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Thématique :
- Foie
- Hépatites virales
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Philippe SOGNI
Coup de coeur :
 
 
Hepatology
  2015/10  
 
  2015 Oct;62(4):1004-12  
  doi: 10.1002/hep.27937  
 
  Multicenter experience using simeprevir and sofosbuvir with or without ribavirin to treat hepatitis C genotype 1 in patients with cirrhosis  
 
  Aqel BA, Pungpapong S, Leise M, Werner KT, Chervenak AE, Watt KD, Murphy JL, Ryland K, Keaveny AP, McLemore R, Vargas HE  
  http://onlinelibrary.wiley.com/doi/10.1002/hep.27937/abstract  
 
 

Interferon (IFN)-free regimens are needed to treat hepatitis C virus (HCV) infection. Combined simeprevir (SMV) and sofosbuvir (SOF) with or without ribavirin (RBV) results in high sustained virological response (SVR) rates along with minimal adverse events (AEs) in patients with hepatitis C genotype 1 (HCV GT1). The aim of this study was to report on the virological response, safety, and tolerability of SOF and SMV with or without RBV in compensated and decompensated patients with cirrhosis with HCV GT1 infection. Patients treated with standardized clinical protocol utilizing SMV+SOF with or without RBV at three transplant centers were retrospectively reviewed. A total of 119 patients (61% male, 87% white, 69% subtype 1a, 30% Child-Pugh-Turcott [CPT]-B liver cirrhosis [LC], and 82% were treatment experienced) received treatment and were followed for a median of 38 weeks (range, 12-58). Sustained virological response (SVR) at week 12 (SVR12) was achieved in 78% (92 of 118) of patients (95% confidence interval: 69-85). Lower pretreatment Model for End Stage Liver Disease (MELD) score was a predictor of SVR12 (P  = 0.018). Baseline viral load, previous treatment status, RBV use, or GT1 subtype did not impact SVR 12. The majority of patients with SVR12 showed stability or improvement in MELD score. Treatment was very well tolerated with mild degrees of AEs.

Conclusions
The regimen of SMV+SOF with or without RBV for 12 weeks was very well tolerated and resulted in high SVR12 rates (78%) in HCV GT1 patients with LC. SVR12 was inversely related to pretreatment MELD. SVR12 had favorable short-term impact on MELD score. Long-term impact on disease stability is yet to be determined. Longer treatment duration or the use of different regimen may still be needed in this population.

 
Question posée
 
L’association sofosbuvir (inhibiteur de polymérase – IPol) et simeprevir (inhibiteur de Protéase – IP) est-elle efficace chez les patients génotype 1 cirrhotiques ?
 
Question posée
 
Oui, mais pas suffisamment.
 
Commentaires

Les auteurs concluent que 78% de taux de guérison est très satisfaisant, ce qui n’est pas le cas. Cette étude est surtout intéressante pour démontrer que l’efficacité des nouveaux anti-viraux directs reste dépendant de la fonction hépatique initiale et que la guérison peut s’associer à une amélioration de la fonction hépatique même si cette amélioration n’est pas systématique.

 
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