Hepatology (Baltimore, Md.) 2018 04 10() doi 10.1002/hep.29918
Sofosbuvir (SOF) combined with NS5A inhibitors has demonstrated its efficacy in treating a recurrence of HCV after liver transplantation. However, the duration of treatment and the need for ribavirin (RBV) remain unclear in this population. Our aim was to determine whether liver transplant recipients could be treated with an SOF+NS5A inhibitor-based regimen without RBV for 12 weeks after liver transplantation (LT).
Between October 2013 and December 2015, 699 LT recipients experiencing an HCV recurrence were enrolled in the multicentre ANRS CO23 CUPILT cohort. We selected patients receiving SOF and NS5A inhibitor +/- RBV and followed for at least 12 weeks after treatment discontinuation. The primary efficacy endpoint was a SVR12.
Among these 699 patients, 512 fulfilled the inclusion criteria. Their main characteristics were: 70.1% genotype 1, 18.2% genotype 3, 21.1% cirrhosis and 34.4% previously treated patients. We identified four groups of patients according to their treatment and duration: SOF+NS5A without RBV for 12 (156 patients) or 24 (239 patients) weeks; SOF+NS5A+RBV for 12 (47 patients) or 24 (70 patients) weeks. SVR12 values reached 94.9%, 97.9%, 95.7% and 92.9%, respectively (p=0.14). Only twenty patients experienced a treatment failure. Under multivariate analysis, factors such as fibrosis stage, previous treatment, HCV genotype and baseline HCV viral load did not influence the SVR12 rates in the four groups (p=0.21). Haematological adverse events were more common in the RBV group: anaemia (p<0.0001), blood transfusion (p=0.0001). CONCLUSION
SOF+NS5A inhibitors without RBV for 12 weeks constituted reliable therapy for recurrent HCV after liver transplantation with an excellent SVR 12 whatever the fibrosis stage, HCV genotype and previous HCV treatment. This article is protected by copyright. All rights reserved.