Rapid virological and End treatment response of patients treated with Sofosbuvir in Chronic Hepatitis C

• Published in: Pakistan journal of medical sciences Vol. 33; no. 4; pp. 813 - 817
• Main Authors: Siddique, Muhammad Shoaib, Shoaib, Sana, Saad, Alvia, Iqbal, Hamna Javed, Durrani, Noureen
• Format: Journal Article
• Language: English
• Published: Karachi Knowledge Bylanes 31.08.2017; AsiaNet Pakistan (Pvt) Ltd
• Subjects: Age; Antiviral drugs; Biological response modifiers; Care and treatment; Drug resistance; Genotype & phenotype; Health aspects; Hepatitis; Hepatitis C; Hepatitis C virus; Hepatology; Hospitals; Infection; Infections; Interferon; Liver; Patients; Population; Pregnant women
• ISSN: 1682-024X; 1681-715X
• DOI: 10.12669/pjms.334.12785

[...]a large number of subjects with HCV infection remained untreated due to absolute or relative contraindications to interferon therapy, like hepatic decompensation, autoimmune disease, and psychiatric illness.8 Also adverse effects like 'flu-like symptoms, fatigue, fever, leucopenia or thrombocytopenia can be unpleasant and sometimes serious, leading to dose reduction or discontinuation of treatment.9 In this regard the introduction of Sofosbuvir has proven to be groundbreaking as far as cure for hepatitis C is concerned. The safety and efficacy of sofosbuvir as proved by ELECTRON trial previously has it the basis of combination antiviral therapy in patients with chronic HCV genotype 1, 2 and 3 infections, including both treatment-naive and treatmentexperienced patients.11,12 No dose adjustment is required for creatinine clearance higher than 30 ml/ minutes, along with minimal side effects and the advantage of once daily oral dose makes it superior and more desirable other therapies of HCV.13 According to international guidelines of EASL the response to therapy with sofosbuvir is judged initially by the rapid virological response (RVR) that is the undetectable viral load on PCR done at one month while the ultimate goal is to get a sustained virological response (SVR) done after 12 weeks of completion of therapy.14 International studies have shown that twelve weeks of treatment with Sofosbuvir in combination with peginterferon and ribavirin resulted in substantial decreases in the level of HCV RNA during therapy, leading to a sustained virologic response at 24 weeks after treatment in 92% of patients with HCV genotype 2 or 3 infection.15 The same regimen of 12 weeks of treatment with sofosbuvir, peginterferon and ribavirin resulted in a sustained virologic response 24 weeks after treatment in 89% of patients with HCV genotype 1 infection16 But all these statistics reflect the response rates in western population where the distribution of genotypes is different from that of Pakistani population.17-19 The treatment response of oral regimens of 80-85% have been seen while in genotype 3, response is not as good. [...]we may use RVR and EVR to modify treatment in our patients of genotype 3 to save cost and get better results. [...]the aim of this study was to determine the rapid and end treatment response of sofosbuvir based regime in Pakistani population. Sofosbuvir is an oral nucleotide analogue inhibitor of the HCVspecific NS5B polymerase with in vitro activity against all HCV genotypes.10-12 Pakistan has a predominance of genotype 3 which according to some studies is said to be around 78%.21-23 Sofosbuvir has a number of ideal properties, including pan genotypic activity, once daily dosing, no meal restrictions, few adverse effects, minimal drug-drug interactions, high genetic barrier to resistance, good safety and efficacy in patients with advanced liver disease, and excellent sustained virological response rates in patients with unfavorable baseline characteristics.