Terapia con antivirali ad azione diretta in pazienti con epatite cronica HCV e severa fibrosi o cirrosi

Introduction: Chronic hepatitis C (CHC) is the most common viral infection blood-transmitted and it is the leading cause of death from liver disease. Antiviral therapy can prevent disease progression in patients with CHC. Telaprevir and Simeprevir are Direct Acting Antivirals and two protease inhibitor, useful in the eradication of the virus. Aim: to assess the safety and efficacy of telaprevir-based antiviral therapy with pegIFN/ribavirin or simeprevir-based antiviral therapy with sofosbuvir ± ribavirin. Methods: consecutive 35 CHC patients (54.3% males, median age 61, range 43-71) were enrolled in telaprevir group and compared with 70 controls, randomly selected from the population of patients treated with simeprevir-sofosbuvir and matched by age ± 5 years, sex and degree of fibrosis. Efficacy by sustained virological response (SVR) and improvement of laboratory tests and safety were evaluated. Results: patients treated with telaprevir had adverse events in 94.2% of cases while occurred in 28.6% of patients treated with simeprevir (p.000). Severe adverse events occurred all in telaprevir group (20% vs 0%, p 0.000). The most common adverse event in both groups was anemia (77.1% in telaprevir treatment vs 14.3% in simeprevir treatment, p 0.000). SVR was 91.4% in cases and 71.4% in controls (p 0.01). Use of ribavirin, type of genotype 1 and stage of fibrosis did not affect SVR rates. Conclusion: our study showed the telaprevir is less effective and safe compared to simeprevir in patients with advanced fibrosis or cirrhosis. The data confirm the indication to prefer interferon free regimens to those still based on interferon in this setting.