Hepatology Xagena

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Treatment of recurrent hepatitis C after living donor liver transplantation: Simeprevir versus Telaprevir

A study has evaluated the clinical outcomes of Telaprevir- or Simeprevir-based triple therapy for recurrent hepatitis C after living donor liver transplantation.

Twenty-six patients received antiviral therapy, consisting of either Telaprevir [ Incivo, Incivek ] ( n = 12 ) or Simeprevir ( n = 14 ) in combination with Pegylated-Interferon and Ribavirin, plus Cyclosporine.

More patients had a dose reduction of the direct-acting agent ( 36.3% vs 0.0%, P = 0.02 ) or required blood transfusion for anemia ( 58.3% vs 7.1%, P less than  0.01 ) in the Telaprevir group.

The Cyclosporine trough/dose ratio increased significantly from week 0 to week 4 in the Telaprevir group ( 1.6 ± 0.4 to 5.1 ± 2.0, P  less than  0.01 ), but not in the Simeprevir group ( 1.2 ± 0.3 to 1.3 ± 0.2, P = 0.68 ).

The 24-week cumulative viral clearance rate was 91.7% and 85.7% in the Telaprevir and in Simeprevir groups, respectively.

The early viral response and sustained viral response rates were 91.7% and 83.3%, respectively, in the Telaprevir group, compared with 85.7% and 64.3%, respectively, in the Simeprevir group.

Interferon-mediated graft dysfunction occurred in four and five patients in the Telaprevir and Simeprevir groups, respectively; two patients were treated by oral steroids, five by steroid pulse, and two by thymoglobulin, resulting in viral breakthrough in one case.

In conclusion, Simeprevir-based triple therapy was associated with fewer adverse events and drug interactions with Cyclosporine, and possibly less antiviral properties to Telaprevir.
Interferon-mediated graft dysfunction is a significant clinical problem that warrants particular caution following living donor liver transplantation. ( Xagena )

Ikegami T et al, Hepatol Res 2015; Epub ahead of print