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Successful sofosbuvir treatment with ribavirin dose reduction for chronic hepatitis C virus genotype 2 infection in a patient with ulcerative colitis: a case report.

Ohta Y, Kanda T, Katsuno T, Yasui S, Haga Y, Sasaki R, Nakamura M, Wu S, Nakamoto S, Arai M, Yokosuka O - BMC Gastroenterol (2016)

Bottom Line: An interferon-free regimen appears useful, safe and effective for many patients for whom interferon-based treatment is contraindicated.After ribavirin was reduced to 400 mg daily, these symptoms decreased.Clinicians should pay careful attention to the ribavirin dose in the treatment of certain HCV patients with inflammatory bowel disease who are receiving sofosbuvir plus ribavirin.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.

ABSTRACT

Background: Ulcerative colitis is a lifelong, immunologically mediated disease. Direct-acting antivirals (DAAs) are now available for the treatment of chronic hepatitis C virus (HCV) infection. An interferon-free regimen appears useful, safe and effective for many patients for whom interferon-based treatment is contraindicated.

Case presentation: We studied a 56-year-old treatment-naïve Japanese man with chronic HCV genotype 2b infection who had ulcerative colitis. This patient was treated with sofosbuvir and ribavirin for 12 weeks. During treatment, diarrhoea and bloody faeces were frequent. After ribavirin was reduced to 400 mg daily, these symptoms decreased. Finally, the patient achieved a sustained virologic response 12 weeks after the stoppage of the treatment.

Conclusion: Clinicians should pay careful attention to the ribavirin dose in the treatment of certain HCV patients with inflammatory bowel disease who are receiving sofosbuvir plus ribavirin.

No MeSH data available.


Related in: MedlinePlus

Clinical course of the patient. ALT alanine transaminase, WBC white blood cells, w weeks, Neg negative
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Fig1: Clinical course of the patient. ALT alanine transaminase, WBC white blood cells, w weeks, Neg negative

Mentions: The patient was treated with sofosbuvir at 400 mg daily and ribavirin at 600 mg daily. One week after the initiation of this treatment, the patient felt general malaise without any adverse events [white blood cell count (WBC), 7900/μL; hemoglobin, 14.7 g/dL; C-reactive protein (CRP) 0.0 mg/dL; AST, 35 IU/L; and ALT, 49 IU/L]. By week 3, the patient was having up to 10 loose bowel movements per day, with small amounts of blood. As the patient’s HCV RNA became negative and he improved to having 5 loose bowel movements per day by week 4 [WBC, 8600/μL; hemoglobin, 14.3 g/dL; AST, 19 IU/L; and ALT, 19 IU/L], the dose of ribavirin was increased to 800 mg daily. By week 7, however, the patient was having up to 20 loose bowel movements per day, with small amounts of blood, and the dose of ribavirin was decreased to 400 mg daily [WBC, 8200/μL; hemoglobin, 14.7 g/dL; CRP 0.1 mg/dL; AST, 19 IU/L; and ALT, 17 IU/L]. By week 8, the patient improved to having 10 loose bowel movements per day [WBC, 8600/μL; hemoglobin, 14.2 g/dL; CRP 0.1 mg/dL; AST, 20 IU/L; and ALT, 17 IU/L], and by week 11, his diarrhoea had resolved. Finally, the patient was treated with sofosbuvir plus ribavirin for 12 weeks. By week 12 after the initiation of this treatment, the patient’s HCV RNA was negative, and he had achieved a SVR 12 weeks (SVR12) after the stoppage of treatment [WBC, 14400/μL; hemoglobin, 16.2 g/dL; CRP 0.2 mg/dL; AST, 22 IU/L; and ALT, 22 IU/L] (Fig. 1). Three weeks post-treatment, an endoscopic examination of the colon-rectum confirmed that the mucosa was oedematous from the colon transversum to the rectum, although mucosal vascular permeability was reduced from the sigmoid colon to the rectum. The patient did not complain of abdominal pain or fever during treatment.Fig. 1


Successful sofosbuvir treatment with ribavirin dose reduction for chronic hepatitis C virus genotype 2 infection in a patient with ulcerative colitis: a case report.

