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Direct-acting antiviral (DAA)-based therapies are effective and well-tolerated for HCV patients with stage four to five chronic kidney disease, a meta-analysis of published studies shows.
Reviewers at the Second Hospital of Shandong University in China found 11 studies involving a total of 264 patients. The pooled SVR12 rate was 93.2% for the total population, 89.4% for sofosbuvir-based therapies, and 94.7% for non-sofosbuvir-based therapies. For HCV genotype 1 patients, the pooled SVR12 rate was 93.1%.
The pooled incidence of serious adverse events was 12.1%, and the pooled discontinuation rate because of adverse events or serious adverse events was 2.2%.
Efficacy and safety of DAA-based antiviral therapies for HCV patients with stage 4-5 chronic kidney disease: a meta-analysis. Li T, Qu Y, Guo Y et al. Liver Int. 2016 Dec 10 [Epub ahead of print]
A large observational study in the USA confirmed haemophilia per se does not have a specific influence on transplant outcomes in HCV patients, but that HIV infection increases the risk of mortality in both haemophilic (H) and non-haemophilic (NH) patients.
Researchers identified 2,502 HCV-positive liver transplant candidates from eight US university-based transplant centres between 2004 and 2010, including 144 HIV-positive and 2,358 HIV-negative; 36 H and 2,466 NH; 1,213 transplanted and 1,289 not transplanted patients.
In univariate analysis, 90-day pre-transplant mortality was associated with higher baseline MELD (hazard ratio 1.15), lower baseline platelet count (hazard ratio 1.11 per 25k/µL), and having HIV/HCV-positive haemophilia.
In multivariate analysis, pre-transplant mortality was associated with higher MELD and was significantly greater in HIV-positive than HIV- groups, but did not differ between HIV-positive H and NH (hazard ratio 1.7). Among HIV/HCV-positive, post-transplant mortality was similar between H and NH, despite lower CD4 in H.
Haemophilia liver transplantation observational study (HOTS). Ragni MV, Humar A, Stock PG et al. Liver Transpl. 2016 Dec 9 [Epub ahead of print]
A significant number of HCV patients develop a major depressive episode (MDE) during interferon-alpha (IFN-α) based immunotherapy, and several mechanisms may be involved.
Authors of a new literature review found eight unique references which met their inclusion criteria, and which involved 826 people with HCV (37.3% females). The overall MDE incidence rate was 34.8%, with follow-up ranging between four and 48 weeks. The methodological quality varied across selected studies. It was found that Interleukin-6, salivary cortisol, arachidonic acid/eicosapentaenoicacid plus ocosahexaenoic acid ratio, and genetic polymorphisms may present variations which are linked to a predisposition to INF-α-induced depression.
However, a meta-analysis could not be performed because of the diverse biological mechanisms investigated and the lack of replicated evidence. The reviewers, therefore, concluded the mechanisms involved in IFN-α-induced depression in humans remained unclear.
Biological mechanisms of depression following treatment with interferon for chronic hepatitis C: a critical systematic review. Machado MO, Oriolo G, Bortolato B et al. J Affect Disord. 2016 Nov 27; 209:235-245 [Epub ahead of print]
Some patients with non-alcoholic steatohepatitis (NASH) show recurrence of fibrosis as early as six to 12 months following their transplant.
This emerged in a study at the Medical University of Vienna which compared the recurrence of liver fibrosis in 15 patients transplanted for NASH with 12 to cryptogenic cirrhosis (CC) patients after orthotopic liver transplantation (OLT) between 2004 and 2015.
The case load for OLT because of NASH was constantly increasing (two in 2004-2007 compared with nine in 2012-2015) whilst decreasing for CC (six in 2004-2007 compared with two in 2012-2015). Patient characteristics at OLT were similar, except for an older age and a higher BMI in the NASH patients.
Although post-OLT plasma lipid levels and the incidence of de-novo hypertension, diabetes, and hyperlipidemia were similar between groups, the post-transplant NAFLD fibrosis score (NFS) re-increased in the NASH group but not in the CC group (-0.1317 versus -1.3645 at 12 months post-OLT.
