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Klimova EA, Burnevich EZ, Chulanov VP, Gusev DA, Znoyko OO, Batskikh SN, Kizlo SN, Mamonova NA, Tarkhova EP, Krasavina EN, Samsonov MY, Yushchuk ND. [Efficacy and safety of narlaprevir/ritonavir and daclatasvir non interferon combination in population of Russian patients with chronic hepatitis C]. TERAPEVT ARKH 2019; 91:67-74. [PMID: 32598756 DOI: 10.26442/00403660.2019.08.000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Indexed: 11/22/2022]
Abstract
AIM Evaluate efficacy and safety of a combination of direct - acting antivirals narlaprevir/ritonavir with daclatasvir in patients with viral hepatitis C. MATERIALS AND METHODS The study enrolled adult patients with HCV genotype 1b infection without demonstrated NS5A resistance - associated substitutions Y93C/H/N/S and/or L31F/M/V/I. Patients were treated with narlaprevir 200 mg QD, ritonavir 100 mg QD and daclatasvir 60 mg QD. Treatment duration was 12 weeks. Proportion of patients achieving sustained virological response 12 weeks after treatment (SVR12) was the primary efficacy endpoint. RESULTS AND DISCUSSION In total, 105 (75.0%) patients were treatment with the study combination. Patients' age varied from 21 to 69 years, the mean age being 43.2±10.9 years. There were slightly more women (55.2%), and 69 patients (65.7%) had comorbidities. SVR 12 was 89.5% (95% CI 82.0-94.7%). In 10 of 11 patients with treatment failures NS5A resistance - associated substitutions in residues 31 and/or 93 were found, as well as less clinically relevant substitutions L28M, P58S, R30Q, Q62K. Adverse events (AEs) were found in less than one half of patients (45 patients, or 42.9% in the safety population). Almost all recorded AEs were mild to moderate. CONCLUSION Efficacy of treatment with a combination of narlaprevir/ritonavir and daclatasvir in treatment - naïve patients with HCV genotype 1b was close to 90%. This combination was found to be safe and well - tolerated.
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Affiliation(s)
- E A Klimova
- Yevdokimov Moscow State University of Medicine and Dentistry
| | - E Z Burnevich
- Sechenov First Moscow State Medical University (Sechenov University).,City Clinical Hospital №24
| | - V P Chulanov
- Sechenov First Moscow State Medical University (Sechenov University).,Central Research Institute of Epidemiology
| | - D A Gusev
- Centre for the Prevention and Control of AIDS and Infectious Diseases
| | - O O Znoyko
- Yevdokimov Moscow State University of Medicine and Dentistry
| | | | - S N Kizlo
- Centre for the Prevention and Control of AIDS and Infectious Diseases
| | | | | | | | | | - N D Yushchuk
- Yevdokimov Moscow State University of Medicine and Dentistry
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Calvaruso V, Mazzarelli C, Milazzo L, Badia L, Pasulo L, Guaraldi G, Lionetti R, Villa E, Borghi V, Carrai P, Alberti A, Biolato M, Piai G, Persico M, Santantonio T, Felder M, Angelico M, Montalbano M, Mancusi RL, Grieco A, Angeli E, D'Offizi G, Fagiuoli S, Belli L, Verucchi G, Puoti M, Craxì A. Daclatasvir-based regimens in HCV cirrhosis: experience from the Italian early access program. Sci Rep 2019; 9:585. [PMID: 30679515 PMCID: PMC6345835 DOI: 10.1038/s41598-018-36734-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/06/2018] [Indexed: 12/13/2022] Open
Abstract
We reported the efficacy and safety data for daclatasvir (DCV)-based all-oral antiviral therapy in patients treated in the Italian compassionate-use program. 275 patients were included (202 male-73.5%, mean age: 57.4 years, 62 HIV-coinfected, 94 with recurrence of hepatitis C post-OLT). Forty-nine patients (17.8%) had Child-Pugh B, Genotype(G) distribution was: G1a:72 patients (26.2%), G1b:137 (49.8%); G3:40 (14.5%) and G4:26 (9.5%). Patients received DCV with sofosbuvir(SOF) (n = 221, 129 with ribavirin(RBV) or with simeprevir (SMV) or asunaprevir (ASU) (n = 54, 19 with RBV) for up to 24 weeks. Logistic regression was used to identify baseline characteristics associated with sustained virological response at week 12 post-treatment (SVR12). Liver function changes between baseline and follow up were assessed in 228 patients. 240 patients achieved SVR12 (87.3%), post transplant and HIV co-infected patients were equally distributed among SVR and no SVR (35% vs 34.3%; p = 0.56 and 24.2% vs 11.4%, p = 0.13, respectively). SVR rate was significantly higher with the combination DCV + SOF compared with DCV + SIM or ASU (93.2% vs 63.0%, p < 0.0001). Bilirubin value (OR: 0.69, CI95%: 0.54–0.87, p = 0.002) and regimen containing SOF (OR: 9.99, CI95%: 4.09–24.40; p < 0.001) were independently related with SVR. Mean albumin and bilirubin values significantly improved between baseline and follow-up week 12. DCV-based antiviral therapy was well tolerated and resulted in a high SVR when combined with SOF either in pre-transplant and in OLT patients and in “difficult to treat” HCV genotypes. Regimens containing DCV in combination with NS3 protease inhibitors obtained suboptimal results.
