Rates of treatment-related serious AEs and discontinuations resulting from AEs were similarly low (<1%) in both groups. The rate of SVR in those receiving RBV and those not receiving RBV was the same (97%). CONCLUSION LDV/SOF plus RBV was associated with a greater incidence of AEs as well as concomitant medication use than LDV/SOF alone. Use of RBV did not impact the efficacy of LDV/SOF regimens in the ION phase III studies.
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Affiliation(s)
| | - Nezam Afdhal
- Hepatology, Beth Israel Deaconess Medical Center, Boston, MA
| | - Stefan Zeuzem
- Department of Medicine, Johann Wolfgang Goethe University, Frankfurt, Germany
| | | | - Alessandra Mangia
- Department of Hepatology, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Paul Kwo
- Gastroenterology-Hepatology, Indiana University School of Medicine, Indianapolis, IN
| | - Michael Fried
- Liver Center, University of North Carolina Health Care, Chapel Hill, NC
| | - Jenny C Yang
- Liver Diseases, Gilead Sciences, Inc, Foster City, CA
| | - Xiao Ding
- Liver Diseases, Gilead Sciences, Inc, Foster City, CA
| | | | | | - David Pound
- Indianapolis Gastroenterology Research Foundation, Indianapolis, IN
| | - K Rajender Reddy
- Division of Gastroenterology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Patrick Marcellin
- Department of Hepatology, Centre Hospitalier Universitaire Beaujon, Clichy-sous-Bois, France
| | - Kris V Kowdley
- Liver Care Network and Organ Care Research, Swedish Medical Center, Seattle, WA
| | - Mark Sulkowski
- Department of Medicine, Johns Hopkins Hospital, Baltimore, MD
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Telaprevir-S isomer enhances ribavirin exposure and the ribavirin-related haemolytic anaemia in a concentration-dependent manner. Antiviral Res 2014; 109:7-14. [DOI: 10.1016/j.antiviral.2014.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 06/09/2014] [Accepted: 06/12/2014] [Indexed: 01/25/2023]
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