Efficacy of Sofosbuvir Based Therapy for Recurrent Hepatitis C After Liver Transplantation
1Internal Medicine, Henry Ford Hospital, Detroit, MI
2Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, MI.
Meeting: 2015 American Transplant Congress
Abstract number: A192
Keywords: Hepatitis C, Liver, Liver transplantation, Viral therapy
Session Information
Session Name: Poster Session A: Liver Transplantation: Viral Hepatitis
Session Type: Poster Session
Date: Saturday, May 2, 2015
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
Purpose: Evaluate outcomes of sofosbuvir-based hepatitis C therapy in liver transplant patients in a single center clinical setting, including interferon-free regimens.
Methods: All patients with history of liver transplant (LT) initiated on Sofosbuvir based therapy between December 19, 2013 and August 4, 2014 were evaluated for efficacy of therapy. Viral response was determined by HCV RNA levels on treatment at 4 weeks and 12 weeks, at end of treatment, and post treatment sustained viral response at week 4 (SVR 4) and week 12 (SVR 12).
Results: A total of 46 patients initiated therapy. Mean age was 61. Average BMI was 27.9. 14 had biopsies with Ishak score of 3 or greater.
| Regimen, Sofosbuvir with: | Total Patients | Virus PCR Undetectable At: | ||||
| Week 4 | Week 12 | End of Treatment | SVR4 | SVR12 | ||
| Ribavirin | 18 | 12/18 | 16/17 | 12/14 | 8/12 | 2/6 |
| Ribavirin/ Interferon | 9 | 6/9 | 9/9 | 9/9 | 6/8 | 6/8 |
| Simeprevir | 11 | 10/11 | 10/10 | 10/10 | 9/9 | 3/3 |
| Daclatasvir | 8 | 4/8 | 8/8 | 4/4 | 3/3 | – |
| Overall | 46 | 32/46 | 43/44 | 35/37 | 26/32 | 11/17 |
Of the 14 patients with detectable HCV PCR at 4 weeks into treatment, 11 had viral level less than 43 IU/mL. Of the patients for whom data is available, 26/32 (81%) have an SVR4 and 11/17 (65%) have SVR12. The combination of sofosbuvir with either simeprevir or daclatasvir were especially effective with SVR4 rates of 100%. 24 patients had Genotype 1a, with an SVR4 of 87%. 16 patients were Genotype 1b, with an SVR4 of 75%. Patients with Ishak score of 4 or higher or known cirrhosis had an end of treatment undetectable viral PCR rate of 100% (7 patients) and SVR12 of 100% (3 patients).
Average hemoglobin nadir was approximately 1.9 g/dL lower than pretreatment hemoglobin overall (12.6 g/dL to 10.7 g/dL). This was managed with ribavirin dose reduction and no discontinuation of therapy. Fatigue was the most common documented patient-reported side effect, affecting 20% of patients. One patient died while on treatment secondary to autoimmune hepatitis affecting the transplanted liver.
Conclusion: The use of sofosbuvir in hepatitis C after liver transplantation appears encouraging based on our limited patient sample. Our results suggest that interferon-free regimens built around sofosbuvir may be more efficacious than regimens with interferon. Combining sofosbuvir with either simeprevir or daclatasvir was especially efficacious with SVR4 of 100%. Sofosbuvir based regimens were well tolerated.
To cite this abstract in AMA style:
Weick A, George K, Jafri S-M, Moonka D. Efficacy of Sofosbuvir Based Therapy for Recurrent Hepatitis C After Liver Transplantation [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/efficacy-of-sofosbuvir-based-therapy-for-recurrent-hepatitis-c-after-liver-transplantation/. Accessed November 21, 2024.« Back to 2015 American Transplant Congress