Friday, July 31, 2015

How I Expect Evolving Options for HCV Therapy Will Affect Posttransplant Management

How I Expect Evolving Options for HCV Therapy Will Affect Posttransplant Management  

Paul Y. Kwo, MD - 7/29/2015
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Will we finally have options to prevent posttransplantation HCV recurrence across the spectrum of genotypes?

Although current options for posttransplantation recurrence of genotype 1 and 4 HCV can achieve high SVRs, options with equivalent efficacy for posttransplantation recurrence of genotype 3 HCV are limited. At the 2015 European Association for the Study of the Liver (EASL) meeting, data from the phase III ALLY-1 study gave us a clear glimpse at an upcoming option for managing patients with genotype 3 HCV recurrence following orthotopic liver transplantation. The multicenter, open-label trial evaluated the investigational NS5A inhibitor daclatasvir in combination with sofosbuvir and ribavirin for 12 weeks in patients with advanced cirrhosis or posttransplantation HCV recurrence.

Eligible patients were ≥ 3 months posttransplantation with no evidence of rejection at enrollment. Of importance, any immunosuppressive regimen was allowed. The overall SVR12 rate in this posttransplantation population of 53 patients was 94%; when broken down by patient factors, 97% of patients with genotype 1a, 90% of those with genotype 1b, and 91% of those with genotype 3 HCV infection achieved SVR12. There was even 1 patient with genotype 6 HCV infection enrolled, who also achieved SVR12.

The regimen was well tolerated, with the few serious adverse events considered unrelated to treatment.

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