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Real-world efficacy and safety of ledipasvir and sofosbuvir in patients with hepatitis C virus genotype 1 infection: a nationwide multicenter study by the Japanese Red Cross Liver Study Group

  • Keiji Tsuji
  • Masayuki Kurosaki
  • Jun Itakura
  • Nami Mori
  • Shintaro Takaki
  • Chitomi Hasebe
  • Takehiro Akahane
  • Kouji Joko
  • Hitoshi Yagisawa
  • Jirou Takezawa
  • Ryou Nakata
  • Atsunori Kusakabe
  • Yuji Kojima
  • Hiroyuki Kimura
  • Takashi Tamada
  • Haruhiko Kobashi
  • Akeri Mitsuda
  • Masahiko Kondou
  • Chikara Ogawa
  • Yasushi Uchida
  • Tetsuro Sohda
  • Ryouichi Narita
  • Namiki Izumi
Original Article—Liver, Pancreas, and Biliary Tract

Abstract

Background

We 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.

Methods

This retrospective analysis of a prospective, nationwide, multicenter registry included GT1-infected patients treated with LDV/SOF for 12 weeks. We assessed the rate of sustained virological response at 12 weeks post-treatment (SVR12), incidence of adverse events, and serum markers of hepatocellular carcinoma (HCC).

Results

Among the 1461 patients included (mean age, 69 years; 29.5% aged > 75 years; 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 13.4 ± 37.6 to 6.0 ± 10.6 ng/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

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.

Keywords

Chronic hepatitis C Ledipasvir Sofosbuvir Alpha-fetoprotein 

Notes

Acknowledgements

This study was supported by a Grant-in aid from the Japan Agency for Medical Research and Development (Grant number: 15fk0210007h0002).

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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Keiji Tsuji
    • 1
  • Masayuki Kurosaki
    • 2
  • Jun Itakura
    • 2
  • Nami Mori
    • 1
  • Shintaro Takaki
    • 1
  • Chitomi Hasebe
    • 3
  • Takehiro Akahane
    • 4
  • Kouji Joko
    • 5
  • Hitoshi Yagisawa
    • 6
  • Jirou Takezawa
    • 7
  • Ryou Nakata
    • 8
  • Atsunori Kusakabe
    • 9
  • Yuji Kojima
    • 10
  • Hiroyuki Kimura
    • 11
  • Takashi Tamada
    • 12
  • Haruhiko Kobashi
    • 13
  • Akeri Mitsuda
    • 14
  • Masahiko Kondou
    • 15
  • Chikara Ogawa
    • 16
  • Yasushi Uchida
    • 17
  • Tetsuro Sohda
    • 18
  • Ryouichi Narita
    • 19
  • Namiki Izumi
    • 2
  1. 1.Department of GastroenterologyHiroshima Red Cross Hospital and Atomic-bomb Survivors HospitalHiroshimaJapan
  2. 2.Department of Gastroenterology and HepatologyMusashino Red Cross HospitalTokyoJapan
  3. 3.Department of GastroenterologyJapanese Red Cross Asahikawa HospitalAsahikawaJapan
  4. 4.Department of GastroenterologyJapanese Red Cross Ishinomaki HospitalIshinomakiJapan
  5. 5.Center for Liver-Biliary-Pancreatic DiseaseMatsuyama Red Cross HospitalMatsuyamaJapan
  6. 6.Department of GastroenterologyJapanese Red Cross Akita HospitalAkitaJapan
  7. 7.Department of Internal MedicineJapanese Red Cross Haramachi HospitalHaramachiJapan
  8. 8.Department of GastroenterologyJapanese Red Cross Medical CenterTokyoJapan
  9. 9.Department of GastroenterologyJapanese Red Cross Nagoya Daini HospitalNagoyaJapan
  10. 10.Department of HepatologyJapanese Red Cross Ise HospitalIseJapan
  11. 11.Department of GastroenterologyJapanese Red Cross Kyoto Daiichi HospitalKyotoJapan
  12. 12.Department of GastroenterologyTakatsuki Red Cross HospitalTakatsukiJapan
  13. 13.Department of GastroenterologyJapanese Red Cross Okayama HospitalOkayamaJapan
  14. 14.Department of GastroenterologyJapanese Red Cross Tottori HospitalTottoriJapan
  15. 15.Department of GastroenterologyJapanese Red Cross Otsu HospitalOtsuJapan
  16. 16.Department of GastroenterologyTakamatsu Red Cross HospitalTakamatsuJapan
  17. 17.Department of GastroenterologyMatsue Red Cross HospitalMatsueJapan
  18. 18.Department of HepatologyJapanese Red Cross Fukuoka HospitalFukuokaJapan
  19. 19.Department of GastroenterologyOita Red Cross HospitalOitaJapan

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