High Efficacy and Safety of Flat-Dose Ribavirin Plus Sofosbuvir/Daclatasvir in Genotype 3 Cirrhotic Patients

• Published in: Gut and liver Vol. 14; no. 3; pp. 357 - 367
• Main Authors: Pellicelli, Adriano, Messina, Vincenzo, Giannelli, Valerio, Distefano, Marco, Palitti, Valeria Pace, Vignally, Pascal, Tarquini, Pierluigi, Izzi, Antonio, Moretti, Alessandra, Babudieri, Sergio, Dell'Isola, Serena, Marignani, Massimo, Scifo, Gaetano, Iovinella, Vincenzo, Cariti, Giuseppe, Pompili, Maurizio, Candilo, Francesco Di, Fontanella, Luca, Ettorre, Giuseppe M, Vennarecci, Giovanni, Ippolito, Antonio Massimo, Barbarini, Giorgio
• Format: Journal Article
• Language: English
• Published: Korea (South) Editorial Office of Gut and Liver 15-05-2020; Gastroenterology Council for Gut and Liver; 거트앤리버 소화기연관학회협의회
• Subjects: Antiviral Agents - administration & dosage; Carbamates - administration & dosage; cirrhosis; daclatasvir; drug therapy; Drug Therapy, Combination; Female; Genotype; genotypes 3; Hepacivirus - genetics; hepatitis c; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - drug therapy; Humans; Imidazoles - administration & dosage; liver; Liver Cirrhosis - drug therapy; Liver Cirrhosis - virology; Male; Middle Aged; Original; Pyrrolidines - administration & dosage; Retrospective Studies; ribavirin; Ribavirin - administration & dosage; Sofosbuvir - administration & dosage; Sustained Virologic Response; Treatment Outcome; Valine - administration & dosage; Valine - analogs & derivatives; 내과학; Daclatasvir; Cirrhosis; Genotypes 3; liver; Drug therapy; Hepatitis C; Ribavirin
• ISSN: 1976-2283; 2005-1212
• DOI: 10.5009/gnl18269

Patients with genotype 3 hepatitis C virus (G3-HCV) cirrhosis are very difficult to treat compared to patients with other HCV genotypes. The optimal treatment duration and drug regimen associated with ribavirin (RBV) remain unclear. To evaluate the efficacy and safety of daclatasvir (DCV)/sofosbuvir (SOF) plus a flat dose of 800 mg RBV (flat dose) compared to DCV/SOF without RBV or DCV/SOF plus an RBV dose based on body weight (weight-based) in G3-HCV patients with compensated or decompensated cirrhosis.
We analyzed data for 233 G3 cirrhotic patients. Of these, 70 (30%), 87(37%) and 76 (33%) received SOF/DCV, SOF/DCV/RBV flat dose, and SOF/DCV/RBV weight-based dose, respectively. Treatment duration was 24 weeks. Sustained virological response (SVR) was evaluated at week 12 posttreatment (SVR12).
Overall, SVR12 was achieved in 220 out of 233 patients (94.4%). The SVR12 rate was lower in the DCV/SOF group than in the DCV/SOF/RBV flat-dose group and the DCV/SOF/RBV weight-based group (87.1% vs 97.7% and 97.4%, respectively, p=0.007). A higher incidence of anemia occurred in the DCV/SOF/RBV weight-based group compared to those in the other two groups (p<0.007).
We found that the DCV/SOF/RBV flat-dose regimen is an effective treatment in terms of efficacy and safety in patients with G3-HCV compensated or decompensated cirrhosis. Therefore, antiviral regimens without RBV should be restricted only to naïve patients with G3-HCV compensated cirrhosis who have a clear contraindication for RBV.