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Kronik hepatit C’de üçlü tedavi: bir üniversite hastanesi gastroenteroloji kliniğinin deneyimi

Yıl 2016, Cilt: 26 Sayı: 3, 92 - 97, 01.09.2016

Mehmet Asıl Ramazan Yolaçan Ramazan Dertli Murat Bıyık Hüseyin Ataseven Hakkı Polat Ali Demir

Öz

Amaç: Pegile interferon+ribavirin kombinasyonu uzun yıllar kronik hepatit C tedavisinde standart tedavi olmuştur. Son yıllarda proteaz inhibitörleri bu kombinasyona ilave edilmiş ve daha yüksek kalıcı virolojik yanıt oranları elde edilebilmiştir. Biz bu çalışmada kliniğimizde takip edilen ve PEG-İFN+ribavirin+proteaz inhibitörü içeren üçlü tedavi alan hastalarımızın verilerini retrospektif olarak değerlendirmeyi amaçladık.Gereç ve Yöntem: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Gastroenteroloji Kliniğine Aralık 2012-Aralık 2015 tarihleri arasında başvuran ve proteaz inhibitörü içeren 3’lü tedavi verilen 23 kronik HCV hastasının verileri retrospektif olarak incelenmiştir.Bulgular: Hastaların 18’i %78,3 kadın ve 5’i %21,7 erkek ve median yaşları 58 yıl Aralık 42-70 yıl idi. Toplam 16 hastada %69,6 kalıcı virolojik yanıt elde edilmişti. Telaprevir kullanan 18 hastanın 13’ünde %72,2 ve boseprevir kullanan 5 hastanın 3’ünde %60 kalıcı virolojik yanıt elde edildi. Daha önce PEG IFN+ribavirin ikili tedavisi alıp nüks olan 11 hastanın 10’unda %90,1 , kısmi yanıt veren 3 hastanın tamamında ve ilk tedavide primer yanıtsız olan 4 hastanın 2’sinde %50 kalıcı virolojik yanıt elde edildi. Sirotik olan 9 hastanın 7’si %77,8 planlanan tedavi süresini tamamladı, 5 hastada %55,6 kalıcı virolojik yanıt elde edildi. Sirozu olmayan 14 hastanın 12’si %85,7 tedaviyi tamamlarken, bu hastaların 11’inde %78,5 kalıcı virolojik yanıt elde edildi. 4 hastada %17,4 çeşitli yan etkiler nedeniyle tedavi süresi tamamlanamadı.Sonuç: İnterferonsuz tedavi rejimlerinin ülkemizde henüz rutin kullanıma girmediği göz önüne alınırsa, seçilmiş vakalarda PEG IFN, ribavirin ve bir proteaz inhibitörü içeren üçlü tedavilerin hala bir seçenek olabileceği kanaatindeyiz

