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van den Ouweland F, Charpentier N, Türeci Ö, Rizzi R, Mensa FJ, Lindemann C, Pather S. Safety and reactogenicity of the BNT162b2 COVID-19 vaccine: Development, post-marketing surveillance, and real-world data. Hum Vaccin Immunother 2024; 20:2315659. [PMID: 38407186 PMCID: PMC10900268 DOI: 10.1080/21645515.2024.2315659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/03/2024] [Indexed: 02/27/2024] Open
Abstract
The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to urgent actions by innovators, vaccine developers, regulators, and other stakeholders to ensure public access to protective vaccines while maintaining regulatory agency standards. Although development timelines for vaccines against SARS-CoV-2 were much quicker than standard vaccine development timelines, regulatory requirements for efficacy and safety evaluations, including the volume and quality of data collected, were upheld. Rolling review processes supported by sponsors and regulatory authorities enabled rapid assessment of clinical data as well as emergency use authorization. Post-authorization and pharmacovigilance activities enabled the quantity and breadth of post-marketing safety information to quickly exceed that generated from clinical trials. This paper reviews safety and reactogenicity data for the BNT162 vaccine candidates, including BNT162b2 (Comirnaty, Pfizer/BioNTech COVID-19 vaccine) and bivalent variant-adapted BNT162b2 vaccines, from preclinical studies, clinical trials, post-marketing surveillance, and real-world studies, including an unprecedentedly large body of independent evidence.
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Affiliation(s)
| | | | | | - Ruben Rizzi
- Global Regulatory Affairs, BioNTech, Germany, Germany
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Albertson TE, Hansen C, Bihari S, Gayed J, Xu X, Simón-Campos JA, Dever ME, Cardona JF, Mitha E, Baker JB, Keep G, Oladipupo I, Mensa FJ, Feng Y, Ma H, Koury K, Mather S, Ianos CA, Anderson AS, Türeci Ö, Şahin U, Gruber WC, Gurtman A, Sabharwal C, Kitchin N. Serum Troponin I Assessments in 5- to 30-Year-Olds After BNT162b2 Vaccination. Infect Dis Ther 2024; 13:699-714. [PMID: 38489117 PMCID: PMC11058143 DOI: 10.1007/s40121-024-00927-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/19/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Rare myocarditis and pericarditis cases have occurred in coronavirus disease 2019 (COVID-19) messenger RNA (mRNA) vaccine recipients. Troponin levels, a potential marker of myocardial injury, were assessed in healthy participants before and after BNT162b2 vaccination. METHODS Vaccine-experienced 12- to 30-year-olds in phase 3 crossover C4591031 Substudy B (NCT04955626) who had two or three prior BNT162b2 30-μg doses were randomized to receive BNT162b2 30 μg followed by placebo, or placebo followed by BNT162b2 30 µg, 1 month apart. A participant subset, previously unvaccinated against COVID-19, in the phase 3 C4591007 study (NCT04816643) received up to three vaccinations (BNT162b2 10 μg or placebo [5- to 11-year-olds]) or open-label BNT162b2 30 μg (12- to 15-year-olds). Blood samples collected pre-vaccination, 4 days post-vaccination, and 1-month post-vaccination (C4591031 Substudy B only) were analyzed. Frequencies of elevated troponin I levels (male, > 35 ng/l; female, > 17 ng/l) were assessed. RESULTS Percentages of 12- to 30-year-olds (n = 1485) in C4591031 Substudy B with elevated troponin levels following BNT162b2 or placebo receipt were 0.5% and 0.8% before vaccination, 0.7% and 1.0% at day 4, and 0.7% and 0.5% at 1 month, respectively. In Study C4591007 (n = 1265), elevated troponin I levels were observed in 0.2, 0.4, and 0.2% of 5- to 11-year-old BNT162b2 recipients at baseline and 4 days post-dose 2 and 3, respectively; corresponding values in 12- to 15-year-olds were 0.4, 0.4, and 0.7%. No 5- to 11-year-old placebo recipients had elevated troponin levels. No myocarditis or pericarditis cases or deaths were reported. CONCLUSIONS Among 5- to < 30-year-olds in both studies, troponin levels were rarely elevated (≤ 1.0%) and similar before and post-vaccination; troponin levels were also similar between BNT162b2 and placebo in 12- to 30-year-old and 5- to 11-year-old recipients in the respective studies. No myocarditis or pericarditis cases were reported. These findings did not provide evidence that BNT162b2 causes troponin elevations. No utility of routine measurement of troponin levels in asymptomatic BNT162b2 recipients was identified.
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Affiliation(s)
| | - Caitlin Hansen
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Smiti Bihari
- Vaccine Research and Development, Pfizer Ltd, Hurley, UK
| | - Juleen Gayed
- Vaccine Research and Development, Pfizer Ltd, Hurley, UK.
| | - Xia Xu
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - J Abraham Simón-Campos
- Faculty of Medicine, Köhler and Milstein Research/Autonomous University of Yucatan, Mérida, Yucatan, Mexico
| | | | - Jose F Cardona
- Indago Research and Health Center, Inc, Hialeah, FL, USA
| | - Essack Mitha
- Newtown Clinical Research, Johannesburg, South Africa
| | | | - Georgina Keep
- Vaccine Research and Development, Pfizer Ltd, Hurley, UK
| | | | | | - Ye Feng
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Hua Ma
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Kenneth Koury
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Susan Mather
- Worldwide Safety, Safety Surveillance and Risk Management, Pfizer Inc, Collegeville, PA, USA
| | | | | | | | | | - William C Gruber
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | | | - Charu Sabharwal
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
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Usdan L, Patel S, Rodriguez H, Xu X, Lee DY, Finn D, Wyper H, Sci BB, Lowry FS, Mensa FJ, Lu C, Cooper D, Koury K, Anderson AS, Türeci Ö, Şahin U, Swanson KA, Gruber WC, Kitchin N. A Bivalent Omicron-BA.4/BA.5-Adapted BNT162b2 Booster in ≥12-Year-Olds. Clin Infect Dis 2023:ciad718. [PMID: 38016021 DOI: 10.1093/cid/ciad718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Protection against contemporary SARS-CoV-2 variants requires sequence-adapted vaccines. METHODS In this ongoing phase 2/3 trial, 12-17-year-olds (n=108), 18-55-year-olds (n=313), and >55-year-olds (n=306) who previously received 3 original BNT162b2 30-µg doses, received a fourth dose (second booster) of 30-µg bivalent original/Omicron-BA.4/BA.5-adapted BNT162b2 (BNT162b2-Omi.BA.4/BA.5). For comparisons with original BNT162b2, participants were selected from another phase 3 trial. Immunologic superiority 1-month post-vaccination, with respect to 50% neutralizing titers (GMR lower bound [LB] 2-sided 95%CI >1), and noninferiority with respect to seroresponse rates (rate-difference LB 2-sided 95%CI >-5%), for Omicron BA.4/BA.5 were assessed in >55-year-olds versus original BNT162b2 as a second booster. Noninferiority with respect to neutralizing titer level (GMR LB 2-sided 95%CI >0.67) and seroresponse rate (rate-difference LB 2-sided 95%CI >-10%) of Omicron BA.4/BA.5 immune response for BNT162b2-Omi.BA.4/BA.5 in 18‒55-year-olds versus >55-year-olds was assessed. RESULTS One-month post-vaccination in >55-year-olds, model-adjusted GMR of Omicron BA.4/BA.5 neutralizing titers for the BNT162b2-Omi.BA.4/BA.5 versus BNT162b2 group (2.91; 95%CI 2.45-3.44) demonstrated superiority of BNT162b2-Omi.BA.4/BA.5. Adjusted difference in percentages of >55-year-olds with seroresponse (26.77%; 95%CI 19.59-33.95) showed noninferiority of BNT162b2-Omi.BA.4/BA.5 to BNT162b2. Noninferiority of BNT162b2-Omi.BA.4/BA.5 in 18‒55-year-olds to >55-year-olds was met for model-adjusted GMR and seroresponse. GMTs in 12-17-year-olds increased from baseline to 1-month post-vaccination. The BNT162b2-Omi.BA.4/BA.5 safety profile was similar to booster doses of bivalent Omicron BA.1-modified BNT162b2 and original BNT162b2 reported in previous studies. CONCLUSIONS Based on immunogenicity and safety data up to 1-month post-vaccination in participants who previously received 3 original BNT162b2 doses, a BNT162b2-Omi.BA.4/BA.5 30 µg booster has a favorable benefit-risk profile. CLINICAL TRIAL REGISTRATION NCT05472038.
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Affiliation(s)
| | - Sohil Patel
- Vaccine Research and Development, Pfizer Ltd, Hurley, UK
| | | | - Xia Xu
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Dung-Yang Lee
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | - Daniel Finn
- Kentucky Pediatric/Adult Research, Bardstown, KY, USA
| | | | - B Biomed Sci
- Vaccine Research and Development, Pfizer Ltd, Hurley, UK
| | - Francine S Lowry
- Vaccine Research and Development, Pfizer Inc, Collegeville, PA, USA
| | | | - Claire Lu
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - David Cooper
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - Kenneth Koury
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | | | | | | | - Kena A Swanson
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
| | - William C Gruber
- Vaccine Research and Development, Pfizer Inc, Pearl River, NY, USA
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Winokur P, Gayed J, Fitz-Patrick D, Thomas SJ, Diya O, Lockhart S, Xu X, Zhang Y, Bangad V, Schwartz HI, Denham D, Cardona JF, Usdan L, Ginis J, Mensa FJ, Zou J, Xie X, Shi PY, Lu C, Buitrago S, Scully IL, Cooper D, Koury K, Jansen KU, Türeci Ö, Şahin U, Swanson KA, Gruber WC, Kitchin N. Bivalent Omicron BA.1-Adapted BNT162b2 Booster in Adults Older than 55 Years. N Engl J Med 2023; 388:214-227. [PMID: 36652353 PMCID: PMC9933930 DOI: 10.1056/nejmoa2213082] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The emergence of immune-escape variants of severe acute respiratory syndrome coronavirus 2 warrants the use of sequence-adapted vaccines to provide protection against coronavirus disease 2019. METHODS In an ongoing phase 3 trial, adults older than 55 years who had previously received three 30-μg doses of the BNT162b2 vaccine were randomly assigned to receive 30 μg or 60 μg of BNT162b2, 30 μg or 60 μg of monovalent B.1.1.529 (omicron) BA.1-adapted BNT162b2 (monovalent BA.1), or 30 μg (15 μg of BNT162b2 + 15 μg of monovalent BA.1) or 60 μg (30 μg of BNT162b2 + 30 μg of monovalent BA.1) of BA.1-adapted BNT162b2 (bivalent BA.1). Primary objectives were to determine superiority (with respect to 50% neutralizing titer [NT50] against BA.1) and noninferiority (with respect to seroresponse) of the BA.1-adapted vaccines to BNT162b2 (30 μg). A secondary objective was to determine noninferiority of bivalent BA.1 to BNT162b2 (30 μg) with respect to neutralizing activity against the ancestral strain. Exploratory analyses assessed immune responses against omicron BA.4, BA.5, and BA.2.75 subvariants. RESULTS A total of 1846 participants underwent randomization. At 1 month after vaccination, bivalent BA.1 (30 μg and 60 μg) and monovalent BA.1 (60 μg) showed neutralizing activity against BA.1 superior to that of BNT162b2 (30 μg), with NT50 geometric mean ratios (GMRs) of 1.56 (95% confidence interval [CI], 1.17 to 2.08), 1.97 (95% CI, 1.45 to 2.68), and 3.15 (95% CI, 2.38 to 4.16), respectively. Bivalent BA.1 (both doses) and monovalent BA.1 (60 μg) were also noninferior to BNT162b2 (30 μg) with respect to seroresponse against BA.1; between-group differences ranged from 10.9 to 29.1 percentage points. Bivalent BA.1 (either dose) was noninferior to BNT162b2 (30 μg) with respect to neutralizing activity against the ancestral strain, with NT50 GMRs of 0.99 (95% CI, 0.82 to 1.20) and 1.30 (95% CI, 1.07 to 1.58), respectively. BA.4-BA.5 and BA.2.75 neutralizing titers were numerically higher with 30-μg bivalent BA.1 than with 30-μg BNT162b2. The safety profile of either dose of monovalent or bivalent BA.1 was similar to that of BNT162b2 (30 μg). Adverse events were more common in the 30-μg monovalent-BA.1 (8.5%) and 60-μg bivalent-BA.1 (10.4%) groups than in the other groups (3.6 to 6.6%). CONCLUSIONS The candidate monovalent or bivalent omicron BA.1-adapted vaccines had a safety profile similar to that of BNT162b2 (30 μg), induced substantial neutralizing responses against ancestral and omicron BA.1 strains, and, to a lesser extent, neutralized BA.4, BA.5, and BA.2.75 strains. (Funded by BioNTech and Pfizer; ClinicalTrials.gov number, NCT04955626.).
