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Hepatite C: Resultados na vida real (Hepatitis C: Real Life Results)
André Castro Lyra
# Prof. Associado e Livre Docente do Depto de Medicina – Universidade Federal da Bahia # Chefe do Serviço de Gastro-Hepatologia do Hospital Universitário Prof. Edgard Santos - UFBA # Coordenador do Serviço de Gastro-Hepatologia do Hospital São Rafael
XXII Workshop de Hepatites Virais de Pernambuco
Sexta-feira - 11/05/2016 – 11:30h as 11:45h
Therapeutic regimen
Therapeutic regimen
PLOS ONE | https://doi.org/10.1371/journal.pone.0184654 October 5, 2017
Co-morbidities
Sofosbuvir based treatment of chronic hepatitis C genotype 3 infections - A Scandinavian real-life study
Olav Dalgard et al. (2017) PLoS ONE 12(7): e0179764. https://doi.org/ 10.1371/journal.pone.0179764
Sustained virological response (SVR) 12 weeks after end of treatment
N=311
Fig. 2 Sustained virological response (SVR) according to liver elasticity levels in patients with chronic HCV genotype 3 infection, treated with a sofosbuvir based
Loreta A. Kondili et al. PLoS ONE 12(10):e0185728. https://doi.org/10.1371/journal. pone.0185728
Table 3. Failure rates following the first DAA regimen, by HCV genotype and treatment regimen in patients who completed the 12 weeks post treatment evaluation (n = 3,830 patients).
Patients who received a second DAA treatment, by type of first regimen and HCV genotype (n = 72 patients).
Patients who received a second DAA treatment, by type of first regimen and HCV genotype (n = 72 patients).
Liver International. 2018;38:602–610.
SVR = 96.6%
Compensated cirrhosis, genotype 1b.
On multivariate analysis:
• lack of IFN pretreatment (P = .02)
• presence of comorbidities (P = .001)
• Increased total bilirubin (P < .001),
• prolonged INR (P = .007)
• ↓ creatinine clearance (P = .001)
non-response to antiviral therapy.
Liver International. 2018;38:733–741.
SVR 73%
suitable for inactivation
and then delisting
Daclatasvir and reduced-dose sofosbuvir: an effective and pangenotypic treatment for hepatitis C in patients with
eGFR <30 ml/min
Amit Goel et al. Nephrology. Ahead of print
Sofosbuvir 200 mg/dia 12 semanas (24 semanas se cirrótico)
DACLA 60 mg/dia
+
Table 1: Clinical and laboratory characteristics of 41 patients with HCV infection treated with daclatasvir and low-dose sofosbuvir
Virological response rates on intention-to-treat basis
Kidney Blood Press Res 2018;43:594-605
Table. Baseline patients’ characteristics
SVR 100% (23 patients)
Table 2. Adverse events overview
w/RBV without/RBV
Serious AE (N. of patients, %)
3 (42.9%) 2 (12.5%)
Afunctional kidney graft rejection
0 (0%) 1 (6.25%)
Renal cyst infection 0 (0%) 1 (6.25%)
Early gastric cancer 1 (14.3%) 0 (0%)
Initiation of haemodialysis
1 (14.3%) 0 (0%)
Salmonellosis 1 (14.3%) 0 (0%)
Baseline characteristics of the entire cohort of 87 patients with posttransplant hepatitis C recurrence and severe fibrosis and of the two treatment groups
The individual treatment schedules were decided by each investigator, and RBV use and dosage was at the physician’s discretion according to tolerability and clinical features.
Sofosbuvir plus daclatasvir with or without ribavirin is safe and effective for post- transplant hepatitis C recurrence and severe fibrosis and cirrhosis: A prospective study
F I G U R E 1. SVR12 according to HCV genotypes overall and in the two treatment groups.
SVR12 among cirrhotic patients according to Child- Pugh class overall and in the two treatment groups.
Patients who received RBV had significantly higher SVR12 than those who did not.
