Early efficacy and safety of direct-acting antiviral agents for the treatment of cirrhotic patients with hepatitis C

AN Zi-ying; SHENG Qiu-ju; ZHANG Chong; BAI Han; WANG Jing-yan; DOU Xiao-guang; DING Yang

doi:10.3969/j.issn.1007-8134.2016.02.005

Abstract：Objective To evaluate early efficacy and safety of direct-acting antiviral agents (DAAs) for the treatment of cirrhotic patients with hepatitis C.Methods HCV genotype 1b patients with cirrhosis were treated with DAAs [treatment protocol 1: sofosbuvir+ribavirin (RBV), treatment protocol 2: sofosbuvir+ledipasvir+RBV, treatment protocol 3: sofosbuvir+daclatasvir+RBV] for 24 weeks. Virological and biochemical markers were monitored at different time points, and adverse reactions were observed. This study focused on the analysis of the data obtained from 24 patients receiving 12 weeks of treatment.Results Of 24 patients, who had completed 12 weeks of treatment, 12 received treatment protocol 1, 6 treatment protocol 2, and the other 6 treatment protocol 3. Negative conversion rates of HCV RNA at week 1, 2, 4 and 12 were 25.00% (6/24), 45.83% (11/24), 66.67% (16/24) and 70.83% (17/24), respectively. Prolonged DAAs treatment resulted in an increased negative conversion rate of HCV RNA. Of patients receiving treatment protocol 1, HCV RNA negative conversion was obtained in 4 na?ve patients and 1 experienced patient at week 12 of treatment. Of patients receiving treatment protocol 2 and 3, HCV RNA negative conversion was obtained in 3 na?ve patients and 3 experienced patients at week 12 of treatment, respectively. As of January 2016, 3 patients were followed up for 12 weeks after medication cessation, of whom the 1 patient receiving treatment protocol 1 relapsed after medication cessation for 12 weeks with HCV RNA of 1.8×106 IU/ml, and the other 2 patients receiving treatment protocol 2 achieved sustained virological response with HCV RNA undetectable. ALT decreased to normal after 2 weeks of treatment and kept normal at week 12. Both CK and CK-MB elevated slightly after 1 week of treatment, but there were no significant differences at baseline and week 1. The two markers decreased to normal after 2 weeks of treatment and kept normal at week 12. BUN and CRE didn't increase during DAAs treatment, so there was no need to adjust the dose of DAAs. The common adverse reaction was nausea (58.83%).Conclusions DAAs treatment achieves good early efficacy and safety in HCV genotype 1b patients with cirrhosis. Treatment-experienced patients should be given a combination of sofosbuvir plus ledipasvir or daclatasvir.