New Ways to Treat HCV Infection After Liver Transplant

New direct-acting agents against hepatitis C virus (HCV) can cure the infection when it recurs in patients with liver transplants.

Researchers reported findings from 3 separate studies at the 65th Annual Meeting of the American Association for the Study of Liver Diseases last week in Boston.

HCV is the leading indication for liver transplant in the US. However, the virus always reinfects the graft, leading to cirrhosis in 20%−30% of patients, and even graft loss. However, combinations of direct-acting antiviral agents appear to effectively eradicate the virus when it recurs.

K. Rajender Reddy et al. reported the effects of combination treatment with ledipasvir, sofosbuvir, and ribavirin in 223 patients who developed recurrence of HCV genotype 1 or 4 infection following liver transplantation.

Yahoo News wrote that following 12 or 24 weeks treatment, 96% and 98%, respectively, of patients without cirrhosis had a sustained viral response 12 weeks after therapy ended (SVR12). Among patients with compensated cirrhosis, 96% achieved an SVR12 with 12 or 24 weeks of treatment. The rate of SVR12 among patients with decompensated cirrhosis was 81% with 12 weeks or 24 weeks of therapy.

In a late-breaking abstract session at the meeting, Robert Brown reported that 12 weeks treatment with a combination of sofosbuvir and simeprevir led to SVR12 in 90% in transplant recipients.

Parvez Mantry reported findings from a phase 2 trial of 34 liver transplant recipients with recurrent genotype 1 HCV and no or mild fibrosis in the hepatitis plenary session at the meeting. The subjects received 24 weeks treatment with the NS5A inhibitor ombitasvir, the protease inhibitor ABT-450, and the non-nucleoside NS5B polymerase inhibitor dasabuvir (known as the 3D combination), along with ritonavir and ribavirin.

Medpage Today wrote that 33 of the patients (97%) achieved an SVR12 and remained without evidence of HCV infection at 24 weeks following treatment. Mantry said that they observed an SVR12 in all 5 patients (100%) with genotype 1b infections.

However, Mantry added that the drug combination interacted with tacrolimus (an immunosuppressant given to patients receiving organ transplants), and therefore required dose reduction.

Mantry and colleagues also published their findings in the New England Journal of Medicine.

MedPage Today wrote that a key issue with this combination is that the drugs are expensive and not covered by insurance companies. However, use of the combination earlier in the disease course might prevent the need for transplant, saving $200,000 or so for the procedure itself and also about $10,000 a year for immune suppression.

 

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