The post-transplant course of patients undergoing liver transplantation for nonalcoholic steatohepatitis versus cryptogenic cirrhosis: a retrospective case-control study. Unger LW, Herac M, Staufer K et al. Eur J Gastroenterol Hepatol. 2016 Dec 2 [Epub ahead of print]
A new study has concluded that the new direct-acting antivirals (DAAs) are highly effective with minimal adverse effects for the treatment of HCV in haemodialysis, and are a very important advance in HCV management.
In this retrospective study, HCV antibodies were analysed in 465 patients at two Madrid hospitals. Positive antibodies were found in 54, and, among these, 29 with genotypes 1 and 4 were treated with different DAA regimens, including combinations of paritaprevir/ritonavir, ombitasvir, dasabuvir, sofosbuvir, simeprevir, daclatasvir and ledipasvir, with/without ribavirin. The most important aetiology of chronic kidney disease involved glomerular abnormalities.
In all cases, a sustained viral response was achieved after 24 weeks, regardless of DAA regimen received. Adverse effects were not relevant and no case required stopping treatment. In 15 cases, ribavirin was combined with the DAA. In these cases, the most significant adverse effect was an anaemic tendency, which was reflected in the increase of the dose of erythropoietin stimulating agents, although none required transfusions.
Effectiveness of direct-acting antivirals in Hepatitis C virus infection in haemodialysis patients. Abad S, Vega A, Rincón D et al. Nefrologia. 2016 Nov 30 [Epub ahead of print]
Although tenofovir (TDF) was more effective at three months, there was no significant difference between TDF and entecavir (ETV) in the long-term treatment of HBV related liver cirrhosis, a new meta-analysis of studies found.
A literature search, conducted by reviewers from Beijing You'an Hospital, found significant difference of ALT norm level at three months (RR 1.43) and six months (RR 0.89), and significant difference of undetectable HBV-DNA only at three months follow-up period (RR 1.59) between TDF and ETV, but no significant difference in the long-term period. There was a significant difference between TDF and ETV in eGFR level (RR 1.601) and hypophosphatemia incidence (RR 4.008).
The efficacy and safety comparison between tenofovir and entecavir in treatment of chronic hepatitis B and HBV related cirrhosis: a systematic review and meta-analysis. Han Y, Zeng A, Liao H et al. Int Immunopharmacol. 2016 Dec 1;42: 168-175 [Epub ahead of print]
A new study of HBV patients shows that the protective effect against cirrhosis of being female is gradually lost with increasing age.
This multicentre study from China investigated the interaction of female gender and older age on the development of cirrhosis in patients recorded in the China Registry of HBV. A total of 17,809 chronic HBV patients were studied.
The prevalence of cirrhosis in the females increased faster than that in the males over 50 years old. Multivariate analysis showed that the increase of adjusted odds ratios for developing cirrhosis in females started to accelerate after 50 years of age: 11.19 in women versus 14.75 in men aged 50 to 59; 21.67 versus 24.4 at ages 60 to 69; and 18.78 versus 12.09 in those aged over 70.
The study authors suggest that disease progression should be monitored more closely in elderly women with chronic HBV.
Female gender lost protective effect against disease progression in elderly patients with chronic hepatitis B. You H, Kong Y, Hou J et al. Sci Rep. 2016 Nov 28;6: 37498
Two otherwise unrelated studies have testified to the efficacy and safety of the combination of simeprevir and sofosbuvir in patients with HCV.
In the US-based GALAXY study, the combination, with or without ribavirin, was efficacious and well tolerated in patients with recurrent HCV genotype 1 post-orthotopic liver transplant (1).
Thirty-three such patients without cirrhosis were randomised into three arms: Arm 1, received simeprevir+sofosbuvir+ribavirin for 12 weeks; Arm 2, received simeprevir+sofosbuvir for 12 weeks; Arm 3 received simeprevir+sofosbuvir for 24 weeks; 13 additional subjects (two with cirrhosis, 11 without cirrhosis) entered Arm 3.
