[3] Brunetti E, Kern P, Vuitton DA, Writing panel for the WHO-IWGE.
Expert Dominique-Angèle Vuitton2
consensus for the diagnosis and treatment of cystic and alveolar echino-
coccosis in humans. Acta Tropica 2010;114:1–16.
[4] Aji T, Dong J-H, Shao Y-M, Zhao JM, Li T, Tuxun T, et al. Ex vivo liver
resection and auto transplantation as alternative to allo transplantation for
end-stage hepatic alveolar echinococcosis. J Hepatol 2018;69:1037–1046.
[5] Pawluk SA, Roels CA, Wilby KJ, Ensom MH. A review of pharmacokinetic
drug-drug interactions with the anthelmintic medications albendazole and
mebendazole. Clin Pharmacokinet 2015;54:371–383.
[6] Wen H, New RR, Muhmut M, Wang JH, Wang YH, Zhang JH, et al. Phar-
macology and efficacy of liposome-entrapped albendazole in experimental
secondary alveolar echinococcosis and effect of co-administration with
cimetidine. Parasitology 1996;113(Pt 2):111–121.
[7] Nagy J, Schipper HG, Koopmans RP, Butter JJ, Van Boxtel CJ, Kager PA. Effect
of grapefruit juice or cimetidine coadministration on albendazole
bioavailability. Am J Trop Med Hyg 2002;66(3):260–263.
[8] Anderson GD, Chan L-N. Pharmacokinetic drug interactions with tobacco,
cannabinoids and smoking cessation products. Clin Pharmacokinet
2016;55(11):1353–1368.
[9] Li G, Simmler C, Chen L, Nikolic D, Chen SN, Pauli GF, et al. Cytochrome
P450 inhibition by three licorice species and fourteen licorice constituants.
Eur J Pharm Sci 2017;109:182–190.
Solange Bresson-Hadni1,2,3,4,5,*
Damien Montange1,6
Carine Richou1,7
Eléonore Brumpt1,8
Aurélie Fillion9
Brigitte Bartholomot10
Oleg Blagosklonov1,11
Eric Delabrousse1,8
Frédéric Grenouillet1,3,12
EASL recommendations on treatment of hepatitis C: Final update of
the series – Some issues
To the Editor:
We read with great interest the final update of the EASL rec-
ommendations on the treatment of hepatitis C, which is one of
the most important guidelines in the world.1 Having read the
guidelines, we wanted to raise the following points:
For the treatment-naïve patients infected with genotype 3
with compensated (Child-Pugh A) cirrhosis (naïve GT-3 CC), the
recommendations mentioned that they should be treated with
the fixed-dose combination of glecaprevir and pibrentasvir
(glecaprevir/pibrentasvir) for 12 weeks, the fixed-dose combi-
nation of sofosbuvir and velpatasvir (sofosbuvir/velpatasvir)
with weight-based ribavirin (1,000 or 1,200 mg in patients <75
kg or >−75 kg, respectively) for 12 weeks, or the fixed-dose
combination of sofosbuvir, velpatasvir and voxilaprevir for 12
weeks. For these naïve GT-3 CC patients, 8-week glecaprevir/
pibrentasvir therapy is effective2 and has been approved by the
U.S. FDA (September 2019) and European Commission (March
2020), as well as being recommended by the AASLD-IDSA
Keywords: Hepatitis C virus; Chronic hepatitis C; Direct acting antivirals.
