Tarao Kazuo, Yamada Kouzo
Tarao's Gastroenterological Clinic, Yokohama, Japan.
Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan.
Case Rep Gastroenterol. 2017 Jun 9;11(2):369-376. doi: 10.1159/000462965. eCollection 2017 May-Aug.
Oral direct-acting antivirals (DAAs) are the main therapy for hepatitis C virus (HCV)-associated liver disease in Japan. Daclatasvir/asunaprevir is the first agent and sofosbuvir/ledipasvir is the secondary agent for HCV genotype 1b. More recently, ombitasvir/paritaprevir/ritonavir is also recommended as a potent therapy for HCV genotype 1b. Among the adverse events associated with these oral DAAs, interstitial pneumonia is one of the most severe ones. Regarding treatment with daclatasvir plus asunaprevir or sofosbuvir plus ledipasvir, a few cases have already been reported in a postmarketing surveillance. Recently, we have encountered a HCV-associated genotype 1b cirrhosis patient who developed interstitial pneumonia during treatment with ombitasvir/paritaprevir/ritonavir and who recovered after drug discontinuation without corticosteroid therapy. Interstitial pneumonia was confirmed by chest x-ray and chest computed tomography. The serum KL-6 level was elevated to 1,180 U/mL. The total duration of the drug administration was 7 weeks, and she achieved SVR. This is the first detailed report in the literature on the development of interstitial pneumonia during treatment with ombitasvir/paritaprevir/ritonavir. When dry cough appeared in the treatment with DAAs, chest computed tomography and the evaluation of serum KL-6 level were recommended.
在日本，口服直接抗病毒药物（DAAs）是丙型肝炎病毒（HCV）相关肝病的主要治疗方法。对于HCV 1b型，达卡他韦/阿舒瑞韦是一线治疗药物，索磷布韦/来迪派韦是二线治疗药物。最近，奥比他韦/帕利哌韦/利托那韦也被推荐作为HCV 1b型的有效治疗方案。在这些口服DAAs相关的不良事件中，间质性肺炎是最严重的不良事件之一。关于达卡他韦联合阿舒瑞韦或索磷布韦联合来迪派韦治疗，在上市后监测中已经报告了几例。最近，我们遇到了一名HCV 1b型肝硬化患者，在用奥比他韦/帕利哌韦/利托那韦治疗期间发生了间质性肺炎，停药后未经皮质类固醇治疗即康复。通过胸部X线和胸部计算机断层扫描确诊为间质性肺炎。血清KL-6水平升高至1180 U/mL。给药总时长为7周，患者实现了持续病毒学应答。这是文献中关于使用奥比他韦/帕利哌韦/利托那韦治疗期间发生间质性肺炎的首份详细报告。当使用DAAs治疗出现干咳时，建议进行胸部计算机断层扫描和血清KL-6水平评估。