Anahtar Kelimeler

Hepatit C telaprevir boseprevir

Kaynakça

  • Zaltron S, Spinetti A, Biasi L, Baiguera C, Castelli F. Chro- nic HCV infection: Epidemiological and clinical relevance. BMC Infect 2012; 12(Suppl. 2): S2.
  • Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology 2013;57:1333-42.
  • Simmonds P, Bukh J, Combet C, et al. Consensus proposals for a unified system of nomenclature of hepatitis C virus genotypes. Hepatology 2005;42: 962-73.
  • Steinhauer DA, Domingo E, Holland JJ. Lack of eviden- ce for proofreading mechanisms associated with an RNA viruspolymerase. Gene 1992; 122: 281-8.
  • Bozdayi AM, Aslan N, Bozdayi G, et al. Molecular epide- miology of hepatitis B, C and D viruses in Turkish patients. Arch Virol 2004;149:2115-29.
  • Abacioglu YH, Davidson F, Tuncer S, et al. The distribution of hepatitis C virus genotypes in Turkish patients. J Viral Hepat 1995; 2: 297-301.
  • Altuglu I, Soyler I, Ozacar T, Erensoy S. Distribution of he- patitis C virus genotypes in patients with chronic hepatitis C infection in Western Turkey. Int J Infect 2008; 12: 239-44.
  • Dincer D. Hepatit C Epidemiyolojisi ve Patogenezi. Turkiye Klinikleri J Gastroenterohepatol-Special 2010; 3: 77-80.
  • Tozun N, Ozdogan OC, Cakaloglu Y, et al. A Nationwide prevalance study and risk factors for hepatitis A, B, C and D infections in Turkey Hepatology 2010; 52(Suppl 1); 697.
  • Tabak F, Tosun S, Balık İ, ve ark. Ülkemizde HBV ve HCV seroprevalansı değişiyor mu? [Özet]. XI. Ulusal Viral He- patit Kongresi (12-15 Nisan 2012, Antalya) Kitabı. Ankara: Viral Hepatitle Savaşım Derneği, 2012: 69.
  • Farci P, Shimoda A, Coiana A, et al. The outcome of acute hepatitis C predicted by the evolution of the viral quasispe- cies. Science 2000;288: 339-44.
  • Veldt BJ, Heathcote EJ, Wedemeyer H, et al. Sustained vi- rologic response and clinical outcomes in patients with chronic hepatitis C and advanced fibrosis. Ann Intern 2007;147:677-84.
  • Ghany MG, Strader DB, Thomas DL, Seef LB, American Association for the Study of Liver Diseases. Diagnosis, ma- nagement, and treatment of hepatitis C: an update. Hepato- logy 2009;49:133574.
  • Cunningham M, Foster GR. Efficacy and safety of telapre- vir in patients with genotype 1 hepatitis C infection. Therap Adv 2012; 5: 139-51.
  • Habersetzer F,Leboeuf C, Doffoel M, Baumert TF. Bocepre- vir and personalized medicine in hepatitis C virus infecti- on. Pharmgenomics Pers 2012; 5: 125-37.
  • Kurt H, Battal I, Memikoğlu O, Yeşilkaya A, Tekeli E. Anka- ra bolgesinde sağlıklı bireylerde HAV, HBV ve HCV serop- revalansının yaşa ve cinsiyete gore dağılımı. Viral Hepatit 2003; 8: 88-96.
  • Yildirim B, Barut S, Bulut Y,et al. Seroprevalence of hepati- tis B and C viruses in the province of Tokat in the Black Sea region of Turkey: A population-based study. Turk J Gastro- enterol 2009 Mar; 20: 27-30.
  • Karaca C, Cakaloğlu Y, Demir K, et al. Risk factors for the transmission of hepatitis C virus infection in the Turkish population. Dig Dis Sci 2006; 51: 365-9.
  • Nar H, Uyanıkoğlu A, Aydoğan T, Yenice N. Şanlıurfa Yore- si Hepatit C Hastalarının Değerlendirilmesi. Viral Hepatitis Journal 2013; 19: 62-6.
  • Seeff LB. Natural history of chronic hepatitis C. Hepatology 2002; 36: 35-46.
  • Thomas DL, Seeff LB. Natural history of hepatitis C. Clin Liver 2005; 9: 383-98.
  • Butt AA, Wang X, Moore CG. Effect of hepatitis C virus and its treatment on survival.Hepatology 2009;50:387-92.
  • Uyanikoglu A, Kaymakoglu S, Danalioglu A, Akyuz F, Er- mis F, Pinarbasi B, et al. Durability of sustained virologic response in chronic hepatitis C. Gut Liver 2013;7: 458-61.
  • Zeuzem S, Andreone P, Pol S, et al. Telaprevir for retreat- ment of HCV infection. N Engl J Med 2011; 364:2417-28.
  • McHutchison JG, Manns MP, Muir AJ, et al. Telaprevir for previously treated chronic HCV infection. N Engl J 2010; 362:1292-303.
  • Roujeau JC, Mockenhaupt M, Tahan SR, et al. Telapre- vir-related dermatitis. JAMA 2013;149:152-8.
  • Asıl M, Bıyık M, Çiftçi S, et al. Partial splenic embolization may be an option to overcome thrombocytopenia interfe- ring with triple therapy in HCV (+) cirrhotic patients: A case report. Viral Hepat J 2015;21:102-5.

