AI Article Synopsis
- Intravenous silibinin (SIL) combined with ribavirin (RBV) was tested as an interferon-free treatment for a patient with hepatitis C, focusing on its safety, effectiveness, and the use of mathematical modeling in determining treatment duration.
- The treatment resulted in a sustained virological response (SVR) after 34 weeks, confirming the feasibility and safety of this regimen.
- This study highlights the potential of using real-time mathematical modeling for tailoring treatment duration and involves patients in decision-making regarding their therapy.
Article Abstract
Background & Aims: 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.
Methods: 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.
Results: 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 was feasible, safe and achieved SVR (week-33).
Conclusions: 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.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304917 | PMC |
| http://dx.doi.org/10.1111/liv.12692 | DOI Listing |
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