title: Multicenter experience using simeprevir and sofosbuvir with or without ribavirin to treat hepatitis C genotype 1 in patients with cirrhosis.
abstract: Interferon (IFN)-free regimens are needed to treat hepatitis C virus (HCV) infection. Combined simeprevir (SMV) and sofosbuvir (SOF) with or without ribavirin (RBV) results in high sustained virological response (SVR) rates along with minimal adverse events (AEs) in patients with hepatitis C genotype 1 (HCV GT1). The aim of this study was to report on the virological response, safety, and tolerability of SOF and SMV with or without RBV in compensated and decompensated patients with cirrhosis with HCV GT1 infection. Patients treated with standardized clinical protocol utilizing SMV+SOF with or without RBV at three transplant centers were retrospectively reviewed. A total of 119 patients (61% male, 87% white, 69% subtype 1a, 30% Child-Pugh-Turcott [CPT]-B liver cirrhosis [LC], and 82% were treatment experienced) received treatment and were followed for a median of 38 weeks (range, 12-58). Sustained virological response (SVR) at week 12 (SVR12) was achieved in 78% (92 of 118) of patients (95% confidence interval: 69-85). Lower pretreatment Model for End Stage Liver Disease (MELD) score was a predictor of SVR12 (P = 0.018). Baseline viral load, previous treatment status, RBV use, or GT1 subtype did not impact SVR 12. The majority of patients with SVR12 showed stability or improvement in MELD score. Treatment was very well tolerated with mild degrees of AEs.
  
  
  CONCLUSIONS
  The regimen of SMV+SOF with or without RBV for 12 weeks was very well tolerated and resulted in high SVR12 rates (78%) in HCV GT1 patients with LC. SVR12 was inversely related to pretreatment MELD. SVR12 had favorable short-term impact on MELD score. Long-term impact on disease stability is yet to be determined. Longer treatment duration or the use of different regimen may still be needed in this population.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ.
authors.forename: Bashar A
authors.initials: BA
authors.lastname: Aqel
authors.affiliation: Department of Transplant, Mayo Clinic, Jacksonville, FL.
authors.forename: Surakit
authors.initials: S
authors.lastname: Pungpapong
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Michael
authors.initials: M
authors.lastname: Leise
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ.
authors.forename: K Tuesday
authors.initials: KT
authors.lastname: Werner
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Chervenak
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Kymberly D
authors.initials: KD
authors.lastname: Watt
authors.affiliation: Department of Transplant, Mayo Clinic, Jacksonville, FL.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Murphy
authors.affiliation: Department of Transplant, Mayo Clinic, Jacksonville, FL.
authors.forename: Kristen
authors.initials: K
authors.lastname: Ryland
authors.affiliation: Department of Transplant, Mayo Clinic, Jacksonville, FL.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Keaveny
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ.
authors.forename: Ryan
authors.initials: R
authors.lastname: McLemore
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ.
authors.forename: Hugo E
authors.initials: HE
authors.lastname: Vargas
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage*; D004338:Drug Combinations; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000145:classification / Q000235:genetics; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage*; D000069616:Simeprevir / Q000008:administration & dosage*; D000069474:Sofosbuvir / Q000008:administration & dosage*
chemical_list: D000998:Antiviral Agents; D004338:Drug Combinations; D012254:Ribavirin; D000069616:Simeprevir; D000069474:Sofosbuvir