Received 13 October 2020; accepted 17 October 2020; available online 19 November 2020
https://doi.org/10.1016/j.jhep.2020.10.013
Journal of Hepatology 2021 vol. 74 j 469–490
Laurence Millon1,2,3
1
Laboratoire de Parasitologie-Mycologie, Centre Hospitalier Régional
Universitaire de Besançon, Besançon, France
2
Centre National de Référence Echinococcoses, Centre Hospitalier
Régional Universitaire de Besançon, Besançon, France
3
UMR 6249, Chronoenvironnement, Université de Franche-Comté, 25030
Besançon, France
4
Services d’Hepato-Gastroenterologie et
5
de Médecine Tropicale et Humanitaire, Hôpitaux Universitaires de
Genève, Suisse
6
Laboratoire de Pharmacologie Clinique, Centre Hospitalier Régional
Universitaire de Besançon, Besançon, France
7
Service d’Hépatologie, Centre Hospitalier Régional Universitaire de
Besançon, Besançon, France
8
Service de Radiologie Viscérale, Centre Hospitalier Régional
Universitaire de Besançon, Besançon, France
9
Service de Maladies Infectieuses, Centre Hospitalier Chalon sur Saône,
France
10
Cabinet de Radiologie des Hauts de Chazal, Besançon, France
11
Service de Médecine Nucléaire, Centre Hospitalier Régional
Universitaire de Besançon, Besançon, France
12
Sérologie Infectieuse, Centre Hospitalier Régional Universitaire de
Besançon, Besançon, France
*
Corresponding author. Address: Pr Solange Bresson-Hadni, National
Reference Center for Echinococcosis, Parasitology-Mycology
Laboratory, Jean Minjoz University Hospital 25030 Besançon cedex,
France.
E-mail address: sbresson@chu-besancon.fr (S. Bresson-Hadni)
guidance on hepatitis C published in 2019.3 Actually in the
discussion about simplified, genotyping/subtyping-free, pan-
genotypic (S-Gf-P) anti-HCV treatment, 8-week glecaprevir/
pibrentasvir was recommended in any setting where genotype
and subtype determination is not available, not affordable and/or
would limit access to therapy, based on the determination of the
presence or absence of cirrhosis by a non-invasive method.1
Since confirming the presence/absence of cirrhosis is
mandatory in pretreatment evaluation for direct-acting antivi-
rals (DAAs), 8-week glecaprevir/pibrentasvir can be recom-
mended for treatment-naïve GT-3 CC patients. Notably, protease
inhibitor-containing regimens are contraindicated not only in
patients with currently decompensated (Child-Pugh B or C)
cirrhosis but also in patients with compensated (Child-Pugh A)
cirrhosis with previous episodes of decompensation.1 Thus, it is
very important to carefully identify the history of
decompensation in patients with compensated cirrhosis who
are due to be treated with S-Gf-P regimens of glecaprevir/
pibrentasvir. On the other hand, S-Gf-P regimens of 12-week
sofosbuvir/velpatasvir are recommended for treatment-naïve
and -experienced patients without cirrhosis or with
compensated (Child-Pugh A) cirrhosis.1 However, sofosbuvir/
473
Letters to the Editor
velpatasvir with weight-based ribavirin for 12 weeks has less
favorable efficacy in genotype 3b patients (reported previously4),
as mentioned in the present EASL recommendations1 and the
Taiwan consensus statement on the management of hepatitis
C, 2020.5 As such, we believe that the recommendation for a S-
Gf-P regimen of sofosbuvir/velpatasvir need to be limited to
treatment-naïve GT-3 patients without cirrhosis.
Sofosbuvir-containing regimens can be used in patients with
renal diseases, including those with an eGFR < −30 mL/min and
those with end-stage renal disease on hemodialysis, based on
previous guidance,1,6 with no need for dose adjustments of
DAAs.1,7 Thus, these patients are considered eligible for S-Gf-P
regimens. Under the circumstances, evaluation of renal
function does not seem necessary if applying S-Gf-P anti-HCV
treatments.
Lastly, we believe that it may be inadequate to omit the tests
for sustained virologic response (SVR) even with the very high
SVR12 rates expected with these regimens, as determining
treatment response is crucial for the further management of pa-
tients, particularly for those with advance fibrosis or cirrhosis.1,3,6
Financial support
The authors received no financial support to produce this
manuscript.
Conflict of interest
CY Dai: Consultant of Gilead, Abbvie; Speaker of Gilead, Abbvie
and Merck. WL Chuang: Speaker of Gilead and Abbvie. ML Yu:
Research support (grant) from Gilead and Abbott; Consultant of
Gilead, Abbvie and Merck; Speaker of Gilead, Abbvie and Merck.
Please refer to the accompanying ICMJE disclosure forms for
further details.
Authors’ contributions
Chia-Yen Dai and Ming-Lung Yu conceived of the presented idea.
