Treatment of HCV infection in liver transplant recipients with ledipasvir and sofosbuvir without ribavirin. Issue 11 (6th April 2017)

• Record Type: Journal Article
• Authors: Pillai, A. A.; Maheshwari, R.; Vora, R.; Norvell, J. P.; Ford, R.; Parekh, S.; Cheng, N.; Patel, A.; Young, N.; Spivey, J. R.; Mgbemena, O.; Wedd, J. P.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 45:Issue 11(2017)
• Page Start: 1427
• Page End: 1432
• Publication Date: 2017-04-06
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.14059
• Languages: English
• ISSNs: 0269-2813

Abstract

Summary: Background: Ledipasvir and sofosbuvir is a well‐tolerated regimen with high sustained virological response (SVR) rates in pre‐liver transplant patients infected with chronic hepatitis C virus (HCV), but data in liver transplant recipients outside of clinical trials is limited. Aim: To address this knowledge gap and assess SVR rates without the use of ribavirin in liver transplant recipients Methods: This is a retrospective study examining the treatment of 75 post‐liver transplant recipients with ledipasvir and sofosbuvir without ribavirin. Differences between SVR cohorts and predictors of SVR were analysed in an intention‐to‐treat (ITT) fashion. Results: A total of 408 genotype 1, HCV patients were treated with ledipasvir/sofosbuvir from October 2014 to August 2015 at our centre. Seventy‐three patients were post‐liver transplant and were treated with a median of 2.9 years from transplant. Ledipasvir/sofosbuvir achieved an SVR12 of 95.9%. African Americans made up 28.8% of the cohort. Sixty‐three per cent of patients were treated previously, including 13.7% of patients previously treated with direct‐acting antivirals. Only 2.7% had recurrent allograft cirrhosis, and the majority (90.4%) was on calcineurin inhibitor based immunosuppressive therapy. Approximately 82% of patients had chronic kidney disease (CKD) stage 2 or 3. In univariate logistic regression, only detectable week 8 viral load was predictive of failure to achieve SVR. Conclusion: Our data confirm excellent SVR outcomes and favourable safety and tolerability profiles with ledipasvir/sofosbuvir without ribavirin in post‐liver transplant recipients infected with HCV, despite treatment guidelines to use ribavirin. Abstract : Linked Content This article is linked to Schmidt‐Martin and Elsharkawy paper. To view this article visithttps://doi.org/10.1111/apt.14110 .