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Hyperbilirubinaemia secondary to haemolysis: case report A study of 40 chronic hepatitis C patients, who were treated at four hospital in Australia between December 2016 and March 2018 under a special access scheme supported by Merck Sharp and Dohme Australia, described a patient, who developed hyperbilirubinaemia secondary to haemolysis during treatment with ribavirin for chronic hepatitis C [route and dose not stated]. The patient, who had chronic hepatitis C virus genotype 3 infection and was non-responders to licensed direct-acting antiviral therapy, started receiving treatment with combination of sofosbuvir and elbasvir/grazoprevir 100/50 mg/day plus ribavirin 400 mg/day for chronic hepatitis C (Planned for 16 weeks). The patient received elbasvir/grazoprevir through special access scheme in Australia (off-label use). The patient was cirrhotic with portal hypertension (Child-Pugh A6). Thereafter, the patient developed increased bilirubin levels (from 30 µmol/L to 50 µmol/L; hyperbilirubinaemia) and INR prolongation (from 1.3 to 1.5) [aetiology unknown] at treatment week 6. The patient’s treatment was immediately (at treatment week 6) changed to sofosbuvir, velpatasvir and ribavirin due to initial concerns of protease inhibitor associated hepatotoxicity. However, the hyperbilirubinaemia was attributed to ribavirin-associated haemolysis. Thereafter, the bilirubin levels remained stable at 40–50 µmol/L during ribavirin therapy and subsequently normalised. The INR remained stable between 1.4–1.5 throughout the period of evaluation. The patient received new treatment for 12 additional weeks and achieved SVR12 (sustained virological response at week 12 after the end of treatment). Papaluca T, et al. Retreatment with elbasvir, grazoprevir, sofosbuvir +/- ribavirin is effective for GT3 and GT1/4/6 HCV infection after relapse. Liver International 39: 803449550 2285-2290, No. 12, Dec 2019. Available from: URL: http://doi.org/10.1111/liv.14201

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Reactions 25 Jan 2020 No. 1788