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Affiliation(s)
- Vincenza Calvaruso
- Gastroenterology and Hepatology Unit, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy.
| | | | - Laura Milazzo
- Section of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | - Lorenzo Badia
- Infectious Diseases Unit - Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Luisa Pasulo
- Gastroenterology and Liver unit, San giovanni XXIII Hospital, Bergamo, Italy
| | - Giovanni Guaraldi
- Infectious Disease Unit - Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | - Erica Villa
- Gastroenterology Unit Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Vanni Borghi
- Infectious Disease Unit - Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | | | - Alfredo Alberti
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Marco Biolato
- Liver Transplant Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Guido Piai
- Azienda Ospedaliera San Sebastiano-Caserta, Caserta, Italy
| | | | | | - Martina Felder
- Gastroenterology Unit, Ospedale Centrale Bolzano, Bolzano, Italy
| | | | | | | | - Antonio Grieco
- Liver Transplant Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Elena Angeli
- Section of Infectious Diseases, L. Sacco University Hospital, Milan, Italy
| | | | - Stefano Fagiuoli
- Gastroenterology and Liver unit, San giovanni XXIII Hospital, Bergamo, Italy
| | - Luca Belli
- Gastroenterology and Liver unit, Niguarda Ca' granda, Milan, Italy
| | - Gabriella Verucchi
- Infectious Diseases Unit - Research Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Massimo Puoti
- Section of Infectious Diseases, Niguarda Ca' granda, Milan, Italy
| | - Antonio Craxì
- Gastroenterology and Hepatology Unit, Dipartimento Biomedico di Medicina Interna e Specialistica, University of Palermo, Palermo, Italy
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Brown AN, Liu L, Rodriquez JL, Zhao L, Schuster L, Li E, Wang GP, Neely MN, Yamada W, Drusano GL. Sofosbuvir (SOF) Suppresses Ledipasvir (LDV)-resistant Mutants during SOF/LDV Combination Therapy against Genotype 1b Hepatitis C Virus (HCV). Sci Rep 2017; 7:14421. [PMID: 29089577 PMCID: PMC5663921 DOI: 10.1038/s41598-017-15007-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/20/2017] [Indexed: 12/17/2022] Open
Abstract
Our objective was to identify drug interactions between ledipasvir (LDV) and sofosbuvir (SOF) against a genotype 1b replicon to determine optimal exposures for each agent that will maximize antiviral activity against susceptible and drug-resistant subpopulations. LDV and SOF were evaluated using a fully factorial experimental design in the BelloCell system. Replicon levels and drug-resistant variants were quantified at various times post-therapy for 14 days and a high-dimensional mathematical model was fit to the data. Mutations associated with SOF resistance were not detected; but LDV-resistant mutants were selected and mutant subpopulations increased as exposure intensity increased. Combination therapy was additive for the total replicon population and the LDV-resistant population, but a threshold concentration of 100 ng/ml of SOF must be attained to suppress LDV-resistant subpopulations. These novel findings hold important implications for not only improving therapeutic outcomes, but also maximizing the clinical utility of LDV and SOF combination regimens.
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Affiliation(s)
- Ashley N Brown
- Institute For Therapeutic Innovation, Department of Medicine, University of Florida, 6550 Sanger Road, Orlando, FL, 32827, United States.
| | - Lin Liu
- Infectious Diseases and Global Medicine, University of Florida, Gainesville, FL, United States
| | - Jaime L Rodriquez
- Institute For Therapeutic Innovation, Department of Medicine, University of Florida, 6550 Sanger Road, Orlando, FL, 32827, United States
| | - Lisa Zhao
- Infectious Diseases and Global Medicine, University of Florida, Gainesville, FL, United States
| | - Layla Schuster
- Infectious Diseases and Global Medicine, University of Florida, Gainesville, FL, United States
| | - Eric Li
- Infectious Diseases and Global Medicine, University of Florida, Gainesville, FL, United States
| | - Gary P Wang
- Infectious Diseases and Global Medicine, University of Florida, Gainesville, FL, United States.,Medical Service, North Florida/South Georgia Veterans Health System, Gainesville, FL, United States
| | - Michael N Neely
- Laboratory of Applied Pharmacokinetics and Bioinformatics (LAPKB), Children's Hospital Los Angeles Saban Research Institute, Los Angeles, CA, United States
| | - Walter Yamada
- Laboratory of Applied Pharmacokinetics and Bioinformatics (LAPKB), Children's Hospital Los Angeles Saban Research Institute, Los Angeles, CA, United States
| | - George L Drusano
- Institute For Therapeutic Innovation, Department of Medicine, University of Florida, 6550 Sanger Road, Orlando, FL, 32827, United States
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