Combination Therapy Eliminates HCV in Liver Transplant Patients

Interferon-free combination therapy in patients who undergo liver transplantation can eliminate the hepatitis C virus (HCV) infection, according to 2 studies published in Gastroenterology.

The 2 studies both looked at the use of sofosbuvir and ribavirin in hepatitis C patients. The first study found that the combination therapy taken 48 weeks prior to liver transplantation prevented the recurrence of HCV infection in 70% of patients who had undetectable levels of HCV RNA before transplantation and 50% in all patients.

“Patients with hepatitis C virus at the time of liver transplantation universally experience recurrent HCV infection,” lead study author Michael P. Curry, MD, from Beth Israel Deaconess Medical Center, said in a statement. “Recurrent HCV infection follows an aggressive course. Given the burden of disease — the increased morbidity, mortality and costs — and the lack of a safe and broadly effective treatment to prevent recurrence of HCV infection, these results provide hope for patients in need.”

Discontinuation of the therapy due to adverse events was low. Patients who participated in this study were enrolled at 13 centers in the United States, and one each in New Zealand and Spain.

“Given the burden of disease owing to HCV recurrence post-transplantation—the increased morbidity, mortality, and costs—these results provide hope for patients in need,” the authors concluded.

In the second study, patients with recurrent HCV infection after liver transplant were given an all-oral regimen of sofosbuvir and ribavirin for 24 weeks. In this study, too, 70% of patients had no detectable virus.

“A well tolerated and effective treatment protocol for recurrence of HCV infection following liver transplantation is an important unmet clinical need,” said lead study author Michael R. Charlton, MD, Mayo Foundation, said. “Our study demonstrates that patients with characteristics that have historically been difficult to cure with interferon-based regimens, including those with advanced disease, may benefit from this all-oral interferon-free therapy.”

The population in this study included a high proportion of patients who have been historically difficult to cure with interferon-based regimens: HCV genotype 1, prior treatment experience, advanced fibrosis and cirrhosis, and concurrent immunosuppression.