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Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Jean-Marie PERON
Coup de coeur :
 
 
Gastroenterology
  2016/08  
 
  2016 Aug 23. pii: S0016-5085(16)34927-7  
  doi: 10.1053/j.gastro.2016.08.004.  
 
  Effectiveness of Ledipasvir-Sofosbuvir Combination in Patients With Hepatitis C Virus Infection and Factors Associated of Sustained Virologic Response.  
 
  Terrault NA, Zeuzem S, Di Bisceglie AM, Lim JK, Pockros PJ, Frazier LM, Kuo A, Lok AS, Shiffman ML, Ben Ari Z, Akushevich L, Vainorius M, Sulkowski MS, Fried MW, Nelson DR; HCV-TARGET Study Group.  
  https://www.ncbi.nlm.nih.gov/pubmed/?term=Terrault+NA1%2C+Zeuzem+S2%2C+Di+Bisceglie+AM3%2C+Lim+JK4%2C+Pockros+PJ5%2C+Frazier+LM6%2C+Kuo+A7%2C+Lok+AS8%2C+Shiffman+ML9%2C+Ben+Ari+Z10%2C+Akushevich+L11%2C+Vainorius+M11%2C+Sulkowski+MS12%2C+Fried+MW11%2C+Nels  
 
 

BACKGROUND & AIMS:

The combination of ledipasvir and sofosbuvir has been approved for treatment of genotype 1 hepatitis C virus (HCV) infection, including an 8-week regimen for treatment-naïve patients without cirrhosis and a baseline level of HCV RNA <6 million IU/mL. We analyzed data from a multicenter, prospective, observational study to determine real-world sustained virologic responses 12 weeks after treatment (SVR12) with regimens containing ledipasvir and sofosbuvir and identify factors associated with treatment failure.

METHODS:

We collected data from 2099 participants in the HCV-TARGET study with complete virologic data (per protocol population). We analyzed data from 1788 patients receiving ledipasvir-sofosbuvir (282 for 8 weeks, 910 for 12 weeks, 510 for 24 weeks, and 86 for a different duration) and 311 receiving ledipasvir-sofosbuvir plus ribavirin (212 for 12 weeks and 81 for 24 weeks, 18 for other duration) to estimate SVR12 (with 95% CI), and logistic regression methods to identify factors that predicted an SVR12.

RESULTS:

The overall study population was 25% Black, 66% with HCV genotype 1A infection, 41% with cirrhosis, 50% treatment experienced, and 30% receiving proton pump inhibitors (PPIs) at start of treatment. In the per protocol population, SVR12s were achieved by 96% of patients receiving ledipasvir-sofosbuvir for 8 weeks (95% CI, 93%-98%), 97% receiving the drugs for 12 weeks (95% CI, 96%-98%), and 95% receiving the drugs for 24 weeks (95% CI, 93%-97%). Among patients also receiving ribavirin, SVR12s were achieved by 97% of the patients receiving the drugs for 12 weeks (95% CI, 94%-99%) and 95% receiving the drugs for 24 weeks (95% CI, 88%-99%). Of the 586 patients who qualified for 8 weeks treatment, only 255 (44%) received the drugs for 8 weeks. The rate of SVR12 among those who qualified for and received 8 weeks therapy was similar in those who qualified for 8 weeks but received 12 weeks therapy (96%; 95% CI, 92%-99% vs 98%; 95% CI, 95%-99%). Factors that predicted SVR12 were higher albumin (≥3.5 g/dL), lower total bilirubin (≤1.2 g/dL), absence of cirrhosis, and absence of PPI use.

CONCLUSIONS:

Regimens containing ledipasvir and sofosbuvir are highly effective for a broad spectrum of patients with HCV genotype 1 infection treated in different clinical practice settings. Expanded use of 8-week treatment regimens for eligible patients is supported by these real-world results. Modification of PPI use may increase rates of SVR. ClinicalTrials.gov no. NCT01474811.

 
Question posée
 
Efficacité de l’association Sofosbuvir-Lédipasvir dans la vraie vie.
 
Question posée
 
Résultats de vraie vie équivalents à ceux des études randomisées. 2 remarques : 1- pas assez de patients sont traités 8 semaines (44% de ceux qui avaient les critères de traitement court : géno 1 naïfs de traitement non cirrhotique, charge virale < 6 millions/ml) 2- il y a une diminution significative de la RVS chez les patients sous IPP, surtout > 20 mg /j. Il vaut probablement mieux si possible arrêter les IPP pour la durée du traitement ou prendre la dose minimale possible.
 
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