Chia-Yen Dai and Ming-Lung Yu wrote the manuscript in
consultation with Wan-Long Chuang. All authors discussed the
results and contributed to the final manuscript.
Reply to: “EASL recommendations on treatment of hepatitis C: Final
update of the series – some issues”
The EASL Panel read with interest the Letter to the Editor by Dai
et al. reporting their opinions on the final update of the EASL
Recommendations on Treatment of Hepatitis C, published in the
November 2020 issue of Journal of Hepatology.1 The
Recommendations contain the responses to their comments, as
well as the scientific evidence that supports them, as follows.
Received 20 October 2020; accepted 20 October 2020; available online 20 November 2020
https://doi.org/10.1016/j.jhep.2020.10.025
474 Journal of Hepatology 2021 vol. 74 j 469–490
Supplementary data
Supplementary data to this article can be found online at https://
doi.org/10.1016/j.jhep.2020.10.013.
References
[1] EASL recommendations on treatment of hepatitis C: final update of the
series. J Hepatol 2020;73(5):1170–1218.
[2] Brown RS Jr, Buti M, Rodrigues L, Chulanov V, Chuang WL, Aguilar H, et al.
Glecaprevir/pibrentasvir for 8 weeks in treatment-naïve patients with
chronic HCV genotypes 1-6 and compensated cirrhosis: the EXPEDITION-8
trial. J Hepatol 2020;72:441–449.
[3] Ghany MG, Morgan TR, AASLD-IDSA Hepatitis C Guidance Panel. Hepatitis
C guidance 2019 update: American Association for the Study of Liver
Diseases-Infectious Diseases Society of America recommendations for
testing, managing, and treating hepatitis C virus infection. Hepatology
2020;71:686–721.
[4] Wei L, Lim SG, Xie Q, Van KN, Piratvisuth T, Huang Y, et al. Sofosbuvir-
velpatasvir for treatment of chronic hepatitis C virus infection in Asia: a
single-arm, open-label, phase 3 trial. Lancet Gastroenterol Hepatol
2019;4:127–134.
[5] Yu ML, Chen PJ, Dai CY, Hu TH, Huang CF, Huang YH, et al. Taiwan
consensus statement on the management of hepatitis C: part (I) general
population. J Formos Med Assoc 2020;119:1019–1040.
[6] AASLD-IDSA HCV Guidance Panel. Hepatitis C Guidance 2018 up-
date: AASLD-IDSA recommendations for testing, managing, and
treating hepatitis C virus infection. Clin Infect Dis 2018;67:1477–
1492.
[7] Yu ML, Chen PJ, Dai CY, Hu TH, Huang CF, Huang YH, et al. 2020 Taiwan
consensus statement on the management of hepatitis C: Part (II) special
populations. J Formos Med Assoc 2020;119:1135–1157.
Chia-Yen Dai1,2,3
Wan-Long Chuang1,2
Ming-Lung Yu1,2,3,*
1
Hepatobiliary Division, Department of Internal Medicine, Kaohsiung
Medical University Hospital, Kaohsiung Medical University,
Kaohsiung, Taiwan
2
Hepatitis Center, Kaohsiung Medical University Hospital, Kaohsiung
Medical University, Kaohsiung, Taiwan
3
Faculty of Internal Medicine, College of Medicine, Kaohsiung Medical
University, Kaohsiung, Taiwan
*
Corresponding author. Address: Department of Internal Medicine,
Kaohsiung Medical University Hospital, 100, Shi-Tzyou 1st Road,
Kaohsiung 807, Taiwan.
E-mail address: fish6069@gmail.com (M.-L. Yu)
Regarding glecaprevir/pibrentasvir treatment duration in
patients infected with genotype 3 with compensated cirrhosis:
“A small number of patients infected with HCV genotype 3a with
compensated (Child-Pugh A) cirrhosis have been included in
clinical trials with the fixed-dose combination of glecaprevir and
pibrentasvir [.]. In the phase III EXPEDITION-8 trial, the efficacy
of an 8-week treatment regimen in treatment-naïve patients
with genotype 3a and cirrhosis is supported by the inclusion of
only 63 patients, with 1 post-treatment relapse. In a real-world
study including 11,101 adults treated with glecaprevir/