文章：

慢性丙型肝炎患者合并活动性恶性肿瘤时直接抗病毒药物的真实世界疗效与安全性研究

The Real-World Efficacy and Safety of Direct-Acting Antivirals for Chronic Hepatitis C in Patients Active Malignancies

原文发布日期：9 September 2024

DOI: 10.3390/cancers16173114

类型: Article

开放获取: 是

英文摘要：

Background: Over the past years, the introduction of direct-acting antivirals (DAAs) revolutionized chronic hepatitis C treatment. We aimed to characterize and assess treatment efficacy in three specific groups of patients treated with DAAs: those with active solid malignant tumors (SMTs), hematological diseases (HDs) and hepatocellular carcinomas (HCCs). Methods: A total of 203 patients with active oncological disease (SMTn= 61, HD = 67, HCCn= 74) during DAA treatment in 2015–2020 selected from the EpiTer-2 database were analyzed retrospectively and compared to 12,983 patients without any active malignancy. Results: Extrahepatic symptoms were more frequent in HD patients (17.2% vs. SMT = 10.3%, HCC = 8.2%, without = 7.8%,p= 0.004). HCC patients characterized with the highest ALT activity (81 IU/L vs. SMT = 59.5 IU/L, HD = 52 IU/L, without = 58 IU/L,p= 0.001) more often had F4 fibrosis as well (86.11% vs. SMT = 23.3%, HD = 28.8%, controls = 24.4%,p= 0.001). A significant majority of subjects in HCC, HD and SMT populations completed the full treatment plan (HCC = 91%;n= 67, HD = 97%;n= 65, SMT = 100%;n= 62). Concerning the treatment efficacy, the overall sustained virologic response, excluding non-virologic failures, was reported in 93.6% HD, 90.16% SMT and 80.6% in HCC patients. Conclusions: As presented in our study, DAA therapy has proven to be highly effective and safe in patients with active SMTs and HDs. However, therapy discontinuations resulting from liver disease progression remain to be the major concern in HCC patients.

摘要翻译： 

背景：近年来，直接抗病毒药物（DAAs）的引入彻底改变了慢性丙型肝炎的治疗模式。本研究旨在对接受DAAs治疗的三类特定患者群体——活动性实体恶性肿瘤（SMTs）、血液系统疾病（HDs）及肝细胞癌（HCCs）患者——进行特征分析并评估其治疗效果。方法：回顾性分析从EpiTer-2数据库中选取的2015-2020年间接受DAA治疗期间患有活动性肿瘤疾病的203例患者（SMT组61例、HD组67例、HCC组74例），并与12,983例无活动性恶性肿瘤的患者进行对比。结果：肝外症状在HD患者中更为常见（17.2% vs. SMT组10.3%、HCC组8.2%、对照组7.8%，p=0.004）。HCC患者具有最高的ALT活性（81 IU/L vs. SMT组59.5 IU/L、HD组52 IU/L、对照组58 IU/L，p=0.001），且F4级肝纤维化比例更高（86.11% vs. SMT组23.3%、HD组28.8%、对照组24.4%，p=0.001）。绝大多数HCC、HD和SMT患者完成了完整治疗方案（HCC组91%，67例；HD组97%，65例；SMT组100%，62例）。在治疗效果方面，排除非病毒学失败病例后，总体持续病毒学应答率分别为HD组93.6%、SMT组90.16%、HCC组80.6%。结论：本研究显示，DAA疗法在活动性SMT和HD患者中具有高效性和安全性。然而，因肝病进展导致的治疗中断仍是HCC患者面临的主要问题。

原文链接：

The Real-World Efficacy and Safety of Direct-Acting Antivirals for Chronic Hepatitis C in Patients Active Malignancies