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Sovaldi cures recurrent HCV after liver transplantation in 12 weeks

Twelve weeks of combination Sovaldi and NS5A inhibitors without ribavirin was a reliable therapy with high rates of sustained virologic response for recurrent hepatitis C after liver transplantation, according to a study published in Hepatology.

“Liver recipients with HCV recurrence have always been considered as a difficult-to-treat population,” Pauline Houssel-Debry, MD, from the Pontchaillou University Hospital in France, and colleagues wrote. “Previous HCV treatment post-LT, progression of fibrosis on the graft, a high HCV viral load, and the immunosuppressive therapy implemented had originally prompted clinicians to choose treatment for 24 weeks with [ribavirin] in order to improve SVR12 rates. However, the availability of [direct-acting antivirals] should change these dogmas.”

The study comprised 512 LT recipients treated with Sovaldi (sofosbuvir, Gilead Sciences) and NS5A inhibitors with or without ribavirin. Most patients had HCV genotype 1 (70.1%) while 18.2% were infected with genotype 3.

Overall, 96.1% of patients achieved SVR at 12 weeks, including SVR rates of 94.9% among those who did not receive ribavirin and 95.7% among those who did. Patients with cirrhosis were treated for 24 weeks and had SVR rates of 97.9% without ribavirin and 92.9% with ribavirin.

The researchers also reported the following SVR rates: 95.7% in those with stage 3 or stage 4 fibrosis, 95.7% in those with genotype 3, and 94.8% in the group of patients who did not initially respond to HCV therapy.

Factors previously associated with treatment failure included fibrosis stage, HCV genotype, HCV viral load at baseline, and previous treatment after LT. After multivariate analysis, the researchers found that these factors did not influence 12-week SVR rates in any population.

“Only 20 patients experienced a treatment failure and most of them had not previously been treated, displaying minimal fibrosis at baseline,” Houssel-Debry and colleagues wrote. “The response rates to DAA combination therapy in LT patients were similar to those observed in the nontransplanted population. According to these findings, LT recipients should not be considered as a ‘difficult-to-treat’ population.” – by Talitha Bennett

Disclosure: Houssel-Debry reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financials disclosures.