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Durability of Sustained Virologic Response and Improvement of Fibrosis Markers after Daclatasvir and Asunaprevir Treatment in Genotype 1b Hepatitis C Virus-Infected Patients: a Real Life and Multicenter Study

Journal of Korean Medical Science 2019년 34권 41호 p.264 ~ 264
 ( Shin Seung-Kak ) - Gachon University Gil Medical Center Department of Internal Medicine

 ( Lee Jin-Woo ) - Inha University School of Medicine Department of Internal Medicine
 ( Ra Han-Nah ) - Gachon University Gil Medical Center Department of Internal Medicine
 ( Kwon Oh-Sang ) - Gachon University Gil Medical Center Department of Internal Medicine
 ( Shin Jong-Beom ) - Inha University School of Medicine Department of Internal Medicine
 ( Jin Young-Joo ) - Inha University School of Medicine Department of Internal Medicine
 ( Lee Sang-heun ) - Catholic Kwandong University College of Medicine International St. Mary’s Hospital Department of Internal Medicine
 ( Han Ki-Jun ) - Catholic Kwandong University College of Medicine International St. Mary’s Hospital Department of Internal Medicine
 ( Kim Young-Nam ) - Cheju Halla General Hospital Department of Internal Medicine
 ( Kim Tae-Hun ) - Ewha Womans University School of Medicine Department of Internal Medicine
 ( Kim Yun-Soo ) - Gachon University Gil Medical Center Department of Internal Medicine
 ( Kim Ju-Hyun ) - Gachon University Gil Medical Center Department of Internal Medicine

Abstract


Background: The long-term data with direct acting antiviral agents were rare. This study investigated the durability of a sustained virologic response (SVR) and the improvement of fibrosis after daclatasvir and asunaprevir (DCV/ASV) treatment in genotype 1b (GT1b) hepatitis C virus (HCV)-infected patients.

Methods: A total of 288 HCV GT1b patients without baseline non-structural 5A (NS5A) resistance-associated substitution (RAS) treated with DCV/ASV were enrolled. Virologic response was measured at 12 weeks and 1 year after treatment completion. In cirrhotic patients, liver function, aspartate transaminase to platelet ratio index (APRI), FIB-4 index, fibrosis index (FI), and liver stiffness measurement (LSM) at baseline and 1 year after treatment completion were evaluated.

Results: SVR12 was obtained in 278 patients (96.5%). Six patients who checked NS5A RAS after treatment failure were RAS positive. Only one patient showed no durability of SVR. In cirrhotic patients who achieved SVR12 (n = 59), the changes of albumin (3.8 [2.2?4.7] to 4.3 [2.4?4.9] g/dL; P < 0.001), platelet count (99 [40?329] to 118 [40?399] × 103/mm3; P < 0.001), APRI (1.8 [0.1?14.8] to 0.6 [0.1?4.8]; P < 0.001), FIB-4 index (5.45 [0.6?32.8] to 3.3 [0.4?12.2]; P < 0.001), FI (5.5 [0.6?32.8] to 3.3 [0.4?12.2]; P < 0.001), and LSM (17.2 [5.3?48.0] to 11.2 [3.7?28.1] kPa; P = 0.001) between baseline and 1 year after treatment completion were observed.

Conclusion: DCV/ASV treatment for HCV GT1b infected patients without RAS achieved high SVR rates and showed durable SVR. Cirrhotic patients who achieved SVR12 showed the improvement of liver function and fibrosis markers.

키워드

Asunaprevir; Daclatasvir; Fibrosis; Hepatitis C Virus; Sustained Virologic Response
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