Cardiac effects of Ledipasvir plus sofosbuvir for Hepatitis C treatment in thalassemia
H. Karimi-Sari1,2,3,4,, , A. Khosravi1,2,3,4, B. Behnava1,2,3,4, M. Abedi-Andani1,2,3,4, S.M. Alavian1,2,3,4
1 Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
2 Baqiyatallah Research Center for Gastroenterology and Liver Diseases (BRCGL), Baqiyatallah University of Medical Sciences, Tehran, Iran
3 Middle East Liver Diseases (MELD) Center, Tehran, Iran
4 Atherosclerosis Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran

Aim: This study was designed to evaluate the effects of Ledipasvir plus Sofosbuvir on cardiac function of thalassemia patients.

Introduction: Hepatitis C (HCV) infection is much more prevalent in thalassemia patients because of blood transfusion. Thalassemia patients may also have cardiac abnormalities due to congenital problems, anemia, and increased burden of iron in their myocardium. HCV treatment has been revolutionized after introducing new direct acting antiviral (DAA) drugs, and data is limited about effects of these new drugs on patients’ cardiac function.

Methods: In this study HCV-infected thalassemia patients which were selected for treatment with DAAs in HepCC-2 trial (NCT03061032) were evaluated prospectively. Fixed dose daily tablets of 90mg-Ledipasvir plus 400mg-Sofosbuvir (12/24week, ±ribavirin) was prescribed for patients. All patients were evaluated by a unique echocardiography fellowship for collecting the echocardiography findings of before and after the treatment. Then effects of mentioned drugs on patients’ cardiac function were evaluated.

Results: Thirty-two patients with mean age of 24.2±6.4 years were evaluated. The treatment response, which was evaluated by rapid virological response and sustained virological response rates, was 100%. The patients’ left ventricular end-systolic diameter (LVESD) and volume (LVESV), global longitudinal strain (GLS) of LV and average, and right ventricle (RV) size were significantly increased after finishing the treatment (P<0.05). Changes in abovementioned parameters were not correlated with patients’ myocardium iron load (P>0.05). There were no significant differences in before-after comparison of other echocardiographic parameters (P>0.05).

Conclusion: Ledipasvir-Sofosbuvir combination therapy was safe for our HCV-infected thalassemia patients and cause no serious cardiac events. But minimal changes in strain, size, and volume of left ventricle, and size of right ventricle may refer to needing more precise cardiac evaluations in these patients. Also, our patients’ ejection fraction remained unchanged. Hence, we suggest more specific and long-term echocardiographic evaluations before and after treatment, if needed.1–3

M. Jafroodi,A. Davoudi-Kiakalayeh,Z. Mohtasham-Amiri,A.A. Pourfathollah,A. Haghbin
Trend in prevalence of Hepatitis C virus infection among B-thalassemia major patients: 10 years of experience in Iran
Int J Prev Med, 6 (2015),
W. Poller,Z. Kaya,M. Muche,M. Kasner,C. Skurk,K. Kappert
High incidence of cardiac dysfunction and response to antiviral treatment in patients with chronic Hepatitis C virus infection
Clin. Res. Cardiol., (2017), pp. 1-6
S. Hagiwara,N. Nishida,T. Watanabe,T. Sakurai,H. Ida,Y. Minami
Outcome of combination therapy with sofosbuvir and ledipasvir for chronic type C liver disease
Oncology, 92 (2017), pp. 3-9

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