Treatment of chronic hepatitis C with direct-acting antivirals in patients with beta-thalassaemia major and advanced liver disease

2017 British Journal of Haematology 178;1 (130-136)

Interferon-based regimens for chronic hepatitis C (CHC) were often deferred in patients with beta-thalasaemia major (beta-TM) due to poor efficacy and tolerance. Current guidelines recommend direct-acting antivirals (DAAs) for these patients. The aim of this study was to assess the safety and efficacy of DAAs in patients with beta-TM and advanced liver disease due to CHC. Patients were recruited from eight liver units in Greece. The stage of liver disease was assessed using transient elastography and/or liver histology. Five regimens were used: sofosbuvir (SOF) + ribavirin (RBV); SOF + simeprevir +/- RBV; SOF + daclatasvir +/- RBV; ledipasvir/SOF +/- RBV and ombitasvir/paritaprevir-ritonavir + dasabuvir +/- RBV. Sixty-one patients (median age 43 years) were included. The majority of patients was previously treated for hepatitis C (75%) and had cirrhosis (79%). Viral genotype distribution was: G1a: n = 10 (16%); G1b: n = 22 (36%); G2: n = 2 (3%); G3: n = 14 (23%); G4: n = 13 (22%). The predominant chelation therapy was a combination of deferoxamine and deferiprone (35%). Overall sustained virological response rates were 90%. All treatment regimens were well tolerated and no major adverse events or drug-drug interactions were observed. Approximately half of the patients who received RBV (7/16, 44%) had increased needs for blood transfusion. Treatment of CHC with DAAs in patients with beta-TM and advanced liver disease was highly effective and safe.

Pubmed : 28439915