Ohta Y, Kanda T, Katsuno T, Yasui S, Haga Y, Sasaki R, Nakamura M, Wu S, Nakamoto S, Arai M, Yokosuka O - BMC Gastroenterol (2016)

Clinical course of the patient. ALT alanine transaminase, WBC white blood cells, w weeks, Neg negative
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940930&req=5

Fig1: Clinical course of the patient. ALT alanine transaminase, WBC white blood cells, w weeks, Neg negative
Mentions: The patient was treated with sofosbuvir at 400 mg daily and ribavirin at 600 mg daily. One week after the initiation of this treatment, the patient felt general malaise without any adverse events [white blood cell count (WBC), 7900/μL; hemoglobin, 14.7 g/dL; C-reactive protein (CRP) 0.0 mg/dL; AST, 35 IU/L; and ALT, 49 IU/L]. By week 3, the patient was having up to 10 loose bowel movements per day, with small amounts of blood. As the patient’s HCV RNA became negative and he improved to having 5 loose bowel movements per day by week 4 [WBC, 8600/μL; hemoglobin, 14.3 g/dL; AST, 19 IU/L; and ALT, 19 IU/L], the dose of ribavirin was increased to 800 mg daily. By week 7, however, the patient was having up to 20 loose bowel movements per day, with small amounts of blood, and the dose of ribavirin was decreased to 400 mg daily [WBC, 8200/μL; hemoglobin, 14.7 g/dL; CRP 0.1 mg/dL; AST, 19 IU/L; and ALT, 17 IU/L]. By week 8, the patient improved to having 10 loose bowel movements per day [WBC, 8600/μL; hemoglobin, 14.2 g/dL; CRP 0.1 mg/dL; AST, 20 IU/L; and ALT, 17 IU/L], and by week 11, his diarrhoea had resolved. Finally, the patient was treated with sofosbuvir plus ribavirin for 12 weeks. By week 12 after the initiation of this treatment, the patient’s HCV RNA was negative, and he had achieved a SVR 12 weeks (SVR12) after the stoppage of treatment [WBC, 14400/μL; hemoglobin, 16.2 g/dL; CRP 0.2 mg/dL; AST, 22 IU/L; and ALT, 22 IU/L] (Fig. 1). Three weeks post-treatment, an endoscopic examination of the colon-rectum confirmed that the mucosa was oedematous from the colon transversum to the rectum, although mucosal vascular permeability was reduced from the sigmoid colon to the rectum. The patient did not complain of abdominal pain or fever during treatment.Fig. 1

Bottom Line: An interferon-free regimen appears useful, safe and effective for many patients for whom interferon-based treatment is contraindicated.After ribavirin was reduced to 400 mg daily, these symptoms decreased.Clinicians should pay careful attention to the ribavirin dose in the treatment of certain HCV patients with inflammatory bowel disease who are receiving sofosbuvir plus ribavirin.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Nephrology, Chiba University, Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.

ABSTRACT

Background: Ulcerative colitis is a lifelong, immunologically mediated disease. Direct-acting antivirals (DAAs) are now available for the treatment of chronic hepatitis C virus (HCV) infection. An interferon-free regimen appears useful, safe and effective for many patients for whom interferon-based treatment is contraindicated.

Case presentation: We studied a 56-year-old treatment-naïve Japanese man with chronic HCV genotype 2b infection who had ulcerative colitis. This patient was treated with sofosbuvir and ribavirin for 12 weeks. During treatment, diarrhoea and bloody faeces were frequent. After ribavirin was reduced to 400 mg daily, these symptoms decreased. Finally, the patient achieved a sustained virologic response 12 weeks after the stoppage of the treatment.

Conclusion: Clinicians should pay careful attention to the ribavirin dose in the treatment of certain HCV patients with inflammatory bowel disease who are receiving sofosbuvir plus ribavirin.

No MeSH data available.


Related in: MedlinePlus