Sofosbuvir/Ribavirin therapy for patients experiencing failure of ombitasvir/paritaprevir/ritonavir + ribavirin therapy: Two cases report and review of literature

Abstract

BACKGROUND The effectiveness of sofosbuvir/ribavirin (SOF/RBV) combination therapy, which is one of the 1 st -choice therapeutic options for patients with hepatitis C virus (HCV) genotype 2 (HCV-G2) in Japan according to the most recent version of the Japan Society of Hepatology guideline, for patients who experienced failure of the ombitasvir/paritaprevir/ritonavir plus ribavirin (OBV/PTV/r+RBV) combination therapy, which was another option for patients with HCV-G2, is unknown. CASE SUMMARY We evaluated the effects of SOF/RBV combination therapy in two patients with genotype 2a who could not achieve a sustained virological response (SVR) by OBV/PTV/r+RBV combination therapy. One patient was complicated with Vogt-Koyanagi-Harada (VKH) disease. Resistance-associated variations before SOF/RBV combination therapy were not detected in two patients. Both patients had an SVR at 12 wk after the treatment (SVR12). Regarding adverse events (AEs), itching, chill, a dull feeling in the throat and cough as well as increase of alanine transaminase level were shown in one patient, while a headache and deterioration of light aversion probably due to the recurrence of VKH disease were shown in the other patients. In addition, the latter patient developed arthralgia and morning stiffness approximately 7 wk after the therapy and turned out to be diagnosed with rheumatoid arthralgia. CONCLUSION SOF/RBV therapy might be effective for patients experiencing failure of OBV/PTV/r+RBV therapy, but caution should be taken regarding the AEs.

Prognosis and incidence of immunological and oncological complications after direct-acting antiviral therapy for chronic hepatitis C

“…Our results showed several cases of newonset RA, one of which we reported previously (5), and new-onset MPGN observed after DAA therapy. To our knowledge, there have been no reports of new-onset RA after DAA therapy except for our previously reported case (5). However, cases of new-onset or worsened MPGN have been reported after achieving SVR following DAA therapy (27)(28)(29), which supports our data.…”

“…MPGN was ameliorated following DAA therapy in some but not all cases (24)(25)(26). Our results showed several cases of newonset RA, one of which we reported previously (5), and new-onset MPGN observed after DAA therapy. To our knowledge, there have been no reports of new-onset RA after DAA therapy except for our previously reported case (5).…”

“…Sofosbuvir-based regimens and daclatasvir+asunaprevir combination therapy were administered to five and three cases, respectively. One patient in whom VKH disease deteriorated as an original complication developed new-onset RA, which we previously reported (5). Euthyroid Graves' disease was diagnosed by chance during the detailed examination of hypertension that was discovered while the patient was followed up after DAA therapy.…”

“…The mechanism underlying the development of autoimmune diseases after DAA therapy remains unknown. We previously suggested that one of the reasons was that immune reconstitution/restoration due to DAA therapy might be involved in the mechanism (5). The transcription levels of interleukin (IL)1β and chemokine (C-X-C motif) ligand 10/IFN gamma-induced protein 10 (IP-10) and IFN-induced protein with tetratricopeptide repeats 1 are temporally and numerically increased after two and/or four weeks of DAA therapy compared to the baseline (8).…”

“…After DAA therapy, VKH disease was exacerbated, and rheumatoid arthritis (RA) newly developed. Based on this experience, we considered a potentially causal relationship between DAA therapy and the "deterioration of VKH disease and emergence of RA" (5). Indeed, DAA therapy has been shown to affect the immune system (6)(7)(8).…”