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J Viral Hepat ; 26(6): 666-674, 2019 06.
Article in English | MEDLINE | ID: mdl-30740820

ABSTRACT

The aims of the present study were to evaluate the efficacy and tolerability of ledipasvir/sofosbuvir (LDV/SOF) with or without ribavirin in the treatment of chronic hepatitis C (CHC) in patients with advanced liver disease and to analyse whether the use of LDV/SOF treatment is associated with a new occurrence of hepatocellular carcinoma (HCC) during and after LDV/SOF treatment. The Turkish Early Access Program provided LDV/SOF treatment to a total of 200 eligible CHC patients with advanced liver disease. The median follow-up period was 22 months. All patients were Caucasian, 84% were infected with genotype 1b, and 24% had a liver transplantation before treatment. The sustained virological response (SVR12) was 86.0% with ITT analysis. SVR12 was similar among patients with Child-Pugh classes A, B and C disease and transplant recipients. From baseline to SVR12, serum ALT level and MELD score were significantly improved (P < 0.001). LDV/SOF treatment was generally well tolerated. Only one patient developed a new diagnosed HCC. Seventeen of the 35 patients, who had a history of previous HCC, developed HCC recurrence during the LDV/SOF treatment or by a median follow-up of 6 months after treatment. HCC recurrence was less commonly observed in patients who received curative treatment for HCC compared with those patients who received noncurative treatment (P = 0.007). In conclusion, LDV/SOF with or without ribavirin is an effective and tolerable treatment in CHC patients with advanced liver disease. Eradication is associated with improvements in liver function and a reduced risk of developing a new occurrence of HCC.


Subject(s)
Antiviral Agents/therapeutic use , Benzimidazoles/therapeutic use , Carcinoma, Hepatocellular/prevention & control , Fluorenes/therapeutic use , Hepatitis C, Chronic/drug therapy , Liver Neoplasms/prevention & control , Neoplasm Recurrence, Local/prevention & control , Uridine Monophosphate/analogs & derivatives , Adult , Aged , Aged, 80 and over , Carcinoma, Hepatocellular/virology , Cohort Studies , Drug Therapy, Combination , Female , Genotype , Hepacivirus/drug effects , Hepacivirus/genetics , Humans , Liver Neoplasms/virology , Liver Transplantation , Male , Middle Aged , RNA, Viral/blood , Ribavirin/therapeutic use , Sofosbuvir , Sustained Virologic Response , Uridine Monophosphate/therapeutic use
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