Among the randomised subjects, SVR12 was achieved by 81.8% in Arm 1, 100% in Arm 2, and 93.9% in Arm 3; two subjects did not achieve SVR12: one viral relapse
(follow-up Week 4; Arm 1) and one missing follow-up Week 12 data. Five subjects had a serious adverse event, considered unrelated to treatment per investigator.
In Spain’s PLUTO study, the combination of simeprevir plus sofosbuvir for 12 weeks resulted in SVR12 rates of 100% in treatment-naïve and -experienced patients with HCV genotype 4 with or without compensated cirrhosis, and was well tolerated (2).
Forty patients received the combination for 12 weeks. Seven of the patients had compensated cirrhosis. All achieved SVR12. Adverse events, all Grade 1 or 2, were reported in 20 patients. No serious adverse events were reported and no patients discontinued study treatment. Grade 3 treatment-emergent laboratory abnormalities occurred in two patients.
Efficacy and safety of simeprevir and sofosbuvir with and without ribavirin in subjects with recurrent genotype 1 hepatitis C post-orthotopic liver transplant: the randomized GALAXY study. O'Leary JG, Fontana RJ, Brown K et al. Transpl Int. 2016 Nov 29 [Epub ahead of print]
Simeprevir in combination with sofosbuvir in treatment-naïve and -experienced patients with hepatitis C virus genotype 4 infection: a Phase III, open-label, single-arm study (PLUTO). Buti M, Calleja JL, Lens S et al. Aliment Pharmacol Ther. 2016 Nov 29 [Epub ahead of print]
The overall rate of increase in hepatocellular carcinoma (HCC) slowed between 2010 and 2012, found a nationwide US study. However, it did increase in some sub-groups such as men aged 55 to 64, and whites/Caucasians.
Researchers at Baylor College of Medicine in Texas analysed data from the US Cancer Statistics registry, which covers 97% of the population of all 50 states.
They found that the HCC incidence increased from 4.4/100,000 in 2000 to 6.7/100,000 in 2012, increasing by 4.5% annually between 2000 and 2009, but only by 0.7% annually between 2010 and 2012.
The average annual percentage change (AAPC) between 2000 and 2012 was higher in men (increase of 3.7%) than women (increase of 2.7%), and highest in 55 to 59-year-olds (AAPC 8.9%) and 60 to 64-year-olds (AAPC 6.4%).
By 2012, rates in Hispanics surpassed those in Asians, and rates in Texas surpassed those in Hawaii (9.71/100,000 vs 9.68/100,000). Geographic variation within individual race and ethnic groups was observed, but rates were highest in all major race and ethnic groups in Texas.
Incidence of hepatocellular carcinoma in all 50 United States, from 2000 through
2012. White DL, Thrift AP, Kanwal F et al. Gastroenterology. 2016 Nov 23 [Epub ahead of print]
A comparison of three different anti-HCV regimens concluded that all of them appeared highly effective in achieving sustained virologic response (SVR).
A study at the University of Southern California compared the SVR rates achieved 12 weeks post-treatment in 11,464 patients treated with three such agents by the Veterans Health Administration.
Without controlling for other risk factors, a SVR at least 12 weeks post treatment was achieved in 92% of ledipasvir/ sofosbuvir, 86% of ombitasvir/paritaprevir/ritonavir/dasabuvir, and 83% of simeprevir/sofosbuvir patients.
After adjusting for patient characteristics, simeprevir/sofosbuvir (93.3%) and ledipasvir/sofosbuvir (96.2%) patients were statistically more likely than ombitasvir/paritaprevir/ritonavir/dasabuvir (91.8%) patients to demonstrate a SVR.
HIV, HBV, diabetes, obesity, previous treatment history and augmentation therapy using ribavirin did not impact the SVR rates. Sustained SVR rates were lower for patients under age 65, with cirrhosis, decompensated cirrhosis, hepatocellular carcinoma, indications of fibrosis or a non-genotype 1 infection. Women and Caucasian patients were more likely to achieve a SVR.
Comparative treatment effectiveness of direct acting antiviral regimens for hepatitis C: data from the Veterans Administration. Fox DS, McGinnis JJ, Tonnu-Mihara I et al. J Gastroenterol Hepatol. 2016 Nov 21 [Epub ahead of print]