Telaprevir versus simeprevir for the treatment of recurrent hepatitis C after living donor liver transplantation. Issue 3 (6th July 2015)

• Record Type: Journal Article
• Authors: Ikegami, Toru; Yoshizumi, Tomoharu; Yoshida, Yoshihro; Kurihara, Takeshi; Harimoto, Norifumi; Itoh, Shinji; Shimokawa, Masahiro; Fukuhara, Takasuke; Shirabe, Ken; Maehara, Yoshihiko
• Is Part Of: Hepatology research. Volume 46:Issue 3(2016)
• Page Start: E136
• Page End: E145
• Publication Date: 2015-07-06
• Subjects: hepatitis C -- interferon -- liver transplantation -- living donor -- simeprevir -- telaprevir; Liver -- Diseases -- Periodicals; Liver Diseases -- Periodicals; Foie -- Maladies -- Périodiques; 616.362
• DOI: 10.1111/hepr.12546
• Languages: English
• ISSNs: 1386-6346

Abstract

Abstract : Aim: Our aim was to evaluate the clinical outcomes of telaprevir (TVR)‐ or simeprevir (SMV)‐based triple therapy for recurrent hepatitis C after living donor liver transplantation. Methods: Twenty‐six patients received antiviral therapy, consisting of either TVR ( n = 12) or SMV ( n = 14) in combination with pegylated interferon and ribavirin, plus cyclosporin. Results: More patients had a dose reduction of the direct‐acting agent (36.3% vs 0.0%, P = 0.02) or required blood transfusion for anemia (58.3% vs 7.1%, P < 0.01) in the TVR group. The cyclosporin trough/dose ratio increased significantly from week 0 to week 4 in the TVR group (1.6 ± 0.4 to 5.1 ± 2.0, P < 0.01), but not in the SMV group (1.2 ± 0.3 to 1.3 ± 0.2, P = 0.68). The 24‐week cumulative viral clearance rate was 91.7% and 85.7% in the TVR and in SMV groups, respectively. The early viral response and sustained viral response rates were 91.7% and 83.3%, respectively, in the TVR group, compared with 85.7% and 64.3%, respectively, in the SMV group. Interferon‐mediated graft dysfunction occurred in four and five patients in the TVR and SMV groups, respectively; two patients were treated by oral steroids, five by steroid pulse and two by thymoglobulin, resulting in viral breakthrough in one case. Conclusion: SMV‐based triple therapy was associated with fewer adverse events and drug interactions with cyclosporin, and possibly less antiviral properties to TVR. Interferon‐mediated graft dysfunction is a significant clinical problem that warrants particular caution following living donor liver transplantation.