Tadokoro Tomoko, Morishita Asahiro, Oura Kyoko, Fujita Koji, Mimura Shima, Sakamoto Teppei, Nomura Takako, Tani Joji, Yoneyama Hirohito, Masaki Tsutomu
Department of Gastroenterology and Neurology, Kagawa University School of Medicine/Graduate School of Medicine, Miki, Kagawa 761-0793, Japan.
Exp Ther Med. 2018 Aug;16(2):1026-1028. doi: 10.3892/etm.2018.6207. Epub 2018 May 23.
The treatment of chronic hepatitis C has radically changed due to the development of direct-acting antiviral agents (DAAs). Twelve-week treatment with ledipasvir and sofosbuvir (LDV/SOF), a combination of DAAs, is highly effective in patients with hepatitis C virus (HCV) genotype 1 infection. However, the overall sustained virological response rate 12 weeks after the end of treatment (SVR12) is not 100%. Elbasvir (EBR) combined with grazoprevir (GZR) is the latest approved therapy for patients with genotype 1 or 4 chronic hepatitis C. However, to the best of our knowledge no case reports have described retreatment with GZR/EBR in patients with a history of failed LDV/SOF treatment. The present case report indicated a case in which GZR/EBR was effective for the retreatment of a patient with a history of failed LDV/SOF treatment and chronic hepatitis C. The present study indicated a 55-year-old Japanese male with a history of chronic hepatitis C and compensated liver cirrhosis. The patient exhibited the amino acid mutation Y93H in NS5A. Therefore, treatment with LDV/SOF was initiated, which was effective and suppressed the virus during oral administration. However, 4 weeks after treatment, the patient's viral load relapsed and returned to its original level. After the patient provided informed consent, treatment with GZR/EBR was initiated. No problems related to GZR/EBR were observed during treatment and the patient's SVR12 was evaluated at 12 weeks posttreatment. In conclusion, GZR/EBR treatment was useful for treating a relapse of HCV genotype 1b infection in the present case after LDV/SOF treatment, despite liver fibrosis, in the presence of the high-frequency amino acid mutation Y93H in NS5A. Although it will be necessary to examine a large number of cases, the present findings suggest that GZR/EBR may be a potential treatment option for relapse of HCV genotype 1b infection after LDV/SOF treatment.
由于直接作用抗病毒药物（DAAs）的发展，慢性丙型肝炎的治疗发生了根本性变化。十二周的来迪派韦和索磷布韦（LDV/SOF）联合治疗，一种DAAs组合，对丙型肝炎病毒（HCV）基因1型感染患者非常有效。然而，治疗结束后12周的总体持续病毒学应答率（SVR12）并非100%。艾尔巴韦（EBR）联合格卡瑞韦（GZR）是最新获批用于治疗基因1型或4型慢性丙型肝炎患者的疗法。然而，据我们所知，尚无病例报告描述过LDV/SOF治疗失败的患者再次使用GZR/EBR进行治疗的情况。本病例报告展示了1例GZR/EBR对LDV/SOF治疗失败且患有慢性丙型肝炎的患者再次治疗有效的情况。本研究报告了1例55岁的日本男性，有慢性丙型肝炎病史且存在代偿性肝硬化。该患者在NS5A中出现了氨基酸突变Y93H。因此，开始使用LDV/SOF进行治疗，治疗期间有效并抑制了病毒。然而，治疗4周后，患者的病毒载量复发并恢复到原来水平。在患者提供知情同意后，开始使用GZR/EBR进行治疗。治疗期间未观察到与GZR/EBR相关的问题，且在治疗后12周评估了患者的SVR12。总之，在本病例中，尽管存在肝纤维化且NS5A中有高频氨基酸突变Y93H，但GZR/EBR治疗对LDV/SOF治疗后HCV基因1b型感染复发仍有效。尽管有必要检查大量病例，但目前的研究结果表明，GZR/EBR可能是LDV/SOF治疗后HCV基因1b型感染复发的一种潜在治疗选择。
