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Pellicelli A, Messina V, Giannelli V, Distefano M, Palitti VP, Vignally P, Tarquini P, Izzi A, Moretti A, Babudieri S, Dell'Isola S, Marignani M, Scifo G, Iovinella V, Cariti G, Pompili M, Candilo FD, Fontanella L, Ettorre GM, Vennarecci G, Ippolito AM, Barbarini G. High Efficacy and Safety of Flat-Dose Ribavirin Plus Sofosbuvir/Daclatasvir in Genotype 3 Cirrhotic Patients. Gut Liver 2021; 14:357-367. [PMID: 30970444 PMCID: PMC7234881 DOI: 10.5009/gnl18269] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/12/2018] [Accepted: 12/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background/Aims Patients with genotype 3 hepatitis C virus (G3-HCV) cirrhosis are very difficult to treat compared to patients with other HCV genotypes. The optimal treatment duration and drug regimen associated with ribavirin (RBV) remain unclear. To evaluate the efficacy and safety of daclatasvir (DCV)/sofosbuvir (SOF) plus a flat dose of 800 mg RBV (flat dose) compared to DCV/SOF without RBV or DCV/SOF plus an RBV dose based on body weight (weight-based) in G3-HCV patients with compensated or decompensated cirrhosis. Methods We analyzed data for 233 G3 cirrhotic patients. Of these, 70 (30%), 87(37%) and 76 (33%) received SOF/DCV, SOF/DCV/RBV flat dose, and SOF/DCV/RBV weight-based dose, respectively. Treatment duration was 24 weeks. Sustained virological response (SVR) was evaluated at week 12 posttreatment (SVR12). Results Overall, SVR12 was achieved in 220 out of 233 patients (94.4%). The SVR12 rate was lower in the DCV/SOF group than in the DCV/SOF/RBV flat-dose group and the DCV/SOF/RBV weight-based group (87.1% vs 97.7% and 97.4%, respectively, p=0.007). A higher incidence of anemia occurred in the DCV/SOF/RBV weight-based group compared to those in the other two groups (p<0.007). Conclusions We found that the DCV/SOF/RBV flat-dose regimen is an effective treatment in terms of efficacy and safety in patients with G3-HCV compensated or decompensated cirrhosis. Therefore, antiviral regimens without RBV should be restricted only to naïve patients with G3-HCV compensated cirrhosis who have a clear contraindication for RBV.
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Affiliation(s)
| | - Vincenzo Messina
- Department of Infectious Disease, Sant'Anna and San Sebastiano Hospital, Caserta, Italy
| | - Valerio Giannelli
- Liver and Transplant Unit, San Camillo Forlanini Hospital, Rome, Italy
| | | | | | | | - Pierluigi Tarquini
- Department of Infectious Disease, Giuseppe Mazzini Hospital, Teramo, Italy
| | - Antonio Izzi
- Department of Infectious Disease and Emergency Infectious Disease, Cotugno Hospital, Napoli, Italy
| | | | - Sergio Babudieri
- Department of Infectious Disease, University of Sassari, Sassari, Italy
| | | | | | - Gaetano Scifo
- Liver Unit, Azienda Umberto I Hospital, Siracusa, Italy
| | | | - Giuseppe Cariti
- Infectious Disease, Department of Medical Science, University of Turin, Turin, Italy
| | - Maurizio Pompili
- Department of Internal Medicine, Catholic University, Rome, Italy
| | | | - Luca Fontanella
- Center for Liver Disease, Fatebenefratelli Hospital, Napoli, Italy
| | - Giuseppe M Ettorre
- Division of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Giovanni Vennarecci
- Division of General Surgery and Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Antonio Massimo Ippolito
- Division of Gastroenterology, Casa Sollievo Sofferenza Hospital IRCCS, San Giovanni Rotondo, Pavia, Italy
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