Efficacy and safety of combined directly acting antivirals for treatment of Chinese chronic hepatitis C patients in a real-world setting

Abstract

AIMTo assess the efficacy and safety of combined directly acting antivirals (DAAs) for the treatment of Chinese chronic hepatitis C (CHC) patients in a real-world setting.METHODSHospitalized CHC patients who were treated with DAAs at Peking University First Hospital between January 2015 and December 2016 were enrolled. Samples and clinical data were collected at 0 wk, 2 wk, 4 wk, 8 wk, 12 wk, or 24 wk during DAAs treatment and at 4 wk, 12 wk, and 24 wk after the end of treatment.RESULTSFifty-four patients who underwent DAAs treatment were included in our study, of whom 83.3% (45/54) achieved rapid virological response at 2 wk after treatment initiation (RVR 2) and 94.4% (51/54) achieved sustained virological response at 24 wk after the end of treatment (SVR 24). Serum creatinine and uric acid levels at the end of treatment were significantly increased compared with baseline levels (83.6 ± 17.9 vs 88.8 ± 19.4, P01 < 0.001; 320.8 ± 76.3 vs 354.5 ± 87.6, P01 < 0.001), and no significant improvements were observed at 24w after the end of treatment (83.6 ± 17.9 vs 86.8 ± 19.1, P02 = 0.039; 320.8 ± 76.3 vs 345.9 ± 89.4, P02 = 0.001). The total frequency of adverse events (AEs) during treatment was 33.3% (18/54), with major AEs being fatigue (16.7%), headache (7.4%), anorexia (7.4%), and insomnia (5.6%).CONCLUSIONThough based in a small cohort of patients, the abnormal changes in renal function indices and relative high frequency of AEs during combined DAAs treatment should be taken as a note of caution.

Improvement of hyperuricemia in chronic hepatitis C patients receiving directly acting antiviral agents

“…An animal study demonstrated that SUA levels may decrease after DAA treatment . Nevertheless, it has been suggested that SUA levels may increase via the performance of human studies . It should be noted that the sample sizes in the previous studies were small.…”

“…29 Nevertheless, it has been suggested that SUA levels may increase via the performance of human studies. 30,31 It should be noted that the sample sizes in the previous studies were small. Importantly, drugs that may alter SUA levels were not excluded from previous work as they were in this study.…”

“…Importantly, drugs that may alter SUA levels were not excluded from previous work as they were in this study. For example, the elevated SUA levels during ribavirin use may be misinterpreted, due to the hemolysis of red blood cells . Sofosbuvir has been proposed to affect the levels of xanthine oxidoreductase, which may cause the elevation of SUA levels .…”

Sofosbuvir induced steven Johnson Syndrome in a patient with hepatitis C virus‐related cirrhosis

“…A real‐world experience with sofosbuvir‐based DAA regimens reported rash in up to 2.6% (n = 344) of patients: 6% with sofosbuvir, PEG‐IFN, plus ribavirin; 0% with sofosbuvir plus ribavirin; and 0% with sofosbuvir and daclatasvir/ledipasvir with or without ribavirin . Two other real‐world studies did not report any rash related to sofosbuvir‐based regimens . Interestingly, these studies failed to provide the morphologic description of the rash associated with the DAAs.…”

“…(7) Two other realworld studies did not report any rash related to sofosbuvir-based regimens. (8,9) Interestingly, these studies failed to provide the morphologic description of the rash associated with the DAAs. However, recently there have been reports of seborrheic dermatitis and erythema multiforme with the use of sofosbuvir and daclatasvir, (10,11) lichenoid eruptions with sofosbuvir and simeprevir, (12) and erythrodermic pityriasis rubra pilaris eruptions with sofosbuvir.…”