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亚洲慢性丙型肝炎患者采用索磷布韦为基础的治疗的真实世界研究。

Real-World Study on Sofosbuvir-based Therapies in Asian Americans With Chronic Hepatitis C.

机构信息

Department of Medicine, Division of Gastroenterology and Hepatology, NYU Langone Health, NYU School of Medicine.

Beijing Youan Hospital, Capital Medical University, Beijing, China.

出版信息

J Clin Gastroenterol. 2019 Feb;53(2):147-154. doi: 10.1097/MCG.0000000000001078.

Abstract

BACKGROUND

Limited data exist with regard to treatment outcomes in Asian Americans with chronic hepatitis C (CHC). We evaluated sofosbuvir (SOF)-based regimens in a national cohort of Asian Americans.

METHODS

Eligible Asian Americans patients with CHC who had posttreatment follow-up of 24 weeks for SOF -based therapies from December 2013 to June 2017 were enrolled from 11 sites across the United States. The primary endpoint was sustained virologic response (SVR) rates at posttreatment weeks 12 and 24. Secondary endpoints were to evaluate safety by tolerability and adverse events (AEs).

RESULTS

Among 231 patients screened, 186 were enrolled. At baseline, 31% (57/186) patients were cirrhotic, 34% (63/186) were treatment experienced. Most of the subjects (42%, 79/186) received ledispavir/SOF therapy. The overall SVR12 was 95%, ranging from 86% in genotype (GT) 1b on SOF+ribavirin to 100% in GT 1b patients on ledipasvir/SOF at subgroup analyses. SVR12 was significantly lower in cirrhotic than in noncirrhotic patients [88% (50/57) vs. 98% (126/129), P<0.01]. Stratified by GT, SVR12 were: 96% (43/45) in GT 1a; 93% (67/72) in GT 1b; 100% (23/23) in GT 2; 90% (19/21) in GT 3; 100% (1/1) in GT 4; 83% (5/6) in GT 5; and 100% (16/16) in GT 6. Cirrhotic patients with treatment failure were primarily GT 1, (GT 1a, n=2; GT 1b, n=4) with 1 GT 5 (n=1). Patients tolerated the treatment without serious AEs. Late relapse occurred in 1 patient after achieving SVR12.

CONCLUSIONS

In Asian Americans with CHC, SOF-based regimens were well tolerated without serious AEs and could achieve high SVR12 regardless of hepatitis C viral infection GT.

摘要

背景

关于慢性丙型肝炎(CHC)亚裔美国人的治疗结果,相关数据有限。我们评估了在亚裔美国人全国队列中基于索磷布韦(SOF)的治疗方案。

方法

从 2013 年 12 月至 2017 年 6 月,从美国 11 个地点纳入了接受 SOF 治疗后随访 24 周的 CHC 亚裔美国人合格患者。主要终点是治疗后第 12 周和第 24 周的持续病毒学应答(SVR)率。次要终点是通过耐受性和不良事件(AE)评估安全性。

结果

在 231 名筛选患者中,有 186 名入组。基线时,31%(57/186)的患者为肝硬化,34%(63/186)为治疗经验丰富。大多数患者(42%,79/186)接受了雷迪帕韦/SOF 治疗。总的 SVR12 为 95%,亚组分析显示 GT1b 患者 SOF+利巴韦林为 86%,GT1b 患者 ledipasvir/SOF 为 100%。肝硬化患者的 SVR12 明显低于非肝硬化患者[88%(50/57)比 98%(126/129),P<0.01]。按 GT 分层,SVR12 分别为:GT1a 为 96%(43/45);GT1b 为 93%(67/72);GT2 为 100%(23/23);GT3 为 90%(19/21);GT4 为 100%(1/1);GT5 为 83%(5/6);GT6 为 100%(16/16)。治疗失败的肝硬化患者主要为 GT1,其中 GT1a 为 2 例,GT1b 为 4 例,GT5 为 1 例。患者耐受治疗,无严重不良事件。1 例患者在达到 SVR12 后发生晚期复发。

结论

在 CHC 亚裔美国人中,基于 SOF 的治疗方案耐受性良好,无严重不良事件,可实现高 SVR12,无论丙型肝炎病毒感染 GT 如何。

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