Back to Search Start Over

Sustained virological response with intravenous silibinin: individualized IFN-free therapy via real-time modelling of HCV kinetics

Authors :
Eran Goldin
Gali Weiss
Harel Dahari
Shimon Shteingart
Thomas Tichler
Scott J. Cotler
Yaakov Jack Ashkenazi
Massimo D'Amato
Yoav Lurie
Ralf T. Pohl
Inna Gafanovich
Source :
Liver International. 35:289-294
Publication Year :
2014
Publisher :
Wiley, 2014.

Abstract

Providing here our aims and project background, we note that intravenous silibinin (SIL) is a potent antiviral agent against hepatitis C virus (HCV) genotype-1. In this proof of concept case-study we tested: (i) whether interferon-alfa (IFN)-free treatment with SIL plus ribavirin (RBV) can achieve sustained virological response (SVR); (ii) whether SIL is safe and feasible for prolonged duration of treatment and (iii) whether mathematical modelling of early on-treatment HCV kinetics can guide duration of therapy to achieve SVR. With our method, a 44 year-old female HCV-(genotype-1)-infected patient who developed severe psychiatric adverse events to a previous course of pegIFN+RBV, initiated combination treatment with 1200 mg/day of SIL, 1200 mg/day of RBV and 6000 u/day vitamin D. Blood samples were collected frequently till week 4, thereafter every 1-12 weeks until the end of therapy. The standard biphasic mathematical model with time-varying SIL effectiveness was used to predict the duration of therapy to achieve SVR. Our results show that, based on modelling the observed viral kinetics during the first 3 weeks of treatment, SVR was predicted to be achieved within 34 weeks of therapy. Provided with this information, the patient agreed to complete 34 weeks of treatment. IFN-free treatment with SIL+RBV wasmore » feasible, safe and achieved SVR (week-33). In conclusion, we report, for the first time, the use of real-time mathematical modelling of HCV kinetics to individualize duration of IFN-free therapy and to empower a patient to participate in shared decision making regarding length of treatment. SIL-based individualized therapy provides a treatment option for patients who do not respond to or cannot receive other HCV agents and should be further validated.« less

Details

ISSN :
14783223
Volume :
35
Database :
OpenAIRE
Journal :
Liver International
Accession number :
edsair.doi.dedup.....d55dc0e34b77a2aa0eefa55585d0527f
Full Text :
https://doi.org/10.1111/liv.12692