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Affiliation(s)
- Patricia Winokur
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Juleen Gayed
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - David Fitz-Patrick
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Stephen J Thomas
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Oyeniyi Diya
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Stephen Lockhart
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Xia Xu
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Ying Zhang
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Vishva Bangad
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Howard I Schwartz
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Douglas Denham
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Jose F Cardona
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Lisa Usdan
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - John Ginis
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Federico J Mensa
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Jing Zou
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Xuping Xie
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Pei-Yong Shi
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Claire Lu
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Sandra Buitrago
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Ingrid L Scully
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - David Cooper
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Kenneth Koury
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Kathrin U Jansen
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Özlem Türeci
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Uğur Şahin
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Kena A Swanson
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - William C Gruber
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
| | - Nicholas Kitchin
- From the Division of Infectious Diseases, Carver College of Medicine, University of Iowa, Iowa City (P.W.); Vaccine Research and Development, Pfizer, Hurley, United Kingdom (J. Gayed, O.D., S.L., N.K.); East-West Medical Research Institute, Honolulu (D.F.-P.); the State University of New York, Upstate Medical University, Syracuse (S.J.T.), and Vaccine Research and Development, Pfizer, Pearl River (Y.Z., C.L., S.B., I.L.S., D.C., K.K., K.U.J., K.A.S., W.C.G.) - both in New York; Vaccine Research and Development, Pfizer, Collegeville, PA (X. Xu, V.B., J. Ginis); CenExel RCA, Hollywood (H.I.S.), and Indago Research and Health Center, Hialeah (J.F.C.) - both in Florida; Clinical Trials of Texas, San Antonio (D.D.), and the University of Texas Medical Branch, Galveston (J.Z., X. Xie, P.-Y.S.) - both in Texas; CNS Healthcare, Memphis, TN (L.U.); and BioNTech, Mainz, Germany (F.J.M., Ö.T., U.Ş.)
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Ng TI, Dorr PK, Krishnan P, Cohen DE, Rhee S, Wang SX, Ruzek MC, Mensa FJ, Kati WM. Biomarkers for the clinical development of antiviral therapies. Cytometry B Clin Cytom 2021; 100:19-32. [PMID: 34542933 DOI: 10.1002/cyto.b.21974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/23/2020] [Accepted: 11/17/2020] [Indexed: 06/13/2023]
Abstract
With the morbidity and mortality associated with the COVID-19 pandemic that we are witnessing this year, the risks posed by emerging viral diseases to global health are all too obvious. This pandemic highlights the importance of antiviral drug discovery, which targets emerging viral pathogens, as well as existing pathogenic viruses that undergo continuous evolution. Drug discovery and development is a long and resource intensive process; however, the use of biomarkers can accelerate clinical development of antivirals by providing information regarding diagnosis of specific viral infections, status of infection, potential safety parameters, and antiviral responses. In clinical practice, many of the biomarkers initially utilized to support clinical development are also used for patient care. While viral load is a standard and essential biomarker used to detect the desired viral suppression induced by an antiviral agent, it has become apparent that additional biomarkers, whether related to the virus, the host or as a consequence of the drug's mechanistic effects, are also important for monitoring clinical outcomes associated with an antiviral therapy. This review summarizes the biomarkers used in the clinical development (as well as in clinical practice, where appropriate) of antiviral therapies for hepatitis C virus, hepatitis B virus, human immunodeficiency virus, and severe acute respiratory syndrome coronavirus 2.
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Affiliation(s)
- Teresa I Ng
- Virology Drug Discovery, AbbVie Inc., North Chicago, Illinois, USA
| | - Patrick K Dorr
- General Medicine and Virology, AbbVie Inc., North Chicago, Illinois, USA
| | - Preethi Krishnan
- Virology Drug Discovery, AbbVie Inc., North Chicago, Illinois, USA
| | - Daniel E Cohen
- General Medicine and Virology, AbbVie Inc., North Chicago, Illinois, USA
| | - Susan Rhee
- General Medicine and Virology, AbbVie Inc., North Chicago, Illinois, USA
| | - Stanley X Wang
- General Medicine and Virology, AbbVie Inc., North Chicago, Illinois, USA
| | - Melanie C Ruzek
- Translational Immunology, AbbVie Inc., Worcester, Massachusetts, USA
| | - Federico J Mensa
- General Medicine and Virology, AbbVie Inc., North Chicago, Illinois, USA
| | - Warren M Kati
- Virology Drug Discovery, AbbVie Inc., North Chicago, Illinois, USA
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Gane E, Poordad F, Zadeikis N, Valdes J, Lin CW, Liu W, Asatryan A, Wang S, Stedman C, Greenbloom S, Nguyen T, Elkhashab M, Wörns MA, Tran A, Mulkay JP, Setze C, Yu Y, Pilot-Matias T, Porcalla A, Mensa FJ. Safety and Pharmacokinetics of Glecaprevir/Pibrentasvir in Adults With Chronic Genotype 1-6 Hepatitis C Virus Infections and Compensated Liver Disease. Clin Infect Dis 2020; 69:1657-1664. [PMID: 30923816 PMCID: PMC6821220 DOI: 10.1093/cid/ciz022] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/31/2019] [Indexed: 02/06/2023] Open
Abstract
Background Untreated, chronic hepatitis C virus (HCV) infection may lead to progressive liver damage, which can be mitigated by successful treatment. This integrated analysis reports the safety, efficacy, and pharmacokinetics (PK) of the ribavirin-free, direct-acting, antiviral, fixed-dose combination of glecaprevir/pibrentasvir (G/P) in patients with chronic HCV genotype 1–6 infections and compensated liver disease, including patients with chronic kidney disease stages 4 or 5 (CKD 4/5). Methods Data from 9 Phase II and III clinical trials, assessing the efficacy and safety of G/P treatment for 8–16 weeks, were included. The presence of cirrhosis was determined at screening using a liver biopsy, transient elastography, or serum biomarkers. The objectives were to evaluate safety, the rate of sustained virologic response at post-treatment week 12 (SVR12), and steady-state PK by cirrhosis status. Results Among 2369 patients, 308 (13%) were Child-Pugh Class A, including 20 with CKD 4/5. Overall, <1% of patients experienced an adverse event (AE) that led to G/P discontinuation or G/P-related serious AEs (SAEs). The most common AEs were headache and fatigue, occurring at similar frequencies with and without cirrhosis. SAEs were more common in patients with CKD 4/5, but all were unrelated to G/P. There were no cases of drug-induced liver injury or clinically relevant hepatic decompensation. SVR12 rates were 96.4% (297/308) with compensated cirrhosis and 97.5% (2010/2061) without cirrhosis. PK analysis demonstrated a 2.2-fold increase in glecaprevir exposure, but not pibrentasvir exposure, in patients with compensated cirrhosis. Conclusions G/P was safe and efficacious in patients with compensated liver disease, including those with CKD 4/5. Clinical Trials Registration NCT02243280, NCT02243293, NCT02604017, NCT02640482, NCT02640157, NCT02636595, NCT02642432, NCT02651194, and NCT02446717
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Affiliation(s)
| | - Fred Poordad
- The Texas Liver Institute, University of Texas Health Science Center, San Antonio
| | | | | | | | - Wei Liu
- AbbVie Inc., North Chicago, Illinois
| | | | | | | | | | - Tuan Nguyen
- Research and Education, Inc, San Diego, California
| | | | | | - Albert Tran
- University Hospital of Nice, Digestive Centre, France
| | - Jean-Pierre Mulkay
- Hôpital Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | | | - Yao Yu
- AbbVie Inc., North Chicago, Illinois
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7
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Lawitz E, Flisiak R, Abunimeh M, Sise ME, Park JY, Kaskas M, Bruchfeld A, Wörns MA, Aglitti A, Zamor PJ, Xue Z, Schnell G, Jalundhwala YJ, Porcalla A, Mensa FJ, Persico M. Efficacy and safety of glecaprevir/pibrentasvir in renally impaired patients with chronic HCV infection. Liver Int 2020; 40:1032-1041. [PMID: 31821716 DOI: 10.1111/liv.14320] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Chronic hepatitis C virus (HCV) infection increases the risk of incident chronic kidney disease (CKD) and progression to end-stage renal disease (ESRD). Previously available direct-acting antiviral regimens are not approved for patients with advanced CKD across all HCV genotypes. METHODS EXPEDITION-5 is a phase 3 study to evaluate efficacy and safety of the fixed-dose combination of glecaprevir and pibrentasvir (G/P) for chronic HCV infection (genotype 1 through 6) in adults without cirrhosis or with compensated cirrhosis and with stage 3b, 4 or 5 CKD. Patients received approved duration of G/P according to HCV genotype, cirrhosis status and prior HCV treatment experience. The primary efficacy endpoint was percentage of patients with sustained virologic response at 12 weeks post-treatment (SVR12). RESULTS Among the 101 patients enrolled in the study, 24% had predialysis CKD and 76% were on dialysis. Eighty-four patients were treated with G/P for 8 weeks, 13 patients for 12 weeks and four patients for 16 weeks. Fifty-five per cent of patients had genotype 1, 27% had genotype 2, 15% had genotype 3 and 4% had genotype 4, and none had genotype 5 or 6 infection. The SVR12 rate was 97% (98/101, 95% confidence interval, 91.6-99.0). No patients experienced virologic failure. Adverse events (AEs) reported in at least 5% of the patients were pruritus, bronchitis, hypertension and generalized pruritus. Serious AEs were reported in 12% of patients; none related to study drug. CONCLUSIONS G/P treatment yielded high SVR12 rates irrespective of the presence of stage 3b, 4 or 5 CKD. No safety signals were detected. CLINICALTRIALS. GOV IDENTIFIER This Phase 3 clinical trial was funded by AbbVie and registered with clinicaltrials.gov as NCT03069365 (EXPEDITION-5).
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Affiliation(s)
- Eric Lawitz
- The Texas Liver Institute, University of Texas Health San Antonio, San Antonio, TX, USA
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | | | - Meghan E Sise
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | - Jun Y Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Annette Bruchfeld
- Department of Renal Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Marcus-Alexander Wörns
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andrea Aglitti
- Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy
| | | | | | | | | | | | | | - Marcello Persico
- Internal Medicine and Hepatology Unit, University of Salerno, Salerno, Italy
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8
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Brown A, Welzel TM, Conway B, Negro F, Bräu N, Grebely J, Puoti M, Aghemo A, Kleine H, Pugatch D, Mensa FJ, Chen YJ, Lei Y, Lawitz E, Asselah T. Adherence to pan-genotypic glecaprevir/pibrentasvir and efficacy in HCV-infected patients: A pooled analysis of clinical trials. Liver Int 2020; 40:778-786. [PMID: 31568620 PMCID: PMC7187170 DOI: 10.1111/liv.14266] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/24/2019] [Accepted: 08/21/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND & AIMS Adequate adherence to hepatitis C virus (HCV) treatment is believed to be a key component of treatment success because non-adherence can potentially result in treatment failure and the emergence of resistant viral variants. This analysis assessed factors associated with non-adherence to glecaprevir/pibrentasvir (G/P) therapy and the impact of non-adherence on sustained virological response at post-treatment week 12 (SVR12) rates in HCV genotype (GT) 1-6-infected patients. METHODS Adherence was calculated by pill counts at study visits during treatment, and defined as having a lowest treatment adherence of ≥80% and ≤120% at each study visit. Exploratory logistic regression modelling assessed predictors of non-adherence to G/P therapy. SVR12 rates by treatment adherence were assessed in the intent-to-treat (ITT) population and modified ITT (mITT) population, which excludes non-virological failures. RESULTS Overall, 97% (2024/2091) of patients were adherent to G/P therapy at all consecutive study visits. Alcohol use was the only baseline characteristic independently associated with non-adherence to G/P therapy (OR: 2.38; 95% CI: 1.13-5.01; P = .022). In the mITT population, overall SVR12 rates were high both in patients who were adherent to G/P therapy and those who were not (99% [1983/2008] and 95% [58/61] respectively; P = .047). Corresponding SVR12 rates in the ITT population were 98% (1983/2024) and 87% (58/67) respectively. CONCLUSIONS Most patients adhered to G/P therapy. SVR12 rates were high both in patients who were adherent to G/P treatment and those who were not. Patient education on treatment adherence should remain an important part of HCV treatment. CLINICAL TRIALS REGISTRATION NCT02604017, NCT02640482, NCT02640157, NCT02636595, NCT02642432, NCT02651194, NCT02243293, NCT02446717.
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Affiliation(s)
| | - Tania M. Welzel
- Department of Medicine 1J. W. Goethe University HospitalFrankfurt am MainGermany
| | - Brian Conway
- Vancouver Infectious Diseases CenterVancouverBCCanada
| | - Francesco Negro
- Divisions of Gastroenterology and Hepatology and Clinical PathologyGeneva University HospitalGenevaSwitzerland
| | - Norbert Bräu
- James J. Peters VA Medical CenterIcahn School of Medicine at Mount SinaiNew York CityNYUSA
| | | | - Massimo Puoti
- Department of Infectious DiseasesAO Ospedale Niguarda Ca' GrandaMilanItaly
| | - Alessio Aghemo
- Humanitas University and Clinical and Research HospitalRozzanoItaly
| | | | | | | | | | | | - Eric Lawitz
- Texas Liver InstituteUniversity of Texas Health San AntonioSan AntonioTXUSA
| | - Tarik Asselah
- Department of HepatologyCentre de Recherche sur l'Inflammation (CRI)INSERM UMR 1149University of Paris DiderotAP‐HP Hôpital BeaujonClichyFrance
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9
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Brown RS, Buti M, Rodrigues L, Chulanov V, Chuang WL, Aguilar H, Horváth G, Zuckerman E, Carrion BR, Rodriguez-Perez F, Urbánek P, Abergel A, Cohen E, Lovell SS, Schnell G, Lin CW, Zha J, Wang S, Trinh R, Mensa FJ, Burroughs M, Felizarta F. Glecaprevir/pibrentasvir for 8 weeks in treatment-naïve patients with chronic HCV genotypes 1-6 and compensated cirrhosis: The EXPEDITION-8 trial. J Hepatol 2020; 72:441-449. [PMID: 31682879 DOI: 10.1016/j.jhep.2019.10.020] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Eight-week glecaprevir/pibrentasvir leads to high rates of sustained virological response at post-treatment week 12 (SVR12) across HCV genotypes (GT) 1-6 in treatment-naïve patients without cirrhosis. We evaluated glecaprevir/pibrentasvir once daily for 8 weeks in treatment-naïve patients with compensated cirrhosis. METHODS EXPEDITION-8 was a single-arm, multicenter, phase IIIb trial. The primary and key secondary efficacy analyses were to compare the lower bound of the 95% CI of the SVR12 rate in i) patients with GT1,2,4-6 in the per protocol (PP) population, ii) patients with GT1,2,4-6 in the intention-to-treat (ITT) population, iii) patients with GT1-6 in the PP population, and iv) patients with GT1-6 in the ITT population, to pre-defined efficacy thresholds based on historical SVR12 rates for 12 weeks of glecaprevir/pibrentasvir in the same populations. Safety was also assessed. RESULTS A total of 343 patients were enrolled. Most patients were male (63%), white (83%), and had GT1 (67%). The SVR12 rate in patients with GT1-6 was 99.7% (n/N = 334/335; 95%CI 98.3-99.9) in the PP population and 97.7% (n/N = 335/343; 95% CI 96.1-99.3) in the ITT population. All primary and key secondary efficacy analyses were achieved. One patient (GT3a) experienced relapse (0.3%) at post-treatment week 4. Common adverse events (≥5%) were fatigue (9%), pruritus (8%), headache (8%), and nausea (6%). Serious adverse events (none related) occurred in 2% of patients. No adverse event led to study drug discontinuation. Clinically significant laboratory abnormalities were infrequent. CONCLUSIONS Eight-week glecaprevir/pibrentasvir was well tolerated and led to a similarly high SVR12 rate as the 12-week regimen in treatment-naïve patients with chronic HCV GT1-6 infection and compensated cirrhosis. TRIAL REGISTRATION ClinicalTrials.gov, NCT03089944. LAY SUMMARY This study was the first to evaluate an 8-week direct-acting antiviral (DAA) regimen active against all major types of hepatitis C virus (HCV) in untreated patients with compensated cirrhosis. High virological cure rates were achieved with glecaprevir/pibrentasvir across HCV genotypes 1-6, and these high cure rates did not depend on any patient or viral characteristics present before treatment. This may simplify care and allow non-specialist healthcare professionals to treat these patients, contributing to global efforts to eliminate HCV.
