Journal
JOURNAL OF GASTROENTEROLOGY
Volume 53, Issue 10, Pages 1142-1150Publisher
SPRINGER JAPAN KK
DOI: 10.1007/s00535-018-1455-1
Keywords
Chronic hepatitis C; Ledipasvir; Sofosbuvir; Alpha-fetoprotein
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Funding
- Japan Agency for Medical Research and Development [15fk0210007h0002]
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BackgroundWe aimed to describe the real-world efficacy and safety of combination therapy with ledipasvir and sofosbuvir (LDV/SOF) for chronic hepatitis C virus (HCV) genotype 1 (GT1) infection.MethodsThis retrospective analysis of a prospective, nationwide, multicenter registry included GT1-infected patients treated with LDV/SOF for 12weeks. We assessed the rate of sustained virological response at 12weeks post-treatment (SVR12), incidence of adverse events, and serum markers of hepatocellular carcinoma (HCC).ResultsAmong the 1461 patients included (mean age, 69years; 29.5% aged>75years; cirrhosis, 23.8%; history of treatment for HCC, 10.9%), the overall SVR12 rate was 98.4% (1438/1461). Factors associated with treatment failure were cirrhosis (odds ratio, 4.19; p=0.014) and resistance-associated substitutions (RASs) in NS5A at baseline (odds ratio, 7.78; p=0.0004). The SVR12 rate in patients with cirrhosis and NS5A RASs was 93.0% compared to 100% in patients without cirrhosis or NS5A RASs. In patients with SVR, the levels of alpha-fetoprotein (AFP), AFP-L3, and Mac-2 binding protein glycosylation isomer (M2BPGi) decreased from baseline to end of treatment (from 13.437.6 to 6.0 +/- 10.6ng/mL, p<0.0001; from 2.2 +/- 4.9 to 1.5 +/- 6.3%, p<0.005; and from 3.6 +/- 3.7 to 2.0 +/- 3.5 cut-off index, p<0.0001; respectively). Adverse events were rare and not associated with age. No decrease in estimated glomerular filtration rate was observed in patients with baseline chronic kidney disease stage 3.Conclusions p id=Par4 LDV/SOF therapy is highly effective and safe in elderly Japanese patients with HCV GT1, even in the presence of cirrhosis or NS5A RASs. Patients with SVR may have a lower risk of HCC.
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