Satsangi Sandeep, Mehta Manu, Duseja Ajay, Taneja Sunil, Dhiman Radha K, Chawla Yogesh
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Gastroenterol Hepatol. 2017 Apr;32(4):859-863. doi: 10.1111/jgh.13595.
Sofosbuvir (SOF) was the first directly acting antiviral made available for chronic hepatitis C (CHC) in India. We describe our "real life" experience of using SOF with ribavirin (RBV) with or without pegylated interferon (Peg-IFN) in predominant genotype 3 patients with CHC.
A total of 158 patients (men 99 [62.6%], mean age 40.3 ± 12.8 years) with CHC treated with dual therapy (SOF + RBV) for 24 weeks or triple therapy (Peg-IFN + SOF + RBV) for 12 weeks were included prospectively. Patients with co-infection, decompensated liver disease, and post-organ transplantation were excluded. Data were analysed for the preference of treatment regimen, end of treatment response (ETR), sustained virological response at 12 weeks, and side effects.
Genotype 3 was the predominant genotype (105 [66.4%]) followed by genotype 1 (40 [25.3%]) and genotype 4 (13[8.2%]). Forty-eight (30.37%) patients had cirrhosis (LSM ≥ 13 kPa), and 30 (19%) were treatment experienced with Peg-IFN + RBV. A total of 103 (65.18%) patients received dual therapy, and 55 (34.81%) received triple therapy. Resentment to receive injections, inaccessibility to a facility, fear of injection or its side effects, and financial constraints were the reasons to refuse triple therapy. All patients in triple therapy group and all but two patients (98%) in the dual therapy group attained ETR. All those who achieved ETR achieved sustained virological response at 12 weeks in both groups. But for anemia in three patients (two in triple, one in dual therapy), there were no major side effects.
Most patients with CHC prefer an oral treatment with directly acting antivirals. Both oral and interferon-based regimens achieve high response rate.
索磷布韦（SOF）是印度首个可用于治疗慢性丙型肝炎（CHC）的直接抗病毒药物。我们描述了在主要为基因3型的CHC患者中，使用索磷布韦联合利巴韦林（RBV），加或不加聚乙二醇干扰素（Peg-IFN）的“真实生活”经验。
前瞻性纳入158例接受24周双药治疗（SOF + RBV）或12周三药治疗（Peg-IFN + SOF + RBV）的CHC患者（男性99例[62.6%]，平均年龄40.3±12.8岁）。排除合并感染、失代偿期肝病及器官移植术后患者。分析治疗方案的偏好、治疗结束时的反应（ETR）、12周时的持续病毒学应答及副作用。
基因3型为主要基因型（105例[66.4%]），其次是基因1型（40例[25.3%]）和基因4型（13例[8.2%]）。48例（30.37%）患者有肝硬化（肝脏硬度值≥13 kPa），30例（19%）曾接受Peg-IFN + RBV治疗。共103例（65.18%）患者接受双药治疗，55例（34.81%）接受三药治疗。拒绝三药治疗的原因包括反感注射、无法获得治疗设施、害怕注射或其副作用以及经济限制。三药治疗组的所有患者以及双药治疗组除2例患者外（98%）均达到ETR。两组中所有达到ETR的患者在12周时均获得持续病毒学应答。除3例患者（三药治疗组2例，双药治疗组1例）出现贫血外，无其他严重副作用。
大多数CHC患者更喜欢使用直接抗病毒药物的口服治疗。口服和基于干扰素的治疗方案均有较高的应答率。