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Affiliation(s)
- Robert S Brown
- Weill Cornell Medical College, Center for Liver Disease and Transplantation, New York, NY, USA.
| | - Maria Buti
- Vall d'Hebron University Hospital and CiBERHED del Instituto Carlos III, Barcelona, Spain
| | | | - Vladimir Chulanov
- Central Research Institute of Epidemiology, Reference Center for Viral Hepatitis, Moscow, Russia; Sechenov First Moscow State Medical University, Moscow, Russia
| | - Wan-Long Chuang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | | | - Elimelech Zuckerman
- Liver Unit, Carmel Medical Center, Faculty of Medicine, Technion Institute, Haifa, Israel
| | | | | | - Petr Urbánek
- Charles University and Central Military Hospital, Prague, Czech Republic
| | - Armand Abergel
- CHU Estaing University Hospital, Clermont-Ferrand, France
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10
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Back D, Belperio P, Bondin M, Negro F, Talal AH, Park C, Zhang Z, Pinsky B, Crown E, Mensa FJ, Marra F. Efficacy and safety of glecaprevir/pibrentasvir in patients with chronic HCV infection and psychiatric disorders: An integrated analysis. J Viral Hepat 2019; 26:951-960. [PMID: 30977945 PMCID: PMC6852431 DOI: 10.1111/jvh.13110] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/13/2019] [Accepted: 02/11/2019] [Indexed: 12/25/2022]
Abstract
Although direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection are highly efficacious and safe, treatment initiation is often limited in patients with neuropsychiatric disorders due to concerns over reduced treatment adherence and drug-drug interactions. Here, we report adherence, efficacy, safety and patient-reported outcomes (PROs) from an integrated analysis of registrational studies using the pangenotypic DAA regimen of glecaprevir and pibrentasvir (G/P). Patients with chronic HCV genotypes 1-6 infection with compensated liver disease (with or without cirrhosis) receiving G/P for 8, 12 or 16 weeks were included in this analysis. Patients were classified as having a psychiatric disorder based on medical history and/or co-medications. Primary analyses assessed treatment adherence, efficacy (sustained virologic response at post-treatment week 12; SVR12), safety and PROs. Among 2522 patients receiving G/P, 789 (31%) had a psychiatric disorder with the most common diagnoses being depression (64%; 506/789) and anxiety disorders (27%; 216/789). Treatment adherence was comparably high (>95%) in patients with and without psychiatric disorders. SVR12 rates were 97.3% (768/789; 95% CI = 96.2-98.5) and 97.5% (1689/1733; 95% CI = 96.7-98.2) in patients with and without psychiatric disorders, respectively. Among patients with psychiatric disorders, SVR12 rates remained >96% by individual psychiatric diagnoses and co-medication classes. Overall, most adverse events (AEs) were mild-to-moderate in severity with serious AEs and AEs leading to G/P discontinuation occurring at similarly low rates in both patient populations. In conclusion, G/P treatment was highly efficacious, well-tolerated and demonstrated high adherence rates in patients with chronic HCV infection and psychiatric disorders.
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Affiliation(s)
| | - Pamela Belperio
- U.S. Department of Veterans AffairsVA Palo Alto Healthcare SystemPalo AltoCalifornia
| | | | | | - Andrew H. Talal
- Jacobs School of Medicine and Biomedical SciencesUniversity of BuffaloBuffaloNew York
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11
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Wyles D, Weiland O, Yao B, Weilert F, Dufour JF, Gordon SC, Stoehr A, Brown A, Mauss S, Zhang Z, Pilot-Matias T, Rodrigues L, Mensa FJ, Poordad F. Retreatment of patients who failed glecaprevir/pibrentasvir treatment for hepatitis C virus infection. J Hepatol 2019; 70:1019-1023. [PMID: 30857780 DOI: 10.1016/j.jhep.2019.01.031] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/11/2019] [Accepted: 01/30/2019] [Indexed: 02/07/2023]
Affiliation(s)
- David Wyles
- Denver Health Medical Center, Denver, CO, USA.
| | - Ola Weiland
- Karolinska University Hospital Huddinge, Stockholm, Sweden
| | | | | | - Jean-Francois Dufour
- Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | | | | | - Ashley Brown
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | | | | | | | | | - Fred Poordad
- The Texas Liver Institute, University of Texas Health, San Antonio, TX, USA
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12
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Kosloski MP, Zhao W, Li H, Pugatch D, Asatryan A, Kort J, Mensa FJ, Liu W. Drug-Drug Interactions of Tacrolimus or Cyclosporine With Glecaprevir and Pibrentasvir in Healthy Subjects. Clin Pharmacol Drug Dev 2019; 8:779-789. [PMID: 30861340 DOI: 10.1002/cpdd.671] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 02/18/2019] [Indexed: 12/21/2022]
Abstract
A fixed-dose combination of glecaprevir and pibrentasvir is approved for treatment of chronic infection with hepatitis C virus (HCV) genotypes 1-6. Three phase 1 open-label studies were conducted in healthy volunteers to evaluate the potential for clinically relevant drug-drug interactions of the glecaprevir 300-mg and pibrentasvir 120-mg combination with the immunosuppressants tacrolimus (1 mg) or cyclosporine (100 and 400 mg). Glecaprevir and pibrentasvir exposure was unaffected by tacrolimus, whereas the tacrolimus area under the curve (AUC) value was 45% higher with glecaprevir and pibrentasvir. Cyclosporine 100 mg had a limited effect on glecaprevir or pibrentasvir exposure (≤37% AUC increase), but cyclosporine 400 mg increased exposure of both glecaprevir and pibrentasvir (410% and 93% AUC increase, respectively). Cyclosporine concentration was unaffected by glecaprevir and pibrentasvir at either cyclosporine dose (≤14% AUC change). Adverse events were all grade 1 (mild), with the most common nausea and flushing attributed to cyclosporine. Findings from these studies supported evaluation of glecaprevir/pibrentasvir in HCV-infected kidney and liver transplant recipients receiving tacrolimus without additional dose adjustment or receiving cyclosporine up to 100 mg per day.
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Affiliation(s)
- Matthew P Kosloski
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc., North Chicago, IL, USA
| | - Weihan Zhao
- Data and Statistical Sciences, AbbVie Inc., North Chicago, IL, USA
| | - Hong Li
- Data and Statistical Sciences, AbbVie Inc., North Chicago, IL, USA
| | - David Pugatch
- Infectious Diseases, AbbVie Inc., North Chicago, IL, USA
| | - Armen Asatryan
- Infectious Diseases, AbbVie Inc., North Chicago, IL, USA
| | - Jens Kort
- Infectious Diseases, AbbVie Inc., North Chicago, IL, USA
| | | | - Wei Liu
- Clinical Pharmacology and Pharmacometrics, AbbVie Inc., North Chicago, IL, USA
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13
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Flamm S, Mutimer D, Asatryan A, Wang S, Rockstroh J, Horsmans Y, Kwo PY, Weiland O, Villa E, Heo J, Gane E, Ryder SD, Welzel TM, Ruane PJ, Agarwal K, Ng TI, Xue Z, Lovell SS, Krishnan P, Kopecky‐Bromberg S, Trinh R, Mensa FJ, Wyles DL. Glecaprevir/Pibrentasvir in patients with chronic HCV genotype 3 infection: An integrated phase 2/3 analysis. J Viral Hepat 2019; 26:337-349. [PMID: 30421537 PMCID: PMC7379735 DOI: 10.1111/jvh.13038] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/22/2018] [Indexed: 02/06/2023]
Abstract
Glecaprevir coformulated with pibrentasvir (G/P) is approved to treat hepatitis C virus (HCV) infection and was highly efficacious in phase 2 and 3 studies. Treating HCV genotype (GT) 3 infection remains a priority, as these patients are harder to cure and at a greater risk for liver steatosis, fibrosis progression and hepatocellular carcinoma. Data were pooled from five phase 2 or 3 trials that evaluated 8-, 12- and 16-week G/P in patients with chronic HCV GT3 infection. Patients without cirrhosis or with compensated cirrhosis were either treatment-naïve or experienced with interferon- or sofosbuvir-based regimens. Safety and sustained virologic response 12 weeks post-treatment (SVR12) were assessed. The analysis included 693 patients with GT3 infection. SVR12 was achieved by 95% of treatment-naïve patients without cirrhosis receiving 8-week (198/208) and 12-week (280/294) G/P. Treatment-naïve patients with cirrhosis had a 97% (67/69) SVR12 rate with 12-week G/P. Treatment-experienced, noncirrhotic patients had SVR12 rates of 90% (44/49) and 95% (21/22) with 12- and 16-week G/P, respectively; 94% (48/51) of treatment-experienced patients with cirrhosis treated for 16 weeks achieved SVR12. No serious adverse events (AEs) were attributed to G/P; AEs leading to study drug discontinuation were rare (<1%). G/P was well-tolerated and efficacious for patients with chronic HCV GT3 infection, regardless of cirrhosis status or prior treatment experience. Eight- and 12-week durations were efficacious for treatment-naïve patients without cirrhosis and with compensated cirrhosis, respectively; 16-week G/P was efficacious in patients with prior treatment experience irrespective of cirrhosis status.
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Affiliation(s)
- Steven Flamm
- Northwestern Feinberg School of MedicineChicagoIllinois
| | - David Mutimer
- Queen Elizabeth Hospital and NIHR Liver Biomedical Research UnitBirminghamUK
| | | | | | | | - Yves Horsmans
- Cliniques Universitaires Saint‐LucUCLBrusselsBelgium
| | - Paul Y. Kwo
- Division of Gastroenterology and HepatologyStanford UniversityPalo AltoCalifornia
| | - Ola Weiland
- Karolinska University Hospital Huddinge at Karolinska InstituteStockholmSweden
| | - Erica Villa
- University of Modena and Reggio EmiliaModenaItaly
| | - Jeong Heo
- Department of Internal MedicineCollege of MedicinePusan National University and Medical Research InstitutePusan National University HospitalBusanRepublic of Korea
| | - Edward Gane
- Liver UnitAuckland City HospitalAucklandNew Zealand
| | - Stephen D. Ryder
- NIHR Nottingham Biomedical Research Centre and Nottingham University Hospitals NHS TrustNottinghamUK
| | | | - Peter J. Ruane
- Ruane Medical & Liver Health InstituteLos AngelesCalifornia
| | - Kosh Agarwal
- Institute of Liver StudiesKings College HospitalLondonUK
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14
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Grebely J, Dore GJ, Alami NN, Conway B, Dillon JF, Gschwantler M, Felizarta F, Hézode C, Tomasiewicz K, Fredrick LM, Dumas EO, Mensa FJ. Safety and efficacy of glecaprevir/pibrentasvir in patients with chronic hepatitis C genotypes 1-6 receiving opioid substitution therapy. Int J Drug Policy 2019; 66:73-79. [PMID: 30735896 DOI: 10.1016/j.drugpo.2019.01.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 12/13/2018] [Accepted: 01/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND International guidelines recommend treatment of hepatitis C virus (HCV) infection in people who inject drugs (PWID), including those on opioid substitution therapy (OST). The pangenotypic combination of glecaprevir and pibrentasvir has shown high sustained virologic response at post-treatment Week 12 (SVR12) in clinical trials. Herein, we evaluate the safety and efficacy of glecaprevir/pibrentasvir in patients receiving OST. METHODS Pooled data from patients with HCV genotypes 1-6 who were treated with glecaprevir/pibrentasvir for 8, 12, or 16 weeks in eight Phase 2 and 3 trials were categorized by use of OST. Treatment completion, treatment adherence, SVR12, adverse events (AEs), and laboratory abnormalities were evaluated for patients receiving and not receiving OST. RESULTS Among 2256 patients, 157 (7%) were receiving OST. Compared with patients not receiving OST, OST patients were younger (mean age, 46.8 vs 52.8 years), male (69% vs 54%), white (93% vs 80%), HCV treatment-naïve (86% vs 72%), had HCV genotype 3 (60% vs 26%), and had a history of depression or bipolar disorder (43% vs 19%). Most patients completed (OST: 98% [n/N = 154/157]; non-OST: 99% [n/N = 2070/2099]) and were adherent (received ≥90% of study drug doses) to glecaprevir/pibrentasvir treatment (OST: 98% [n/N = 121/123]; non-OST: 99% [n/N = 1884/1905] among patients with available data). In the intention-to-treat population, SVR12 rates in OST and non-OST patients were 96.2% (n/N = 151/157; 95% CI 93.2-99.2) and 97.9% (n/N = 2055/2099; 95% CI 97.3-98.5), respectively. For OST patients, reasons for nonresponse included virologic relapse (<1%; n = 1), premature study drug discontinuation (<1%; n = 1), and loss to follow-up (3%; n = 4). AEs occurring in ≥10% of OST patients were headache, fatigue, and nausea. Drug-related serious AEs, AEs leading to study drug discontinuation, and Grade 3 or higher laboratory abnormalities were infrequent in both groups (<1%). No HCV reinfections occurred through post-treatment Week 12. CONCLUSION Glecaprevir/pibrentasvir is highly efficacious and well tolerated in HCV-infected patients receiving OST.