Yıl 2016, Cilt: 26 Sayı: 3, 92 - 97, 01.09.2016

Mehmet Asıl Ramazan Yolaçan Ramazan Dertli Murat Bıyık Hüseyin Ataseven Hakkı Polat Ali Demir

Öz

Objective: Pegylated interferon+ribavirin dual combination had been the standard treatment for chronic hepatitis C for years.Recently protease inhibitors were added to this combination.In this manuscript, we aimed to review the data of the patients to whom Pegylated interferon+ribavirin+protease inhibitor containing triple therapy regimen were given in our clinic.Material and Method: This was a retrospective study and 23 chronic hepatitis C patients treated with triple therapy regimen in Necmettin Erbakan University, Meram Faculty of Medicine, Department of Gastroenterology, between December 2012 and December 2015 were included.Results: There were 18 78.3% male and 5 21.7% female patients and median age was 58 years range 42-70 years . 16 69.6% patients achieved sustained virological response. Thirteen 72.2% of 18 patients on telaprevir regimen and 3 60% of 5 patients on boceprevir regimen achieved sustained virological response.When virological response in the prior pegylated interferon+ribavirin treatment was taken into consideration;10 90.1% of 11 patients with relapse,3 patients 100% with partial response and 2 50% of 4 non-responders were found to achieve sustained virological response. Seven 77.8% of 9 cirrhotic patients completed the planned treatment and sustained virological response was achieved in 5 55.6 patients. 12 85.7% of 14 non-cirrhotic patients completed the planned treatment and sustained virological response was achieved in 11 78.5% patients.Treatment was discontinued in 4 17.4% patients due to various side effects.Conclusion: Taking into consideration that novel interferon free treatment regimens are not available in our country yet, triple combination with Pegylated interferon+ribavirin and protease inhibitor is still a treatment option for chronic hepatitis C in selected cases

