Safety and Efficacy of Simeprevir/Sofosbuvir in Hepatitis C–Infected Patients With Compensated and Decompensated Cirrhosis. Issue 3 (30th July 2015)

• Record Type: Journal Article
• Authors: Saxena, Varun; Nyberg, Lisa; Pauly, Marypat; Dasgupta, Aditi; Nyberg, Anders; Piasecki, Barbara; Winston, Bradley; Redd, Jacquelyn; Ready, Joanna; Terrault, Norah A.
• Is Part Of: Hepatology. Volume 62:Issue 3(2015:Sep.)
• Page Start: 715
• Page End: 725
• Publication Date: 2015-07-30
• Subjects: Heart -- Diseases -- Nursing -- Periodicals; Lungs -- Diseases -- Nursing -- Periodicals; Intensive care nursing -- Periodicals; Foie -- Maladies -- Périodiques; 616.362
• DOI: 10.1002/hep.27922
• Languages: English
• ISSNs: 0270-9139

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <p>Risks and benefits of simeprevir plus sofosbuvir (SIM+SOF) in patients with advanced cirrhosis are unknown. We assessed the safety and sustained virological responses (SVR) of SIM+SOF with and without ribavirin (RBV) in patients with Child‐Pugh (CP)‐B/C versus CP‐A cirrhosis and compared to matched untreated controls. This study was of a multicenter cohort of adults with hepatitis C virus genotype 1 and cirrhosis treated with SIM+SOF with/without RBV for 12 weeks. Controls were matched on treatment center, age, CP class, and Model for End‐Stage Liver Disease (MELD) score. Of 160 patients treated with SIM+SOF with/without RBV, 35% had CP‐B/C and 64% had CP‐A, with median baseline MELD 9 (interquartile range, 8‐11). Sustained virological response at week 12 (SVR12) was achieved by 73% of CP‐B/C versus 91% of CP‐A (<italic>P</italic> < 0.01). CP‐B/C versus CP‐A had more early treatment discontinuations (11% vs. 1%), adverse events (AEs) requiring hospitalization (22% vs. 2%), infections requiring antibiotics (20% vs. 1%), and hepatic decompensating events (20% vs. 3%; all <italic>P</italic> < 0.01). There were 2 deaths: 1 CP‐B/C (liver related) and 1 CP‐A (not liver related). In multivariate analysis, CP‐B/C independently predicted lack of SVR12 (odds ratio, 0.27; 95% confidence interval: 0.08‐0.92). In comparing SIM+SOF‐treated patients versus matched untreated controls, AEs requiring hospitalization (9% vs. 13%; <italic>P</italic> = 0.55), infections (8% vs. 6%; <italic>P</italic> = 0.47), and events of decompensation (9% vs. 10%; <italic>P</italic> = 0.78) occurred at similar frequency. <italic>Conclusions</italic>: SIM+SOF with/without RBV has lower efficacy and higher rates of AEs in patients with CP‐B/C cirrhosis, compared to CP‐A. Frequency of adverse safety outcomes were similar to matched untreated controls, suggesting that safety events reflect the natural history of cirrhosis and are not related to treatment. (H<sc>epatology</sc> 2015;62:715–725)</p> </abstract>