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Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | | | - Brian Conway
- Vancouver Infectious Diseases Centre, Vancouver, Canada
| | - John F Dillon
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | - Michael Gschwantler
- Department of Internal Medicine IV, Wilhelminenspital, Vienna, Austria; Sigmund Freud University, Vienna, Austria
| | | | - Christophe Hézode
- Department of Hepatology, Hôpital Henri Mondor, Université Paris-Est, Paris, France
| | - Krzysztof Tomasiewicz
- Department of Infectious Diseases and Hepatology, Medical University of Lublin, Lublin, Poland
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15
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Flamm S, Reddy KR, Zadeikis N, Hassanein T, Bacon BR, Maieron A, Zeuzem S, Bourliere M, Calleja JL, Kosloski MP, Oberoi RK, Lin CW, Yu Y, Lovell S, Semizarov D, Mensa FJ. Efficacy and Pharmacokinetics of Glecaprevir and Pibrentasvir With Concurrent Use of Acid-Reducing Agents in Patients With Chronic HCV Infection. Clin Gastroenterol Hepatol 2019; 17:527-535.e6. [PMID: 30012435 DOI: 10.1016/j.cgh.2018.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/21/2018] [Accepted: 07/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Proton pump inhibitors (PPIs) are commonly prescribed to treat acid-related disorders. Some direct-acting antiviral regimens for chronic hepatitis C virus (HCV) infection have reduced efficacy in patients taking concomitant acid-reducing agents, including PPIs, due to interactions between drugs. We analyzed data from 9 multicenter, phase 2 and 3 trials to determine the efficacy and pharmacokinetics of an HCV therapeutic regimen comprising glecaprevir and pibrentasvir (glecaprevir/pibrentasvir) in patients taking concomitant acid-reducing agents. METHODS We analyzed data from 2369 patients infected with HCV genotypes 1-6 and compensated liver disease treated with an all-oral regimen of glecaprevir/pibrentasvir for 8-16 weeks. We compared efficacy and pharmacokinetics among patients receiving at least 1 dose of an acid-reducing agent (a PPI, an H2 blocker, or antacid). High-dose PPI was defined as daily dose greater than 20 mg omeprazole dose equivalent. The objectives were to evaluate rate of sustained virologic response 12 weeks post-treatment (SVR12) and to assess steady-state glecaprevir and pibrentasvir exposures in patients on acid-reducing agents. RESULTS Of the 401 patients (17%) who reported use of acid-reducing agents, 263 took PPIs (11%; 109 patients took a high-dose PPI and 154 patients took a low-dose PPI). Rates of SVR12 were 97.0% among patients who used acid-reducing agents and 97.5% among those not using acid-reducing agents (P = .6). An SVR12 was achieved in 96.3% taking a high-dose PPI and 97.4% taking a low-dose PPI, with no virologic failures in those receiving a high-dose PPI (P = .7). Glecaprevir, but not pibrentasvir, bioavailability was affected; its exposure decreased by 41% in patients taking a high-dose PPI. CONCLUSIONS In an analysis of data from 9 clinical trials, we observed a high rate of SVR12 (approximately 97%) among patients treated with glecaprevir/pibrentasvir for HCV infection-even among patients taking concomitant ARA or high-dose PPI. This was despite decreased glecaprevir exposures in patients when on high-dose PPIs. ClinicalTrials.gov numbers, NCT02243280 (SURVEYOR-I), NCT02243293 (SURVEYOR-II), NCT02604017 (ENDURANCE-1), NCT02640482 (ENDURANCE-2), NCT02640157 (ENDURANCE-3), NCT02636595 (ENDURANCE-4), NCT02642432 (EXPEDITION-1), NCT02651194 (EXPEDITION-4), NCT02446717 (MAGELLAN-I).
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Affiliation(s)
- Steven Flamm
- Northwestern Feinberg School of Medicine, Chicago, Illinois.
| | | | | | - Tarek Hassanein
- Southern California GI and Liver Centers and Southern California Research Center, Coronado, California
| | - Bruce R Bacon
- Saint Louis University Liver Center, St. Louis, Missouri
| | - Andreas Maieron
- Elisabethinen Hospital, Linz, Austria; University Clinics St. Pölten, Karl Landsteiner University, St. Pölten, Austria
| | | | | | - Jose L Calleja
- Hospital Universitario Puerta de Hierro, Universidad Autonoma de Madrid, Madrid, Spain
| | | | | | | | - Yao Yu
- AbbVie Inc, North Chicago, Illinois
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16
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Foster GR, Asselah T, Kopecky-Bromberg S, Lei Y, Asatryan A, Trinh R, Zadeikis N, Mensa FJ. Safety and efficacy of glecaprevir/pibrentasvir for the treatment of chronic hepatitis C in patients aged 65 years or older. PLoS One 2019; 14:e0208506. [PMID: 30601818 PMCID: PMC6314565 DOI: 10.1371/journal.pone.0208506] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/16/2018] [Indexed: 12/18/2022] Open
Abstract
Finding safe and effective treatments for chronic hepatitis C virus (HCV) infection in the elderly is of clinical interest given the comorbidities and associated polypharmacy in this population. However, the number of patients older than age 65 years enrolled into clinical trials of anti-HCV medications generally have been limited and thus reaching meaningful conclusions for this demographic has been difficult. Glecaprevir/pibrentasvir is a once-daily, all-oral, ribavirin-free, pangenotypic direct-acting antiviral (DAA) combination therapy that has demonstrated high sustained virologic response rates at post-treatment week 12 (SVR12) and a favorable safety profile in patients with chronic HCV infection. This analysis evaluated the safety and efficacy of glecaprevir/pibrentasvir in patients aged ≥65 years. Data were pooled for treatment-naïve and -experienced patients with chronic HCV genotype (GT) 1-6 infections who received glecaprevir/pibrentasvir for 8, 12, or 16 weeks in 9 Phase 2 and 3 trials. SVR12 and adverse events (AEs) were evaluated for patients aged ≥65 versus <65 years. Of the 2369 patients enrolled, 328 (14%) were aged ≥65 years. Among patients aged ≥65 years, 42% and 34% had GT1 and GT2, respectively; 40% were treatment-experienced and 20% had compensated cirrhosis. Glecaprevir/pibrentasvir treatment resulted in SVR12 rates of 97.9% (95% CI, 96.3-99.4; n/N = 321/328) for patients aged ≥65 years and 97.3% (95% CI, 96.6-98.0; n/N = 1986/2041) for patients aged <65 years. The rates were not significantly different between the two age groups (P = 0.555). DAA-related AEs leading to treatment discontinuation, or serious AEs were similarly rare (<0.5%) for patients ≥65 and <65 years old. Glecaprevir/pibrentasvir is an efficacious and well-tolerated treatment option for patients aged ≥65 years with chronic HCV infection.
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Affiliation(s)
- Graham R. Foster
- Barts Liver Centre, Blizard Institute, Queen Mary University of London, London, United Kingdom
| | - Tarik Asselah
- Hepatology Department, UMR1149, Physiopathology and Treatment of Viral Hepatitis, Centre de Recherche sur l’Inflammation and Université Denis Diderot Paris 7, Beaujon Hospital, AP-HP, Clichy, France
| | | | - Yang Lei
- AbbVie Inc., North Chicago, Illinois, United States of America
| | - Armen Asatryan
- AbbVie Inc., North Chicago, Illinois, United States of America
| | - Roger Trinh
- AbbVie Inc., North Chicago, Illinois, United States of America
| | - Neddie Zadeikis
- AbbVie Inc., North Chicago, Illinois, United States of America
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Foster GR, Dore GJ, Wang S, Grebely J, Sherman KE, Baumgarten A, Conway B, Jackson D, Asselah T, Gschwantler M, Tomasiewicz K, Aguilar H, Asatryan A, Hu Y, Mensa FJ. Glecaprevir/pibrentasvir in patients with chronic HCV and recent drug use: An integrated analysis of 7 phase III studies. Drug Alcohol Depend 2019; 194:487-494. [PMID: 30529905 DOI: 10.1016/j.drugalcdep.2018.11.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Injection drug use is the primary mode of transmission for hepatitis C virus (HCV), and treatment guidelines recommend treating HCV-infected people who use drugs; however, concerns about adherence, effectiveness, and reinfection have impeded treatment uptake. METHODS Data were pooled from seven phase III trials that evaluated the efficacy and safety of 8 or 12 weeks of glecaprevir/pibrentasvir (G/P) in patients chronically infected with HCV genotypes 1-6. Patients had compensated liver disease, with or without cirrhosis, and were HCV treatment-naïve or -experienced with interferon or pegylated interferon ± ribavirin, or sofosbuvir plus ribavirin ± pegylated interferon. Patients were grouped into recent drug users (injection drug use ≤12 months before screening, positive urine drug screen [UDS], and/or drug-related adverse event), former drug users (>12 months before screening and negative UDS), or non-drug users. Assessments included sustained virologic response at 12 weeks posttreatment (SVR12), treatment adherence, and safety. RESULTS Among 1819 patients, 5%, 34%, and 61% were recent, former, and non-drug users, respectively. Treatment adherence and completion were high (≥96%) regardless of drug use status. SVR12 was achieved by 93% (n/N = 91/98), 97% (n/N = 591/610), and >99% (n/N = 1106/1111) of recent, former, and non-drug users, respectively (intention-to-treat analysis). The overall rates of virologic failure were ≤1.5% across all three subpopulations, with no HCV reinfections among recent drug users. Drug-related serious adverse events and adverse events leading to treatment discontinuation were experienced by ≤1% of patients. CONCLUSIONS G/P is a well-tolerated and efficacious pangenotypic regimen for chronic HCV-infected people with recent or active drug use.
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Affiliation(s)
- Graham R Foster
- Hepatology Unit, Queen Mary University of London, Mile End Rd., London E1 4NS, UK.
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High St., Kensington NSW 2052, Australia
| | - Stanley Wang
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, USA
| | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Wallace Wurth Building, High St., Kensington NSW 2052, Australia
| | - Kenneth E Sherman
- Division of Digestive Diseases, University of Cincinnati College of Medicine, CARE/Crawley Building, Suite E-870, 3230 Eden Avenue, Cincinnati, OH 45267, USA
| | - Axel Baumgarten
- Center for Infectiology, Driesener Str. 11, 10439 Berlin, Germany
| | - Brian Conway
- Vancouver Infectious Diseases Centre, 1200 Burrard St., Vancouver, BC V6Z 2C7, Canada
| | - Daniel Jackson
- Digestive Health Specialists of the Southeast, 480 Honeysuckle Rd., Dothan, AL 36305, USA
| | - Tarik Asselah
- Université Paris Diderot, INSERM UMR1149, AP-HP Hôpital Beaujon, 100 Boulevard du Général Leclerc, 92110 Clichy, France
| | - Michael Gschwantler
- Department of Internal Medicine IV, Wilhelminenspital, and Sigmund Freud University, Freudplatz, 1A-1020 Vienna, Austria
| | - Krzysztof Tomasiewicz
- Department of Infectious Diseases and Hepatology, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland
| | - Humberto Aguilar
- Louisiana Research Center, 1800 E 70th St, Shreveport, LA 71105, USA
| | - Armen Asatryan
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, USA
| | - Yiran Hu
- AbbVie Inc., 1 North Waukegan Road, North Chicago, IL, USA
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18
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Naganuma A, Chayama K, Notsumata K, Gane E, Foster GR, Wyles D, Kwo P, Crown E, Bhagat A, Mensa FJ, Otani T, Larsen L, Burroughs M, Kumada H. Integrated analysis of 8-week glecaprevir/pibrentasvir in Japanese and overseas patients without cirrhosis and with hepatitis C virus genotype 1 or 2 infection. J Gastroenterol 2019; 54:752-761. [PMID: 30868245 PMCID: PMC6647445 DOI: 10.1007/s00535-019-01569-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 03/01/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection with genotypes (GT) 1 and 2 accounts for over 50% of HCV infections globally, including over 97% of all HCV infections in Japan. Here, we report an integrated analysis of efficacy and safety of 8-week treatment with the all-oral, fixed-dose combination of the direct acting antivirals (DAA), glecaprevir and pibrentasvir (G/P), in DAA-naïve Japanese and overseas patients without cirrhosis and with HCV GT1 or GT2 infection. METHODS Data from 899 DAA-naïve patients without cirrhosis and with HCV GT1 or GT2 infection treated with G/P (300/120 mg) for 8 weeks in the six Phase 2 or 3 overseas or Japan-only clinical trials were included. All patients who received ≥ 1 dose of G/P were included in an intent-to-treat (ITT) analysis. The objectives were to evaluate rate of sustained virologic response 12 weeks post-treatment (SVR12) and safety of the 8-week regimen in the ITT population. RESULTS Overall, SVR12 was achieved by 98.9% (889/899) of DAA-naïve patients without cirrhosis, including 99.2% (597/602) of GT1-infected and 98.3% (292/297) of GT2-infected patients. Less than 1% (2/899) of patients overall and no Japanese patients experienced virologic failure. SVR12 rate was > 97% for patients regardless of baseline characteristics, and common comorbidities or co-medications. Overall, < 1% (2/899) discontinued G/P due to an adverse event (AE) and 1.6% (14/899) of patients experienced a serious AE. CONCLUSIONS 8-week G/P treatment is safe and efficacious in DAA-naive patients without cirrhosis and with HCV GT1 or GT2 infection, demonstrating high SVR12 rates regardless of baseline patient and disease characteristics. CLINICALTRIALS. GOV IDENTIFIERS The trials discussed in this paper were registered with ClinicalTrials.gov as follows: NCT02707952 (CERTAIN-1), NCT02723084 (CERTAIN-2), NCT02243280 (SURVEYOR-I), NCT02243293 (SURVEYOR-II), NCT02604017 (ENDURANCE-1), NCT02738138 (EXPEDITION-2).