Anahtar Kelimeler

Hepatitis C telaprevir boceprevir

Kaynakça

  • Zaltron S, Spinetti A, Biasi L, Baiguera C, Castelli F. Chro- nic HCV infection: Epidemiological and clinical relevance. BMC Infect 2012; 12(Suppl. 2): S2.
  • Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology 2013;57:1333-42.
  • Simmonds P, Bukh J, Combet C, et al. Consensus proposals for a unified system of nomenclature of hepatitis C virus genotypes. Hepatology 2005;42: 962-73.
  • Steinhauer DA, Domingo E, Holland JJ. Lack of eviden- ce for proofreading mechanisms associated with an RNA viruspolymerase. Gene 1992; 122: 281-8.
  • Bozdayi AM, Aslan N, Bozdayi G, et al. Molecular epide- miology of hepatitis B, C and D viruses in Turkish patients. Arch Virol 2004;149:2115-29.
  • Abacioglu YH, Davidson F, Tuncer S, et al. The distribution of hepatitis C virus genotypes in Turkish patients. J Viral Hepat 1995; 2: 297-301.
  • Altuglu I, Soyler I, Ozacar T, Erensoy S. Distribution of he- patitis C virus genotypes in patients with chronic hepatitis C infection in Western Turkey. Int J Infect 2008; 12: 239-44.
  • Dincer D. Hepatit C Epidemiyolojisi ve Patogenezi. Turkiye Klinikleri J Gastroenterohepatol-Special 2010; 3: 77-80.
  • Tozun N, Ozdogan OC, Cakaloglu Y, et al. A Nationwide prevalance study and risk factors for hepatitis A, B, C and D infections in Turkey Hepatology 2010; 52(Suppl 1); 697.
  • Tabak F, Tosun S, Balık İ, ve ark. Ülkemizde HBV ve HCV seroprevalansı değişiyor mu? [Özet]. XI. Ulusal Viral He- patit Kongresi (12-15 Nisan 2012, Antalya) Kitabı. Ankara: Viral Hepatitle Savaşım Derneği, 2012: 69.
  • Farci P, Shimoda A, Coiana A, et al. The outcome of acute hepatitis C predicted by the evolution of the viral quasispe- cies. Science 2000;288: 339-44.
  • Veldt BJ, Heathcote EJ, Wedemeyer H, et al. Sustained vi- rologic response and clinical outcomes in patients with chronic hepatitis C and advanced fibrosis. Ann Intern 2007;147:677-84.
  • Ghany MG, Strader DB, Thomas DL, Seef LB, American Association for the Study of Liver Diseases. Diagnosis, ma- nagement, and treatment of hepatitis C: an update. Hepato- logy 2009;49:133574.
  • Cunningham M, Foster GR. Efficacy and safety of telapre- vir in patients with genotype 1 hepatitis C infection. Therap Adv 2012; 5: 139-51.
  • Habersetzer F,Leboeuf C, Doffoel M, Baumert TF. Bocepre- vir and personalized medicine in hepatitis C virus infecti- on. Pharmgenomics Pers 2012; 5: 125-37.
  • Kurt H, Battal I, Memikoğlu O, Yeşilkaya A, Tekeli E. Anka- ra bolgesinde sağlıklı bireylerde HAV, HBV ve HCV serop- revalansının yaşa ve cinsiyete gore dağılımı. Viral Hepatit 2003; 8: 88-96.
  • Yildirim B, Barut S, Bulut Y,et al. Seroprevalence of hepati- tis B and C viruses in the province of Tokat in the Black Sea region of Turkey: A population-based study. Turk J Gastro- enterol 2009 Mar; 20: 27-30.
  • Karaca C, Cakaloğlu Y, Demir K, et al. Risk factors for the transmission of hepatitis C virus infection in the Turkish population. Dig Dis Sci 2006; 51: 365-9.
  • Nar H, Uyanıkoğlu A, Aydoğan T, Yenice N. Şanlıurfa Yore- si Hepatit C Hastalarının Değerlendirilmesi. Viral Hepatitis Journal 2013; 19: 62-6.
  • Seeff LB. Natural history of chronic hepatitis C. Hepatology 2002; 36: 35-46.
  • Thomas DL, Seeff LB. Natural history of hepatitis C. Clin Liver 2005; 9: 383-98.
  • Butt AA, Wang X, Moore CG. Effect of hepatitis C virus and its treatment on survival.Hepatology 2009;50:387-92.
  • Uyanikoglu A, Kaymakoglu S, Danalioglu A, Akyuz F, Er- mis F, Pinarbasi B, et al. Durability of sustained virologic response in chronic hepatitis C. Gut Liver 2013;7: 458-61.
  • Zeuzem S, Andreone P, Pol S, et al. Telaprevir for retreat- ment of HCV infection. N Engl J Med 2011; 364:2417-28.
  • McHutchison JG, Manns MP, Muir AJ, et al. Telaprevir for previously treated chronic HCV infection. N Engl J 2010; 362:1292-303.
  • Roujeau JC, Mockenhaupt M, Tahan SR, et al. Telapre- vir-related dermatitis. JAMA 2013;149:152-8.
  • Asıl M, Bıyık M, Çiftçi S, et al. Partial splenic embolization may be an option to overcome thrombocytopenia interfe- ring with triple therapy in HCV (+) cirrhotic patients: A case report. Viral Hepat J 2015;21:102-5.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Original Article
Yazarlar

Mehmet Asıl Bu kişi benim

Ramazan Yolaçan Bu kişi benim

Ramazan Dertli Bu kişi benim

Murat Bıyık Bu kişi benim

Hüseyin Ataseven Bu kişi benim

Hakkı Polat Bu kişi benim

Ali Demir Bu kişi benim

Yayımlanma Tarihi 1 Eylül 2016
Yayımlandığı Sayı Yıl 2016 Cilt: 26 Sayı: 3

Kaynak Göster

Vancouver Asıl M, Yolaçan R, Dertli R, Bıyık M, Ataseven H, Polat H, Demir A. Kronik hepatit C’de üçlü tedavi: bir üniversite hastanesi gastroenteroloji kliniğinin deneyimi. Genel Tıp Derg. 2016;26(3):92-7.

Genel Tıp Dergisi Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı (CC BY NC) ile lisanslanmıştır.