Sažetak | Cilj: Prevalencija HCV infekcije u Hrvatskoj je niska i iznosi oko 1%. Od 2001. godine bolesnici s kroničnim hepatitisom C liječeni su pegiliranim interferonom s ribavirinom, a od 2013. na tržištu su dostupni novi direktno djelujući antivirusni lijekovi (DAA). Cilj ovog istraživanja bio je prikazati učinkovitost novih direktno djelujućih antivirusnih lijekova kod 50 bolesnika s kroničnim hepatitisom C koji su liječeni u tri bolnice u Dalmaciji.
Ispitanici i metode: U razdoblju od 1. kolovoza 2015. do 1. kolovoza 2016. godine ukupno je liječeno 50 bolesnika s DAA u Dalmaciji. Od tog broja 22 bolesnika su liječena u Općoj bolnici Zadar, 21 u Kliničkom bolničkom centru Split i 7 u Općoj bolnici Dubrovnik.
Rezultati: Među ispitivanim bolesnicima bilo je 35 muškaraca i 15 žena, a prosječna dob je bila 50.16 godina. Od 37 bolesnika koji su ranije liječeni (konvencionalni interferon, pegilirani interferon s ili bez ribavirina) bilo je 20 relapsera (54%), 2 parcijalna respondera (5%) i 12 non-respondera (33%). Daleko najveći broj bolesnika (80%) je imao cirozu, a preostalih 20% je imalo značajnije oštećenje jetre (fibroza 3). Većina ispitanika imala je genotip 1 (72%), manji broj genotip 3 (18%), dok su genotipovi 2 i 4 bili rijetki (2% i 8%). Svi liječeni bolesnici postigli su trajni virološki odgovor. Primijenjeni su različiti terapijski protokoli i to najčešće kombinacija OBV/PTV/r+DSV+RBV (42% bolesnika), zatim LED/SOF+RBV (24%), SOF/PEG/RBV (12%), SOF+RBV (8%), SIM/IFN/RBV (6%), a najrjeđe kombinacija OBV/PTV/r+DSV (4%) i LED/SOF (4%). Svi terapijski protokoli bili su 100% učinkoviti. Nuspojave su bile rijetke, nisu utjecale na tijek liječenja niti na prekid terapije.
Zaključak: Ovo su prvi rezultati liječenja kroničnog hepatitisa C direktno djelujućim antivirusnim lijekovima u Dalmaciji. Rezultati ovog istraživanja su u skladu s istraživanjima drugih autora. Očekuje se daljnja primjena DAA kod većeg broja bolesnika s kroničnim hepatitisom C u cilju dobivanja još većeg broja podataka o učinkovitosti ovih lijekova u stvarnom životu. |
Sažetak (engleski) | Objectives: Prevalence of HCV infection in Croatia is low and is about 1%. Since 2001, patients with chronic hepatitis C have been treated with pegylated interferon with ribavirin, and since 2013, new direct acting antiviral drugs (DAAs) have been available. The aim of this study was to demonstrate the efficacy of new direct acting antiviral drugs in 50 patients with chronic hepatitis C treated in three hospitals in Dalmatia.
Patients and methods: In the period from August 1st of 2015 to August 1st of 2016, 50 patients were treated with DAAs in Dalmatia. Out of that number, 22 patients were treated in the Zadar General Hospital, 21 in the Clinical Hospital Center of Split and 7 of them were treated in the Dubrovnik General Hospital.
Results: Among the tested patients there were 35 males and 15 females, and the average age was 50.16 years. Among the 37 patients who have been previously treated (conventional interferon, pegylated interferon with or without ribavirin) there were 20 relapsers (54%), 2 partial responders (5%) and 12 non-responders (33%). By far the largest number of patients (80%) had cirrhosis, and the remaining 20% had significant liver damage (fibrosis 3). The majority of tested patients had genotype 1 (72%), then genotype 3 (18%), while genotypes 2 and 4 were rare (2% and 8%). All treated patients achieved a sustained virological response. Different therapeutic protocols were used, most commonly the combination of OBV/PTV/r+DSV+RBV (42% of patients), followed by LED/SOF+RBV (24%), SOF/PEG/RBV (12%), SOF+RBV (8%), SIM/IFN/RBV (6%), and the rarest combinations were OBV/PTV/r+DSV (4%) and LED/SOF (4%). All therapeutic protocols were 100% effective. Adverse effects were rare and did not affect the course of the treatment nor the termination of therapy.
Conclusion: These are the first results of treatment of chronic hepatitis C with direct acting antiviral drugs in Dalmatia. The results of this research are in accordance with other authors' research. Further application of DAAs is expected among a larger number of patients with chronic hepatitis C in order to provide more data on the effectiveness of these drugs in real life. |