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Affiliation(s)
- Atsushi Naganuma
- grid.416698.4Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, 36 Takamatsu-cho, Takasaki-shi, Gunma 370-0829 Japan
| | - Kazuaki Chayama
- 0000 0004 0618 7953grid.470097.dHiroshima University Hospital, Hiroshima, Japan
| | - Kazuo Notsumata
- 0000 0004 1774 4989grid.415130.2Fukuiken Saiseikai Hospital, Fukui, Japan
| | - Edward Gane
- 0000 0000 9027 2851grid.414055.1Liver Unit, Auckland City Hospital, Auckland, New Zealand
| | - Graham R. Foster
- 0000 0001 2171 1133grid.4868.2Queen Mary University of London, Barts Health, London, UK
| | - David Wyles
- 0000000107903411grid.241116.1Denver Health Division of Infectious Diseases, University of Colorado, Denver, CO USA
| | - Paul Kwo
- 0000000419368956grid.168010.eDivision of Gastroenterology and Hepatology, Stanford University, Palo Alto, CA USA
| | - Eric Crown
- 0000 0004 0572 4227grid.431072.3AbbVie Inc., North Chicago, IL USA
| | - Abhi Bhagat
- 0000 0004 0572 4227grid.431072.3AbbVie Inc., North Chicago, IL USA
| | | | - Tetsuya Otani
- 0000 0004 0572 4227grid.431072.3AbbVie Inc., North Chicago, IL USA
| | - Lois Larsen
- 0000 0004 0572 4227grid.431072.3AbbVie Inc., North Chicago, IL USA
| | | | - Hiromitsu Kumada
- 0000 0004 1764 6940grid.410813.fToranomon Hospital, Tokyo, Japan
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Abstract
In recent years, management of chronic hepatitis C virus (HCV) infection has been revolutionized by the availability of oral direct-acting antivirals (DAAs), which have significantly better efficacy and safety profiles than interferon-containing regimens. Simple, short-duration DAA therapies will facilitate expansion of HCV treatment to nonspecialist providers, which will be vital to achieve the WHO target of eliminating chronic HCV as a major public health threat by 2030. Coformulated glecaprevir/pibrentasvir is the only 8-week, pan-genotypic, 2-DAA regimen recommended by international guidelines as a first-line regimen in treatment-naive, noncirrhotic HCV genotype 1-6 patients. This review provides a comprehensive summary of the pharmacodynamic and pharmacokinetic parameters, efficacy, safety and place in the HCV treatment paradigm for glecaprevir/pibrentasvir.
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Affiliation(s)
- Federico J Mensa
- Department of Clinical Development Infectious Diseases, AbbVie Inc., North Chicago, IL 60064, USA
| | - Sandra Lovell
- Department of Statistics, AbbVie Inc., North Chicago, IL 60064, USA
| | - Tami Pilot-Matias
- Department of Clinical Virology, AbbVie Inc., North Chicago, IL 60064, USA
| | - Wei Liu
- Department of Pharmacokinetics, AbbVie Inc., North Chicago, IL 60064, USA
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20
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Krishnan P, Pilot-Matias T, Schnell G, Tripathi R, Ng TI, Reisch T, Beyer J, Dekhtyar T, Irvin M, Xie W, Larsen L, Mensa FJ, Collins C. Pooled Resistance Analysis in Patients with Hepatitis C Virus Genotype 1 to 6 Infection Treated with Glecaprevir-Pibrentasvir in Phase 2 and 3 Clinical Trials. Antimicrob Agents Chemother 2018; 62:e01249-18. [PMID: 30061289 PMCID: PMC6153825 DOI: 10.1128/aac.01249-18] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 07/26/2018] [Indexed: 12/21/2022] Open
Abstract
Over 2,200 patients infected with hepatitis C virus (HCV) genotypes (GT) 1 to 6, with or without cirrhosis, who were treatment naive or experienced to interferon, ribavirin, and/or sofosbuvir were treated with glecaprevir/pibrentasvir for 8, 12, or 16 weeks in eight registrational phase 2 and 3 clinical studies. High rates of sustained virologic response at 12 weeks postdosing (SVR12) were achieved with a <1% virologic failure (VF) rate. The prevalence of baseline polymorphisms (BPs) in NS3 at amino acid position 155 or 168 was low (<3%) in patients infected with GT1, GT2, GT3, GT4, and GT6, while 41.9% of the GT5-infected patients had NS3-D168E; BPs were not detected at position 156 in NS3. The prevalence of NS5A-BPs was high across genotypes, driven by common polymorphisms at amino acid position 30 or 31 in GT2, 58 in GT4, and 28 in GT6. The prevalence of NS5A T/Y93 polymorphisms was 5.5% in GT1, 4.9% in GT3, and 12.5% in GT6. Consistent with the activity of glecaprevir and pibrentasvir against most amino acid polymorphisms in vitro, BPs in NS3 and/or NS5A did not have an impact on treatment outcome for patients infected with GT1 to GT6, with the exception of treatment-experienced GT3-infected patients treated for 12 weeks, for whom a 16-week regimen of glecaprevir/pibrentasvir was required to achieve SVR12 rates of ≥95%. Among the 22 patients experiencing VF, treatment-emergent substitutions were detected in NS3 in 50% of patients and in NS5A in 82% of patients, frequently as a combination of substitutions that conferred resistance to glecaprevir and/or pibrentasvir. The glecaprevir/pibrentasvir regimen, when the recommended durations are used, allows for a pan-genotypic treatment option without the need for baseline resistance testing.
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Affiliation(s)
- Preethi Krishnan
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | | | - Gretja Schnell
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Rakesh Tripathi
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Teresa I Ng
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Thomas Reisch
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Jill Beyer
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Tatyana Dekhtyar
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Michelle Irvin
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Wangang Xie
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Lois Larsen
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
| | - Federico J Mensa
- Research & Development, AbbVie, Inc., North Chicago, Illinois, USA
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21
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Poordad F, Pol S, Asatryan A, Buti M, Shaw D, Hézode C, Felizarta F, Reindollar RW, Gordon SC, Pianko S, Fried MW, Bernstein DE, Gallant J, Lin C, Lei Y, Ng TI, Krishnan P, Kopecky‐Bromberg S, Kort J, Mensa FJ. Glecaprevir/Pibrentasvir in patients with hepatitis C virus genotype 1 or 4 and past direct-acting antiviral treatment failure. Hepatology 2018; 67:1253-1260. [PMID: 29152781 PMCID: PMC5901397 DOI: 10.1002/hep.29671] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/24/2017] [Accepted: 11/14/2017] [Indexed: 12/15/2022]
Abstract
Patients with hepatitis C virus (HCV) who have virological failure (VF) after treatment containing a nonstructural protein 5A (NS5A) inhibitor have limited retreatment options. MAGELLAN-1 Part 2 was a randomized, open-label, phase 3 study to evaluate the efficacy and safety of ribavirin (RBV)-free glecaprevir and pibrentasvir (G/P; 300 mg/120 mg) in patients with chronic HCV and past VF on at least one NS3/4A protease and/or NS5A inhibitor-containing therapy. Patients with compensated liver disease, with or without cirrhosis, and HCV genotype (GT) 1, 4, 5, or 6 were randomized 1:1 to receive 12 or 16 weeks of G/P. The primary endpoint was sustained virological response (SVR) at 12 weeks posttreatment (SVR12). Among 91 patients treated, 87 had GT1 and 4 had GT4 infection. SVR12 was achieved by 89% (39 of 44) and 91% (43 of 47) of patients who received 12 and 16 weeks of G/P, respectively. Virological relapse occurred in 9% (4 of 44) of patients treated with 12 weeks of G/P; there were no relapses with 16 weeks of treatment. Past treatment history with one class of inhibitor (protease or NS5A) had no impact on SVR12, whereas past treatment with both classes of inhibitors was associated with lower SVR12 rate. The most common adverse event (AE) was headache (≥10% of patients), and there were no serious AEs assessed as related to study drugs or AEs leading to discontinuation. CONCLUSION Sixteen weeks of G/P treatment achieved a high SVR12 rate in patients with HCV GT1 infection and past failure to regimens containing either NS5A inhibitors or NS3 protease inhibitors. (Hepatology 2018;67:1253-1260).
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Affiliation(s)
- Fred Poordad
- The Texas Liver InstituteUniversity of Texas HealthSan AntonioTX
| | - Stanislas Pol
- Groupe Hospitalier Cochin‐Saint Vincent De PaulParisFrance
| | | | - Maria Buti
- Vall d'Hebron University Hospital and CiBERHED del Instituto Carlos IIIBarcelonaSpain
| | - David Shaw
- Royal Adelaide HospitalAdelaideAustralia
| | | | | | | | | | - Stephen Pianko
- Monash Health and Monash UniversityCaulfield SouthVictoriaAustralia
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22
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Wyles D, Poordad F, Wang S, Alric L, Felizarta F, Kwo PY, Maliakkal B, Agarwal K, Hassanein T, Weilert F, Lee SS, Kort J, Lovell SS, Liu R, Lin C, Pilot‐Matias T, Krishnan P, Mensa FJ. Glecaprevir/pibrentasvir for hepatitis C virus genotype 3 patients with cirrhosis and/or prior treatment experience: A partially randomized phase 3 clinical trial. Hepatology 2018; 67:514-523. [PMID: 28926120 PMCID: PMC5817409 DOI: 10.1002/hep.29541] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/14/2017] [Accepted: 09/15/2017] [Indexed: 12/11/2022]
Abstract
This study assessed the efficacy and safety of ribavirin-free coformulated glecaprevir/pibrentasvir (G/P) in patients with hepatitis C virus genotype 3 infection with prior treatment experience and/or compensated cirrhosis, a patient population with limited treatment options. SURVEYOR-II, Part 3 was a partially randomized, open-label, multicenter, phase 3 study. Treatment-experienced (prior interferon or pegylated interferon ± ribavirin or sofosbuvir plus ribavirin ± pegylated interferon therapy) patients without cirrhosis were randomized 1:1 to receive 12 or 16 weeks of G/P (300 mg/120 mg) once daily. Treatment-naive or treatment-experienced patients with compensated cirrhosis were treated with G/P for 12 or 16 weeks, respectively. The primary efficacy endpoint was the percentage of patients with sustained virologic response at posttreatment week 12 (SVR12). Safety was evaluated throughout the study. There were 131 patients enrolled and treated. Among treatment-experienced patients without cirrhosis, SVR12 was achieved by 91% (20/22; 95% confidence interval [CI], 72-97) and 95% (21/22; 95% CI, 78-99) of patients treated with G/P for 12 or 16 weeks, respectively. Among those with cirrhosis, SVR12 was achieved by 98% (39/40; 95% CI, 87-99) of treatment-naive patients treated for 12 weeks and 96% (45/47; 95% CI, 86-99) of patients with prior treatment experience treated for 16 weeks. No adverse events led to discontinuation of study drug, and no serious adverse events were related to study drug. Conclusion: Patients with hepatitis C virus genotype 3 infection with prior treatment experience and/or compensated cirrhosis achieved high SVR12 rates following 12 or 16 weeks of treatment with G/P. The regimen was well tolerated. (Hepatology 2018;67:514-523).