TRATAMENTO DA HEPATITE C COM ESQUEMA LIVRE DE INTERFERON. RESULTADOS PRELIMINARES DE UM REGISTRO
NACIONAL DE TRATAMENTO DE VIDA REAL NO BRASIL
Giovanni Faria Silva em nome do Grupo de Registro de Tratamento da Hepatite C com DAAs na Vida Real
DISTRIBUIÇÃO DOS CENTROS MÉDICOS QUE PARTICIPARAM DO PROGRAMA DE REGISTRO DA SOCIEDADE BRASILEIRA DE HEPATOLOGIA
52 CENTROS 20 ESTADOS
DAAs Population ITT
(N=4336)
Follow up
≥12sem Pos
Tx (n=3435)
Ainda a avaliar RVS
Dados inconsistentes ou
incompletos (n=901)
Genotype 1
(n=2576)
Genotype 2 (n=86) Genotypes 4,5,6 (n=17)
Genotype 3 (n=756)
Sofosbuvir Daclatasir Simeprevir
Sofo+Ledispavir 3D Abbvie
Sofo/Peg+RBV
% TOTAL 75% 22% 3%
Resultados Preliminares do Registro Nacional de Tratamento com Novos Agentes Virais de Ação Direta em Pacientes com Hepatite
C Crônica
Agentes antivirais 2a geração no Brasil
População registrada
ITT (N= 4336)
seguimento≥12s
Pos Tx (n=3435)
Ainda a avaliar dados(n=901)
Genotipo 1
(n=2576) Genotipo 2 (n=86)
Outros (n=17) Genotipo 3
(n=756)
Sofosbuvir Daclatasir Simeprevir
PEGInterferon Ribavirina
N=3435
45,5% Cirrose
9,1% Cirrose Child B e C
54% Experimentados
12% Tx Fígado ou outro órgão 3,75% Co-infectados
4,1% CDK3 (<60ml/min)
% TOTAL 75% 22% 3%
Resultados Preliminares do Registro Nacional de Tratamento com Novos Agentes Virais de Ação Direta em Pacientes com Hepatite C Crônica
100 80 60 40 20 0
%RVS (ITT)
97 89 89
Total Genótipo 1 Genótipo 3 Genótipo 2
95
35 3435 2576 756 84
Resultados Preliminares do Registro Nacional de Tratamento com Novos Agentes Virais de Ação Direta em Pacientes com Hepatite
C Crônica
Resultados Preliminares do Registro Nacional de Tratamento com Novos Agentes Virais de Ação Direta em Pacientes com Hepatite C
Crônica
94 95 96 88
0
10
20
30
40
50
60
70
80
90
100
HCV mono não Tx HCV-HIV HCV+TX CIRR Child B e C
N = 2975 97 363 140
% R
VS
Resposta Virológica Sustentada Nos Principais Genótipos da Hepatite C, de Acordo com a Presença ou Ausência de Cirrose
98 98 93 95
81 85
0
20
40
60
80
100
Genótipo 1 Genótipo 2 Genótipo 3
Não Cirrose Cirrose
43 43
1437 1139
379 377 N=
Genótipo 1 Genótipo 2 Genótipo 3
DISTRIBUIÇÃO DOS DAAs EM PACIENTES CIRRRÓTICOS GENÓTIPOS 1 e 3
GENOTIPO 1 (n=1129)
SOFO + PR / +R 1%
DACLA + SOFO 64%
SOFO + SIME 29%
SOFO + LEDI 3%
3 D 3%
1%
64%
29%
3% 3%
Percentual
SOF/PR/P DACLA/SOF SOFO/SIME
SOFO/LEDI 3D
Genotipo 3 (n=378)
SOFO+DACLA 91%
SOFO+PR; SOFO+R 9%
93 7
Percentual
DACLA+SOFO
SOFO+PR
Obrigado
Resposta virológica sustentada de acordo com o genótipo do HCV
9790
0
20
40
60
80
100
1a 1b 3
91
Poordad F et al. Hepatology. 2016 Jan 11. doi: 10.1002/hep.28446. [Epub ahead of print]
N=10/11 N=9/10 N=30/31
EOT response and SVR (
%)
91 89
100
80
60
40
20
EOT SVR12
• 3 virological breakthroughs and
• 2 relapses • Patients treated with
daclatasvir/simeprevir ± RBV
Fontana RJ et al. Liver Transpl. 2016 Feb 17. doi: 10.1002/lt.24416. [Epub ahead of print]
92
ALL DCV+SOF±RBV
DCV+SMV±RBV
87
72
91
ALL DCV+SOF±RBV
DCV+SMV±RBV
SVR 12 according to liver function post-transplant
SVR
12
(%
) 96-98% 100
80
60
40
20
0 No/compensated
cirrhosis
Moderate hepatic impairment
Severe hepatic impairment
85-88%
60-75%
Gastroenterology 2015;149:649–659
All 6 pts with FCH = SVR
Charlton M et al. Gastroenterol 2015;149:649–659