Serum asunaprevir concentrations showing correlation with the extent of liver fibrosis as a factor inducing liver injuries in patients with genotype-1b hepatitis C virus receiving daclatasvir plus asunaprevir therapy

Abstract

Aims: Liver injury can occur during antiviral therapies with direct-acting antivirals (DAAs), potentially necessitating discontinuation of the therapies, with consequent worsening of the sustained viral response (SVR) rates, in patients with hepatitis C virus (HCV). To clarify the mechanisms involved in serum transaminase level elevation, we performed a retrospective evaluation of the serum concentrations of daclatasvir and asunaprevir, both classified as DAAs, in patients receiving treatment with a combination of the two drugs.

Methods: Subjects were 278 Japanese patients with genotype-1b HCV who received daclatasvir plus asunaprevir therapy for more than 4 weeks. Serum concentrations of both the DAAs were measured at 4 weeks after the initiation of therapy.

Result: Liver injuries including serum AST and/or ALT level elevation to 150 U/L or over were found in 34 patients (12.2%). Multivariate logistic regression analysis identified serum asunaprevir concentrations as being significantly associated with developing liver injury, with an odds ratio of 1.046 (95% confidence interval 1.011-1.082, p<0.05). Serum asunaprevir concentrations showed correlation with the extent of liver fibrosis, estimated by peripheral platelets counts and serum albumin levels and baseline and FIB4 index and serum Mac-2 binding protein glycosylation isomer (M2BPGi) levels at 4 weeks of the therapy; the concentrations were significantly higher among patients showing 3.0 or more of M2BPGi levels than among those with the levels less than 3.0; on the other hand, no such correlation/difference was found in serum daclatasvir concentrations.

Conclusion: High serum concentrations of serum asunaprevir, which were associated with the extent of liver fibrosis, appear to provoke the occurrence of liver injury in patients with genotype-1b HCV receiving combined daclatasvir plus asunaprevir therapy.

Fig 1. The scatter plots between serum concentrations of asunaprevir and either Mac-2 binding protein glycosylation isomer (M2BPGi) Levels, FIB4 index, serum albumin levels and peripheral platelet counts.

Serum asunaprevir concentrations were positively correlated with serum M2BPGi levels (r = 0.418, p<0.001) and FIB4 index (r = 0.345, p<0.001) at 4 weeks after the initiation of DAV plus ASV therapy (a and b). Also, the concentrations were negatively correlated with serum albumin levels (r = -0.277, p<0.001) and platelets counts (r = -0.235, p<0.001) at baseline (c and d).

Fig 2. Comparison of serum asunaprevir (ASV) and daclatasvir (DCV) concentrations between patients showing 3.0 C.O.I or more of Mac-2 binding protein glycosylation isomer (M2BPGi) levels and those showing the levels less than 3.0 C.O.I.

Serum ASV concentrations were significantly higher in patients showing 3.0 C.O.I or more of M2BPGi levels at 4 weeks than in those with the levels less than 3.0 C.O.I (812; 27–6,600 ng/mL vs. 275; 11–2,280 ng/mL, p < 0.001), but no such difference was observed for the serum DCV concentrations. In these box-and-whisker plots, lines within the boxes represent the median values; the upper and lower lines of the boxes represent the 25th and 75th percentiles, respectively. The tails indicate the minimum and maximum values. Circles indicate outliers of 1.5–3.0 IQR higher than the 75th percentile or 1.5–3.0 IQR lower than the 25th percentile. Asterisks indicate outliers of more than 3.0 IQR higher than the 75th percentile or less than 3.0 IQR lower than the 25th percentile.

Fig 3. Comparison of serum asunaprevir (ASV) and daclatasvir (DCV) concentrations between patients with liver cirrhosis (LC) and those without LC.

Serum ASV concentrations were significantly higher in patients with LC than in those without LC (579; 56–6,110 ng/mL vs. 315; 11–6,660 ng/mL, p < 0.001), but no such difference was observed for the serum DCV concentrations. In these box-and-whisker plots, lines within the boxes represent the median values; the upper and lower lines of the boxes represent the 25th and 75th percentiles, respectively. The tails indicate the minimum and maximum values. Circles indicate outliers of 1.5–3.0 IQR higher than the 75th percentile or 1.5–3.0 IQR lower than the 25th percentile. Asterisks indicate outliers of more than 3.0 IQR higher than the 75th percentile or less than 3.0 IQR lower than the 25th percentile.