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Affiliation(s)
| | - Fred Poordad
- The Texas Liver InstituteUniversity of Texas HealthSan AntonioTX
| | | | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, CHU Purpan, UMR 152IRD Toulouse 3 UniversityToulouseFrance
| | | | - Paul Y. Kwo
- Division of Gastroenterology and HepatologyStanford UniversityPalo AltoCA
| | | | - Kosh Agarwal
- Institute of Liver Studies, Kings College HospitalLondonUK
| | - Tarek Hassanein
- Southern California GI and Liver Centers and Southern California Research CenterCoronadoCA
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23
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Zeuzem S, Foster GR, Wang S, Asatryan A, Gane E, Feld JJ, Asselah T, Bourlière M, Ruane PJ, Wedemeyer H, Pol S, Flisiak R, Poordad F, Chuang WL, Stedman CA, Flamm S, Kwo P, Dore GJ, Sepulveda-Arzola G, Roberts SK, Soto-Malave R, Kaita K, Puoti M, Vierling J, Tam E, Vargas HE, Bruck R, Fuster F, Paik SW, Felizarta F, Kort J, Fu B, Liu R, Ng TI, Pilot-Matias T, Lin CW, Trinh R, Mensa FJ. Glecaprevir-Pibrentasvir for 8 or 12 Weeks in HCV Genotype 1 or 3 Infection. N Engl J Med 2018; 378:354-369. [PMID: 29365309 DOI: 10.1056/nejmoa1702417] [Citation(s) in RCA: 285] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Glecaprevir and pibrentasvir are direct-acting antiviral agents with pangenotypic activity and a high barrier to resistance. We evaluated the efficacy and safety of 8-week and 12-week courses of treatment with 300 mg of glecaprevir plus 120 mg of pibrentasvir in patients without cirrhosis who had hepatitis C virus (HCV) genotype 1 or 3 infection. METHODS We conducted two phase 3, randomized, open-label, multicenter trials. Patients with genotype 1 infection were randomly assigned in a 1:1 ratio to receive once-daily glecaprevir-pibrentasvir for either 8 or 12 weeks. Patients with genotype 3 infection were randomly assigned in a 2:1 ratio to receive 12 weeks of treatment with either glecaprevir-pibrentasvir or sofosbuvir-daclatasvir. Additional patients with genotype 3 infection were subsequently enrolled and nonrandomly assigned to receive 8 weeks of treatment with glecaprevir-pibrentasvir. The primary end point was the rate of sustained virologic response 12 weeks after the end of treatment. RESULTS In total, 1208 patients were treated. The rate of sustained virologic response at 12 weeks among genotype 1-infected patients was 99.1% (95% confidence interval [CI], 98 to 100) in the 8-week group and 99.7% (95% CI, 99 to 100) in the 12-week group. Genotype 3-infected patients who were treated for 12 weeks had a rate of sustained virologic response at 12 weeks of 95% (95% CI, 93 to 98; 222 of 233 patients) with glecaprevir-pibrentasvir and 97% (95% CI, 93 to 99.9; 111 of 115) with sofosbuvir-daclatasvir; 8 weeks of treatment with glecaprevir-pibrentasvir yielded a rate of 95% (95% CI, 91 to 98; 149 of 157 patients). Adverse events led to discontinuation of treatment in no more than 1% of patients in any treatment group. CONCLUSIONS Once-daily treatment with glecaprevir-pibrentasvir for either 8 weeks or 12 weeks achieved high rates of sustained virologic response among patients with HCV genotype 1 or 3 infection who did not have cirrhosis. (Funded by AbbVie; ENDURANCE-1 and ENDURANCE-3 ClinicalTrials.gov numbers, NCT02604017 and NCT02640157 .).
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Affiliation(s)
- Stefan Zeuzem
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Graham R Foster
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Stanley Wang
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Armen Asatryan
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Edward Gane
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Jordan J Feld
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Tarik Asselah
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Marc Bourlière
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Peter J Ruane
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Heiner Wedemeyer
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Stanislas Pol
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Robert Flisiak
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Fred Poordad
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Wan-Long Chuang
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Catherine A Stedman
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Steven Flamm
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Paul Kwo
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Gregory J Dore
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Gladys Sepulveda-Arzola
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Stuart K Roberts
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Ruth Soto-Malave
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Kelly Kaita
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Massimo Puoti
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - John Vierling
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Edward Tam
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Hugo E Vargas
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Rafi Bruck
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Francisco Fuster
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Seung-Woon Paik
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Franco Felizarta
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Jens Kort
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Bo Fu
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Ran Liu
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Teresa I Ng
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Tami Pilot-Matias
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Chih-Wei Lin
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Roger Trinh
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
| | - Federico J Mensa
- From Goethe University Hospital, Frankfurt (S.Z.), and Medizinische Hochschule Hannover, Hannover (H.W.) - both in Germany; Queen Mary University of London, Barts Health, London (G.R.F.); AbbVie, North Chicago (S.W., A.A., J.K., B.F., R.L., T.I.N., T.P.-M., C.-W.L., R.T., F.J.M.), and Northwestern Feinberg School of Medicine, Chicago (S.F.) - both in Illinois; Liver Unit, Auckland City Hospital, Auckland (E.G.), and Christchurch Hospital and University of Otago, Christchurch (C.A.S.) - both in New Zealand; Toronto Centre for Liver Disease, University of Toronto, Toronto (J.J.F.), University of Manitoba, Winnipeg (K.K.), and LAIR Centre, Vancouver, BC (E.T.) - all in Canada; Centre de Recherche sur l'Inflammation, INSERM UMR 1149, Université Paris Diderot, Service d'hépatologie, Assistance Publique-Hôpitaux de Paris Hôpital Beaujon, Clichy (T.A.), Hôpital Saint Joseph, Marseille (M.B.), and Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.) - all in France; Ruane Medical and Liver Health Institute, Los Angeles (P.J.R.), Stanford University Division of Gastroenterology and Hepatology, Palo Alto (P.K.), and private practice, Bakersfield (F. Felizarta) - all in California; Klinika Chorób Zakaźnych i Hepatologii UM w Białymstoku, Bialystok, Poland (R.F.); the Texas Liver Institute-University of Texas Health, San Antonio (F.P.), and Baylor College of Medicine, Houston (J.V.); Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan (W.-L.C.); Kirby Institute, University of New South Wales Sydney and St. Vincent's Hospital, Sydney (G.J.D.), and Alfred Hospital, Melbourne, VIC (S.K.R.) - both in Australia; Instituto de Investigación Científica del Sur, Ponce (G.S.-A.), and University of Puerto Rico, San Juan (R.S.-M.) - both in Puerto Rico; Azienda Ospedaliera Ospedale Niguarda Ca' Granda, Milan (M.P.); Mayo Clinic, Phoenix, AZ (H.E.V.); Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (R.B.); Centro de Investigaciones Clinicas Viña del Mar, Viña del Mar, Chile (F. Fuster); and Samsung Medical Center, Seoul, South Korea (S.-W.P.)
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Forns X, Mensa FJ. Proton-pump inhibitors and glecaprevir plus pibrentasvir in HCV infection - Authors' reply. Lancet Infect Dis 2017; 17:1240. [PMID: 29173884 DOI: 10.1016/s1473-3099(17)30644-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Xavier Forns
- Liver Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, University of Barcelona, Barcelona, 08036, Spain.
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Gane E, Lawitz E, Pugatch D, Papatheodoridis G, Bräu N, Brown A, Pol S, Leroy V, Persico M, Moreno C, Colombo M, Yoshida EM, Nelson DR, Collins C, Lei Y, Kosloski M, Mensa FJ. Glecaprevir and Pibrentasvir in Patients with HCV and Severe Renal Impairment. N Engl J Med 2017; 377:1448-1455. [PMID: 29020583 DOI: 10.1056/nejmoa1704053] [Citation(s) in RCA: 293] [Impact Index Per Article: 41.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Chronic hepatitis C virus (HCV) infection is more prevalent among patients who have chronic kidney disease than among those who do not have the disease. Patients with chronic kidney disease who also have HCV infection are at higher risk for progression to end-stage renal disease than those who have chronic kidney disease without HCV infection. Patients with both HCV infection and advanced chronic kidney disease have limited treatment options. METHODS We conducted a multicenter, open-label, phase 3 trial to evaluate the efficacy and safety of treatment with the combination of the NS3/4A protease inhibitor glecaprevir and the NS5A inhibitor pibrentasvir for 12 weeks in adults who had HCV genotype 1, 2, 3, 4, 5, or 6 infection and also had compensated liver disease (with or without cirrhosis) with severe renal impairment, dependence on dialysis, or both. Patients had stage 4 or 5 chronic kidney disease and either had received no previous treatment for HCV infection or had received previous treatment with interferon or pegylated interferon, ribavirin, sofosbuvir, or a combination of these medications. The primary end point was a sustained virologic response 12 weeks after the end of treatment. RESULTS Among the 104 patients enrolled in the trial, 52% had genotype 1 infection, 16% had genotype 2 infection, 11% had genotype 3 infection, 19% had genotype 4 infection, and 2% had genotype 5 or 6 infection. The sustained virologic response rate was 98% (102 of 104 patients; 95% confidence interval, 95 to 100). No patients had virologic failure during treatment, and no patients had a virologic relapse after the end of treatment. Adverse events that were reported in at least 10% of the patients were pruritus, fatigue, and nausea. Serious adverse events were reported in 24% of the patients. Four patients discontinued the trial treatment prematurely because of adverse events; three of these patients had a sustained virologic response. CONCLUSIONS Treatment with glecaprevir and pibrentasvir for 12 weeks resulted in a high rate of sustained virologic response in patients with stage 4 or 5 chronic kidney disease and HCV infection. (Funded by AbbVie; ClinicalTrials.gov number, NCT02651194 .).
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Affiliation(s)
- Edward Gane
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Eric Lawitz
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - David Pugatch
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Georgios Papatheodoridis
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Norbert Bräu
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Ashley Brown
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Stanislas Pol
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Vincent Leroy
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Marcello Persico
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Christophe Moreno
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Massimo Colombo
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Eric M Yoshida
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - David R Nelson
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Christine Collins
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Yang Lei
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Matthew Kosloski
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
| | - Federico J Mensa
- From the Liver Unit, Auckland City Hospital, Auckland, New Zealand (E.G.); the Texas Liver Institute, University of Texas Health, San Antonio (E.L.); AbbVie, North Chicago, IL (D.P., C.C., Y.L., M.K., F.J.M.); the Academic Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Athens (G.P.); the James J. Peters Veterans Affairs Medical Center, Bronx, and Icahn School of Medicine at Mount Sinai, New York - both in New York (N.B.); Imperial College Healthcare, London (A.B.); Groupe Hospitalier Cochin-Saint Vincent de Paul, Paris (S.P.), and Centre Hospitalier Universitaire de Grenoble, Grenoble (V.L.) - both in France; the Internal Medicine and Hepatology Unit, University of Salerno, Salerno (M.P.), Humanitas Clinical and Research Center, Rozzano (M.C.), and Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda Ospedale Maggiore Policlinico, Università di Milano, Milan (M.C.) - all in Italy; Cliniques Universitaires de Bruxelles Hôpital Erasme, Université Libre de Bruxelles, Brussels (C.M.); University of British Columbia, Vancouver, Canada (E.M.Y.); and the Department of Medicine, University of Florida, Gainesville (D.R.N.)
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26
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Forns X, Lee SS, Valdes J, Lens S, Ghalib R, Aguilar H, Felizarta F, Hassanein T, Hinrichsen H, Rincon D, Morillas R, Zeuzem S, Horsmans Y, Nelson DR, Yu Y, Krishnan P, Lin CW, Kort JJ, Mensa FJ. Glecaprevir plus pibrentasvir for chronic hepatitis C virus genotype 1, 2, 4, 5, or 6 infection in adults with compensated cirrhosis (EXPEDITION-1): a single-arm, open-label, multicentre phase 3 trial. Lancet Infect Dis 2017; 17:1062-1068. [PMID: 28818546 DOI: 10.1016/s1473-3099(17)30496-6] [Citation(s) in RCA: 249] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 06/28/2017] [Accepted: 07/06/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The once-daily, ribavirin-free, pangenotypic, direct-acting antiviral regimen, glecaprevir coformulated with pibrentasvir, has shown high rates of sustained virological response in phase 2 and 3 studies. We aimed to assess the efficacy and safety of 12 weeks of coformulated glecaprevir and pibrentasvir in patients with hepatitis C virus (HCV) infection and compensated cirrhosis. METHODS We did this single-arm, open-label, multicentre phase 3 study at 40 sites in Belgium, Canada, Germany, South Africa, Spain, and the USA. We enrolled patients aged 18 years or older with HCV genotype 1, 2, 4, 5, or 6 infection and compensated cirrhosis. Patients were either HCV treatment-naive or had not responded to treatment with interferon or pegylated interferon with or without ribavirin, or sofosbuvir plus ribavirin with or without pegylated interferon. Oral glecaprevir (300 mg) coformulated with pibrentasvir (120 mg) was administered once daily for 12 weeks. The primary efficacy endpoint was sustained virological response at post-treatment week 12 (HCV RNA <15 IU/mL). We assessed efficacy and safety in all patients who received at least one dose of study drug (intention-to-treat population). This study is registered with ClinicalTrials.gov, number NCT02642432. FINDINGS Between Dec 7, 2015, and May 4, 2016, we enrolled 146 patients with compensated cirrhosis, of whom 48 (33%) had genotype 1a HCV infection, 39 (27%) had genotype 1b infection, 34 (23%) had genotype 2 infection, 16 (11%) had genotype 4 infection, two (1%) had genotype 5 infection, and seven (5%) had genotype 6 infection. 12 weeks after treatment, 145 patients (99%, 95% CI 98-100) achieved sustained virological response, with one (1%) relapse at post-treatment week 8. We recorded 101 (69%) adverse events, of which 65 (64%) were mild. The most common adverse events were fatigue (n=28 [19%]) and headache (n=20 [14%]). 11 (8%) patients had serious adverse events, none of which were deemed related to study drugs. No patients had elevations in alanine aminotransferase and no patients prematurely discontinued treatment because of adverse events. INTERPRETATION Our results show that 99% of patients treated with once-daily glecaprevir plus pibrentasvir achieved a sustained virological response at 12 weeks. Furthermore, this drug regimen had a favourable safety profile in previously treated or untreated patients with chronic HCV genotype 1, 2, 4, 5, or 6 infection and compensated cirrhosis. These findings could help simplify treatment algorithms and reduce treatment burden. FUNDING AbbVie.
