Resumen de Combined use sofosbuvir and simeprevir in hepatitis c: A case report
Isabel Gómez Valbuena, Daniele Alioto, Olga Serrano Garrote, José Miguel Ferrari Piquero
Introduction: Hepatitis C is a serious disease with a high incidence and incurable until now. New drugs have shown greater efficacy and lower toxicity than traditional.
In Spain recently, the Agencia Española del Medicamento (AGEMED) (Spanish Agency of Medicines and Medical Devices AEMPS) authorized simeprevir and sofosbuvir for this disease. The purpose of this article is to describe a case where the combination of sofosbuvir and simeprevir for 24 weeks reduced viral load significantly. The medical history of the patient was reviewed, focusing on liver involvement, previous therapies against hepatitis C and evolution of viral load after diagnosis.
Case description: Male, 52 years old, diagnosed in 2009 with genotype 1b hepatitis C cirrhosis with a viral load of 119,680 IU/ml. He was treated with peginterferon and ribavirin (IFN-RBV) for nine months, decreasing to 1,408 IU/ml. In October 2011 he had a relapse and resumed treatment with IFN-RBV adding boceprevir without response. In 2012 he underwent liver resection for hepatocellular carcinoma. In April 2014 he underwent a liver transplant. During a post-transplant review a reactivation of the virus was diagnosed with a viral load of 25,575,843 IU/ml and values of GPT and GOT 135 and 352 IU/l, respectively. The patient was found not responder to IFN-RBV, and no response with boceprevir, the use in combination with sofosbuvir and simeprevir was authorized for 12 weeks since it was urgent to treat due to the rapid evolution of the disease. Due to the eighth week of treatment, viral load was still detectable, the treatment duration was increased to 24 weeks. After this period of treatment a sustained virological response was achieved.
Conclusions: Although published trials did not demonstrate superiority when dealing with simeprevir and sofosbuvir for 12 weeks versus 24 weeks, in some complex cases, like ours, increasing treatment duration to 24 weeks serves to control the disease in these patients