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Affiliation(s)
- Xavier Forns
- Liver Unit, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain.
| | | | | | - Sabela Lens
- Liver Unit, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Reem Ghalib
- Texas Digestive Disease Consultants, Arlington, TX, USA
| | | | | | - Tarek Hassanein
- Southern California Liver Centers and Southern California Research Center, Coronado, CA, USA
| | | | - Diego Rincon
- Liver Unit, Hospital General Universitario Gregorio Marañón, CIBERehd, Madrid, Spain
| | - Rosa Morillas
- Liver Section and CIBERehd, Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Stefan Zeuzem
- Johann Wolfgang Goethe University, Frankfurt, Germany
| | - Yves Horsmans
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - David R Nelson
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Yao Yu
- AbbVie, North Chicago, IL, USA
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27
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Poordad F, Felizarta F, Asatryan A, Sulkowski MS, Reindollar RW, Landis CS, Gordon SC, Flamm SL, Fried MW, Bernstein DE, Lin C, Liu R, Lovell SS, Ng TI, Kort J, Mensa FJ. Glecaprevir and pibrentasvir for 12 weeks for hepatitis C virus genotype 1 infection and prior direct-acting antiviral treatment. Hepatology 2017; 66:389-397. [PMID: 28128852 PMCID: PMC5573922 DOI: 10.1002/hep.29081] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/08/2016] [Accepted: 01/23/2017] [Indexed: 02/06/2023]
Abstract
Although direct-acting antiviral (DAA) therapies for chronic hepatitis C virus (HCV) infection have demonstrated high rates of sustained virologic response, virologic failure may still occur, potentially leading to the emergence of viral resistance, which can decrease the effectiveness of subsequent treatment. Treatment options for patients who failed previous DAA-containing regimens, particularly those with nonstructural protein 5A inhibitors, are limited and remain an area of unmet medical need. This phase 2, open-label study (MAGELLAN-1) evaluated the efficacy and safety of glecaprevir (GLE) + pibrentasvir (PIB) ± ribavirin (RBV) in HCV genotype 1-infected patients with prior virologic failure to HCV DAA-containing therapy. A total of 50 patients without cirrhosis were randomized to three arms: 200 mg GLE + 80 mg PIB (arm A), 300 mg GLE + 120 mg PIB with 800 mg once-daily RBV (arm B), or 300 mg GLE + 120 mg PIB without RBV (arm C). By intent-to-treat analysis, sustained virologic response at posttreatment week 12 was achieved in 100% (6/6, 95% confidence interval 61-100), 95% (21/22, 95% confidence interval 78-99), and 86% (19/22, 95% confidence interval 67-95) of patients in arms A, B, and C, respectively. Virologic failure occurred in no patients in arm A and in 1 patient each in arms B and C (two patients were lost to follow-up in arm C). The majority of adverse events were mild in severity; no serious adverse events related to study drug and no relevant laboratory abnormalities in alanine aminotransferase, total bilirubin, or hemoglobin were observed. CONCLUSION The combination of GLE and PIB was highly efficacious and well tolerated in patients with HCV genotype 1 infection and prior failure of DAA-containing therapy; RBV coadministration did not improve efficacy. (Hepatology 2017;66:389-397).
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Affiliation(s)
- Fred Poordad
- Texas Liver InstituteUniversity of Texas Health Science CenterSan AntonioTX
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28
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Sarrazin C, Castelli F, Andreone P, Buti M, Colombo M, Pol S, Calinas F, Puoti M, Olveira A, Shiffman M, Stern JO, Kukolj G, Roehrle M, Aslanyan S, Deng Q, Vinisko R, Mensa FJ, Nelson DR. HCVerso1 and 2: faldaprevir with deleobuvir (BI 207127) and ribavirin for treatment-naïve patients with chronic hepatitis C virus genotype-1b infection. Clin Exp Gastroenterol 2016; 9:351-363. [PMID: 27920566 PMCID: PMC5125810 DOI: 10.2147/ceg.s111116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The interferon-free combination of once-daily faldaprevir 120 mg, twice-daily deleobuvir 600 mg, and weight-based ribavirin was evaluated in two Phase III studies (HCVerso1, HCVerso2) in hepatitis C virus genotype-1b-infected, treatment-naïve patients, including those ineligible for peginterferon (HCVerso2). Patients without cirrhosis were randomized to 16 weeks (Arm 1; n=208 HCVerso1, n=213 HCVerso2) or 24 weeks (Arm 2; n=211 in both studies) of faldaprevir + deleobuvir + ribavirin. Patients with compensated cirrhosis received open-label faldaprevir + deleobuvir + ribavirin for 24 weeks (Arm 3; n=51, n=72). Primary endpoints were comparisons of adjusted sustained virologic response (SVR) rates with historical rates: 71% (HCVerso1) and 68% (HCVerso2). Adjusted SVR12 rates were significantly greater than historical controls for Arms 1 and 2 in HCVerso2 (76%, 95% confidence interval [CI] 71-81, P=0.002; 81%, 95% CI 76-86, P<0.0001) and Arm 2 in HCVerso1 (81%, 95% CI 77-86, P<0.0001), but not for Arm 1 of HCVerso1 (72%, 95% CI 66-77, P=0.3989). Unadjusted SVR12 rates in Arms 1, 2, and 3 were 71.6%, 82.5%, and 72.5%, respectively, in HCVerso1 and 75.6%, 82.0%, and 73.6%, respectively, in HCVerso2. Virologic breakthrough and relapse occurred in 24-week arms in 8%-9% and 1% of patients, respectively, and in 16-week arms in 7%-8% and 9%-11% of patients, respectively. The most common adverse events were nausea (46%-61%) and vomiting (29%-35%). Adverse events resulted in discontinuation of all medications in 6%-8% of patients. In treatment-naïve patients with hepatitis C virus genotype-1b infection, with or without cirrhosis, faldaprevir + deleobuvir + ribavirin treatment for 24 weeks resulted in adjusted SVR12 rates significantly higher than historical controls. Both studies were registered in ClinicalTrials.gov (NCT01732796, NCT01728324).
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Affiliation(s)
- Christoph Sarrazin
- Department of Internal Medicine 1, JW Goethe University Hospital, Frankfurt, Germany
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, University of Brescia, Brescia
| | - Pietro Andreone
- Department of Medical and Surgical Sciences, Università di Bologna and Azienda Ospedaliero-Universitaria, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Maria Buti
- Department of Internal Medicine, Hospital Universitari Vall d'Hebron and CIBERehd del Instituto Carlos III, Barcelona, Spain
| | - Massimo Colombo
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Stanislas Pol
- University Paris Descartes, Department of Hepatology, Hospital Cochin, APHP and INSERM UMS-20, Institut Pasteur, Paris, France
| | - Filipe Calinas
- Department of Gastroenterology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Massimo Puoti
- Department of Infectious Diseases, AO Ospedale Niguarda Cà Granda, Milan, Italy
| | - Antonio Olveira
- Liver Unit, Hospital Universitario La Paz, CIBERehd, Madrid, Spain
| | - Mitchell Shiffman
- Liver Institute of Virginia, Bon Secours Health System, Richmond, VA, USA
| | - Jerry O Stern
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - George Kukolj
- Boehringer Ingelheim Ltd/Ltée, Burlington, ON, Canada
| | - Michael Roehrle
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | - Stella Aslanyan
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Qiqi Deng
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | - Richard Vinisko
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
| | | | - David R Nelson
- Clinical and Translational Science Institute, University of Florida, Gainesville, FL, USA
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Gane E, Poordad F, Wang S, Asatryan A, Kwo PY, Lalezari J, Wyles DL, Hassanein T, Aguilar H, Maliakkal B, Liu R, Lin CW, Ng TI, Kort J, Mensa FJ. High Efficacy of ABT-493 and ABT-530 Treatment in Patients With HCV Genotype 1 or 3 Infection and Compensated Cirrhosis. Gastroenterology 2016; 151:651-659.e1. [PMID: 27456384 DOI: 10.1053/j.gastro.2016.07.020] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/06/2016] [Accepted: 07/11/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND & AIMS The combination of ABT-493 (NS3/4A protease inhibitor) plus ABT-530 (NS5A inhibitor) has shown high rates of sustained virologic response at post-treatment week 12 (SVR12) in noncirrhotic patients infected with hepatitis C virus (HCV) genotypes (GTs) 1-6. We describe 2 open-label phase 2 studies investigating the efficacy and safety of ABT-493 plus ABT-530 with or without ribavirin (RBV) in GT1- or GT3-infected patients with compensated cirrhosis. METHODS Patients with GT1 infection received 200 mg ABT-493 plus 120 mg ABT-530 for 12 weeks. Patients with GT3 infection were randomized 1:1 to receive 300 mg ABT-493 plus 120 mg ABT-530 with or without once-daily 800 mg RBV for 12 weeks; treatment-experienced patients who were not treated with RBV received 16 weeks of therapy. Efficacy was measured by SVR12, defined as an HCV-RNA level less than 25 IU/mL. Adverse events and laboratory parameters were evaluated throughout the study. RESULTS Twenty-seven patients with GT1 infection and 55 patients with GT3 infection were enrolled. The majority were treatment-naive (84%) and male (65%). In patients with GT1 infection, SVR12 was achieved by 96% (26 of 27; 95% confidence interval [CI], 82-99) of patients, with 1 relapse. Among GT3-infected patients, SVR12 was achieved in 96% (27 of 28; 95% CI, 82-99) of patients in the RBV-free arm (1 relapse), and in 100% (27 of 27; 95% CI, 88-100) in the RBV-containing arm. The most common adverse events were headache, fatigue, and nausea. Laboratory abnormalities were rare; no patient discontinued treatment. CONCLUSIONS In cirrhotic HCV GT1- or GT3-infected patients, ABT-493 plus ABT-530 with or without RBV achieved SVR12 rates of 96%-100% and was well tolerated. ClinicalTrials.gov identifiers NCT02243280 and NCT02243293.
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Affiliation(s)
- Edward Gane
- University of Auckland, Auckland, New Zealand.
| | - Fred Poordad
- Texas Liver Institute, University of Texas Health Science Center, San Antonio, Texas
| | | | | | - Paul Y Kwo
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - David L Wyles
- University of California San Diego, La Jolla, California
| | - Tarek Hassanein
- Southern California GI and Liver Centers and Southern California Research Center, Coronado, California
| | | | | | - Ran Liu
- AbbVie, Inc, North Chicago, Illinois
| | | | | | - Jens Kort
- AbbVie, Inc, North Chicago, Illinois
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30
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Berger KL, Sarrazin C, Nelson DR, Scherer J, Sha N, Marquis M, Côté-Martin A, Vinisko R, Stern JO, Mensa FJ, Kukolj G. Resistance Analyses of HCV NS3/4A Protease and NS5B Polymerase from Clinical Studies of Deleobuvir and Faldaprevir. PLoS One 2016; 11:e0160668. [PMID: 27494410 PMCID: PMC4975400 DOI: 10.1371/journal.pone.0160668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 07/23/2016] [Indexed: 01/17/2023] Open
Abstract
Background & Aim The resistance profile of anti-hepatitis C virus (HCV) agents used in combination is important to guide optimal treatment regimens. We evaluated baseline and treatment-emergent NS3/4A and NS5B amino-acid variants among HCV genotype (GT)-1a and -1b-infected patients treated with faldaprevir (HCV protease inhibitor), deleobuvir (HCV polymerase non-nucleoside inhibitor), and ribavirin in multiple clinical studies. Methods HCV NS3/4A and NS5B population sequencing (Sanger method) was performed on all baseline plasma samples (n = 1425 NS3; n = 1556 NS5B) and on post-baseline plasma samples from patients with virologic failure (n = 113 GT-1a; n = 221 GT-1b). Persistence and time to loss of resistance-associated variants (RAVs) was estimated using Kaplan–Meier analysis. Results Faldaprevir RAVs (NS3 R155 and D168) and deleobuvir RAVs (NS5B 495 and 496) were rare (<1%) at baseline. Virologic response to faldaprevir/deleobuvir/ribavirin was not compromised by common baseline NS3 polymorphisms (e.g. Q80K in 17.5% of GT-1a) or by NS5B A421V, present in 20% of GT-1a. In GT-1b, alanine at NS5B codon 499 (present in 15% of baseline sequences) was associated with reduced response. Treatment-emergent RAVs consolidated previous findings: NS3 R155 and D168 were key faldaprevir RAVs; NS5B A421 and P495 were key deleobuvir RAVs. Among on-treatment virologic breakthroughs, RAVs emerged in both NS3 and NS5B (>90%). Virologic relapse was associated with RAVs in both NS3 and NS5B (53% GT-1b; 52% GT-1b); some virologic relapses had NS3 RAVs only (47% GT-1a; 17% GT-1b). Median time to loss of GT-1b NS5B P495 RAVs post-treatment (5 months) was less than that of GT-1b NS3 D168 (8.5 months) and GT-1a R155 RAVs (11.5 months). Conclusion Faldaprevir and deleobuvir RAVs are more prevalent among virologic failures than at baseline. Treatment response was not compromised by common NS3 polymorphisms; however, alanine at NS5B amino acid 499 at baseline (wild-type in GT-1a, polymorphism in GT-1b) may reduce response to this deleobuvir-based regimen.
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Affiliation(s)
- Kristi L. Berger
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, United States of America
- Boehringer Ingelheim Ltd/Ltée, R&D, Laval, QC, Canada
- * E-mail:
| | | | - David R. Nelson
- Clinical and Translational Science Institute, University of Florida, Gainesville, FL, United States of America
| | - Joseph Scherer
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, United States of America
| | - Nanshi Sha
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, United States of America
| | | | - Alexandra Côté-Martin
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, United States of America
- Boehringer Ingelheim Ltd/Ltée, R&D, Laval, QC, Canada
| | - Richard Vinisko
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, United States of America
| | - Jerry O. Stern
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, United States of America
| | - Federico J. Mensa
- Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, United States of America
| | - George Kukolj
- Boehringer Ingelheim Ltd/Ltée, R&D, Laval, QC, Canada
- Boehringer Ingelheim Ltd/Ltée, Burlington, ON, Canada
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Zeuzem S, Mantry P, Soriano V, Buynak RJ, Dufour JF, Pockros PJ, Wright D, Angus P, Buti M, Stern JO, Kadus W, Vinisko R, Böcher W, Mensa FJ. Short article: Faldaprevir, deleobuvir and ribavirin in IL28B non-CC patients with HCV genotype-1a infection included in the SOUND-C3 phase 2b study. Eur J Gastroenterol Hepatol 2016; 28:923-6. [PMID: 27140229 DOI: 10.1097/meg.0000000000000649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND SOUND-C3 was a multicentre, open-label, phase 2b study exploring the safety and efficacy of the interferon-free combination of faldaprevir (an NS3/A4 protease inhibitor), deleobuvir (BI 207127, a non-nucleoside polymerase inhibitor) and ribavirin in treatment-naive patients with chronic hepatitis C virus (HCV) genotype-1 infection. Results in patients with HCV genotype-1b and in IL28B CC genotype patients with HCV genotype-1a have been described previously. This report describes the results in IL28B non-CC genotype patients with HCV genotype-1a. METHODS Patients were randomized to receive faldaprevir 120 mg once daily with deleobuvir at either 800 mg twice daily (b.i.d.; N=26) or 600 mg three times daily (t.i.d.; N=25), and weight-based ribavirin for 24 weeks. The primary endpoint was sustained virological response 12 weeks after treatment (SVR12). RESULTS In each group, five patients completed 24 weeks of treatment. SVR12 rates were 19% (5/26) and 8% (2/25) in the b.i.d. and t.i.d. groups, respectively. On-treatment breakthrough [50% (13/26) and 68% (17/25) in the b.i.d. and t.i.d. groups, respectively] was the most frequent reason for not achieving SVR12. Adverse events led to premature treatment discontinuation in six (23%) patients in the b.i.d. group and in two patients (8%) in the t.i.d. group. The majority of adverse events were mild or moderate; the most frequently reported were nausea (67%), fatigue (35%) and diarrhoea (35%). CONCLUSION In this small study, the interferon-free regimen of faldaprevir, deleobuvir and ribavirin resulted in high rates of virological breakthrough and low rates of SVR12 in IL28B non-CC genotype patients infected with genotype-1a HCV (http://www.clinicaltrials.gov NCT01132313).
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Affiliation(s)
- Stefan Zeuzem
- aJ.W. Goethe University Hospital, Frankfurt am Main bBoehringer Ingelheim Pharma GmbH & Co. KG, Biberach cBoehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany dThe Liver Institute at Methodist Dallas Medical Center, Dallas eCentral Texas Clinical Research, Austin, Texas fNorthwest Indiana Center for Clinical Research, Valparaiso, Indiana gScripps Clinic, La Jolla, California hBoehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Connecticut, USA iHospital Carlos III, Madrid jHospital Universitario Valle de Hebrón and CIBERehd del Instituto Carlos III, Barcelona, Spain kUniversity Clinic for Visceral Surgery and Medicine, University of Bern, Bern, Switzerland lAustin Health, Heidelberg, Victoria, Australia
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Asselah T, Zeuzem S, Soriano V, Bronowicki JP, Lohse AW, Müllhaupt B, Schuchmann M, Bourlière M, Buti M, Roberts SK, Gane EJ, Stern JO, Voss F, Baum P, Gallivan JP, Böcher WO, Mensa FJ. ITPA Genotypes Predict Anemia but Do Not Affect Virological Response with Interferon-Free Faldaprevir, Deleobuvir, and Ribavirin for HCV Infection. PLoS One 2015; 10:e0144004. [PMID: 26650626 PMCID: PMC4674133 DOI: 10.1371/journal.pone.0144004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/11/2015] [Indexed: 12/21/2022] Open
Abstract
Background & Aim Whether inosine triphosphatase (ITPA) gene polymorphisms predict anemia during interferon-free therapy in chronic hepatitis C virus (HCV)-infected patients is unknown. We examined the relationship between two ITPA polymorphisms, anemia, and sustained virological response 12 weeks post-treatment (SVR12) in patients receiving the NS3/4A protease inhibitor faldaprevir, the non-nucleoside polymerase inhibitor deleobuvir, and ribavirin. Methods HCV genotype 1-infected, treatment-naïve patients (N = 362) were randomized and treated in one of five treatment arms with faldaprevir and deleobuvir with or without ribavirin. Two ITPA polymorphisms (rs1127354 and rs6051702) were genotyped and defined as ITPA-deficient (rs1127354 AA or AC; rs6051702 CC or CA) or ITPA-non-deficient (rs1127354 CC; rs6051702 AA) according to their association with ITPA deficiency. Baseline and on-treatment variables associated with anemia and SVR12 were identified using logistic regression. Results In the pooled ribavirin-containing arms, 10.1% (32/316) of patients experienced on-treatment hemoglobin <10 g/dL, and 32.6% (103/316) experienced on-treatment hemoglobin <10 g/dL or a change from baseline ≥3.5 g/dL. Of the latter group, 99% (102/103) had the ITPA-non-deficient rs1127354 genotype. Other variables associated with on-treatment hemoglobin <10 g/dL or a decrease ≥3.5 g/dL were age, baseline hemoglobin, rs6051702 genotype, and plasma ribavirin concentration. In a multivariate analysis, high plasma ribavirin concentration, low baseline hemoglobin, HCV genotype 1b, and IL28B genotype CC were associated with higher SVR12. Conclusions The ITPA rs1127354 CC and rs6051702 AA genotypes may predict ribavirin-induced anemia during treatment with interferon-free, ribavirin-containing regimens. With this interferon-free regimen, SVR was associated with ribavirin levels, but not with anemia or ITPA genotypes. Trial Registration ClinicalTrials.gov: NCT01132313
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Affiliation(s)
- Tarik Asselah
- Service d’Hépatologie, Hôpital Beaujon, INSERM UMR S 1149, CRI, Université Paris Diderot, DHU UNITY, Clichy, France
- * E-mail:
| | - Stefan Zeuzem
- J. W. Goethe University Hospital, Frankfurt, Germany
| | - Vicente Soriano
- Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain
| | - Jean-Pierre Bronowicki
- INSERM U954, Centre Hospitalier Universitaire de Nancy, Université de Lorraine, Vandoeuvre les Nancy, France
| | - Ansgar W. Lohse
- I. Medizinische Klinik und Poliklinik, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Beat Müllhaupt
- Division of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland
| | - Marcus Schuchmann
- Department of Internal Medicine I, University Hospital Mainz, Mainz, Germany
| | - Marc Bourlière
- Service d’hépato-gastro-entérologie, Hôpital Saint Joseph, Marseille, France
| | - Maria Buti
- Liver Unit, Hospital Universitario Valle de Hebron and CIBERehd del Instituto Carlos III, Barcelona, Spain
| | - Stuart K. Roberts
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia
| | | | - Jerry O. Stern
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States of America
| | - Florian Voss
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Patrick Baum
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach, Germany
| | | | - Wulf O. Böcher
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - Federico J. Mensa
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States of America
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Zeuzem S, Dufour JF, Buti M, Soriano V, Buynak RJ, Mantry P, Taunk J, Stern JO, Vinisko R, Gallivan JP, Böcher W, Mensa FJ. Interferon-free treatment of chronic hepatitis C with faldaprevir, deleobuvir and ribavirin: SOUND-C3, a Phase 2b study. Liver Int 2015; 35:417-21. [PMID: 25263751 DOI: 10.1111/liv.12693] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 09/17/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS The safety and efficacy of the interferon-free combination of faldaprevir (NS3/A4 protease inhibitor), deleobuvir (BI 207127, non-nucleoside polymerase inhibitor), and ribavirin in treatment-naïve patients chronically infected with HCV genotype-1 was explored. METHODS SOUND-C3 was a multicenter, open-label Phase 2b study. Treatment-naïve patients chronically infected with HCV genotype-1a (IL28B CC genotype only; n = 12) and genotype-1b (n = 20) were assigned to 16 weeks of treatment with faldaprevir 120 mg once daily, deleobuvir 600 mg twice daily, and weight-based ribavirin. Patients with compensated liver disease, including cirrhosis, were eligible for inclusion in this study. The primary endpoint was sustained virological response 12 weeks after completion of therapy. RESULTS Sustained virological response rates 12 weeks after completion of therapy were 17% and 95% in patients infected with HCV genotype-1a and genotype-1b respectively. All four patients with cirrhosis achieved sustained virological response 12 weeks after completion of therapy. The most frequently reported adverse events of at least moderate intensity were anaemia (16%), nausea, vomiting and fatigue (9% each). Three (9%) patients discontinued because of adverse events. CONCLUSIONS The interferon-free regimen of faldaprevir, deleobuvir and ribavirin was efficacious in patients infected with genotype-1b and generally well tolerated.
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Affiliation(s)
- Stefan Zeuzem
- J. W. Goethe University Hospital, Frankfurt am Main, Germany
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Zeuzem S, Mensa FJ. Concordance between sustained virologic response week 12 (SVR12) and SVR24 in genotype 1 hepatitis C virus patients receiving interferon-free treatment in the SOUND-C2 study. Hepatology 2013; 58:1516. [PMID: 23471832 DOI: 10.1002/hep.26363] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 12/23/2012] [Indexed: 12/07/2022]
Affiliation(s)
- Stefan Zeuzem
- Klinikum der J. W. Goethe-Universität, Frankfurt am Main, Germany
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Zeuzem S, Soriano V, Asselah T, Bronowicki JP, Lohse AW, Müllhaupt B, Schuchmann M, Bourlière M, Buti M, Roberts SK, Gane EJ, Stern JO, Vinisko R, Kukolj G, Gallivan JP, Böcher WO, Mensa FJ. Faldaprevir and deleobuvir for HCV genotype 1 infection. N Engl J Med 2013; 369:630-9. [PMID: 23944300 DOI: 10.1056/nejmoa1213557] [Citation(s) in RCA: 192] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Interferon-free regimens would be a major advance in the treatment of patients with chronic hepatitis C virus (HCV) infection. METHODS In this phase 2b, randomized, open-label trial of faldaprevir (a protease inhibitor) and deleobuvir (a nonnucleoside polymerase inhibitor), we randomly assigned 362 previously untreated patients with HCV genotype 1 infection to one of five groups: faldaprevir at a dose of 120 mg once daily and deleobuvir at a dose of 600 mg three times daily, plus ribavirin, for 16, 28, or 40 weeks (TID16W, TID28W, or TID40W, respectively); faldaprevir at a dose of 120 mg once daily and deleobuvir at a dose of 600 mg twice daily, plus ribavirin, for 28 weeks (BID28W); or faldaprevir at a dose of 120 mg once daily and deleobuvir at a dose of 600 mg three times daily, without ribavirin, for 28 weeks (TID28W-NR). The primary end point was a sustained virologic response 12 weeks after the completion of therapy. RESULTS The primary end point was met in 59% of patients in the TID16W group, 59% of patients in the TID28W group, 52% of patients in the TID40W group, 69% of patients in the BID28W group, and 39% of patients in the TID28W-NR group. The sustained virologic response 12 weeks after the completion of therapy did not differ significantly according to treatment duration or dosage among ribavirin-containing regimens. This response was significantly higher with TID28W than with TID28W-NR (P=0.03). Rates of a sustained virologic response 12 weeks after the completion of therapy were 56 to 85% among patients with genotype 1b infection versus 11 to 47% among patients with genotype 1a infection and 58 to 84% among patients with IL28B CC versus 33 to 64% with non-CC genotypes. Rash, photosensitivity, nausea, vomiting, and diarrhea were the most common adverse events. CONCLUSIONS The rate of a sustained virologic response 12 weeks after the completion of therapy was 52 to 69% among patients who received interferon-free treatment with faldaprevir in combination with deleobuvir plus ribavirin. (Funded by Boehringer Ingelheim; SOUND-C2 ClinicalTrials.gov number, NCT01132313.).
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Affiliation(s)
- Stefan Zeuzem
- Johann Wolfgang Goethe University Medical Center, Frankfurt am Main, Germany.
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Zeuzem S, Asselah T, Angus P, Zarski JP, Larrey D, Müllhaupt B, Gane E, Schuchmann M, Lohse AW, Pol S, Bronowicki JP, Roberts S, Arasteh K, Zoulim F, Heim M, Stern JO, Nehmiz G, Kukolj G, Böcher WO, Mensa FJ. Faldaprevir (BI 201335), deleobuvir (BI 207127) and ribavirin oral therapy for treatment-naive HCV genotype 1: SOUND-C1 final results. Antivir Ther 2013; 18:1015-9. [PMID: 23558093 DOI: 10.3851/imp2567] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Faldaprevir (BI 201335) and deleobuvir (BI 207127) are direct-acting antiviral agents under development for the treatment of chronic HCV infection. This article describes the final results of the Phase Ib SOUND-C1 study that evaluated the interferon-free oral combination of faldaprevir, deleobuvir and ribavirin in 32 treatment-naive patients infected with HCV genotype 1. METHODS Patients were randomized to receive deleobuvir 400 mg (n=15) or 600 mg (n=17) three times daily plus faldaprevir 120 mg once daily and weight-based ribavirin for 4 weeks. Interferon-free therapy was followed by response-guided faldaprevir plus pegylated interferon-α2a/ribavirin to week 24 or 48. RESULTS At week 4, 73% (11/15) and 100% (17/17) of patients in the deleobuvir 400 mg and 600 mg groups achieved HCV RNA<25 IU/ml, respectively. During interferon-free treatment, virological breakthrough was reported in one patient and re-increase of HCV RNA in one patient. Both patients were successfully treated with interferon-containing therapy. The rate of sustained virological response 24 weeks after completion of treatment was 73% (11/15) in the deleobuvir 400 mg group and 94% (16/17) in the 600 mg group. During faldaprevir plus pegylated interferon-α2a/ribavirin treatment, the most common adverse events were pruritus (38% of patients), rash (31%) and asthenia (31%); these were severe in approximately 3% of patients. CONCLUSIONS Potent antiviral activity and favourable safety of the treatment regimen were demonstrated. Furthermore, the results suggest that patients with breakthrough at week 4 may be rescued with an interferon-containing regimen. Clinical trials.gov number NCT01132313.
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Affiliation(s)
- Stefan Zeuzem
- JW Goethe University Hospital, Frankfurt am Main, Germany.
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