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04.10.2017 | short report | Ausgabe 21-22/2017

Wiener klinische Wochenschrift 21-22/2017

Anti-HCV treatment with ombitasvir/paritaprevir/ritonavir ± dasabuvir is associated with increased bile acid levels and pruritus

Wiener klinische Wochenschrift > Ausgabe 21-22/2017
MD Rudolf E. Stauber, Günter Fauler, Florian Rainer, Bettina Leber, Andreas Posch, Andrea Streit, Walter Spindelboeck, Vanessa Stadlbauer, Harald H. Kessler, Harald Mangge
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00508-017-1268-x) contains supplementary material, which is available to authorized users.



Direct acting antiviral (DAA)-based treatment with ombitasvir/paritaprevir/ritonavir ± dasabuvir (OBV/PTV/r ± DSV) is highly effective in HCV genotype 1 or 4 infection and well-tolerated with only few side effects. However, pruritus has been observed in several trials in up to 20% of patients and seems to be unique for this DAA combination.


The aim of this preliminary study was to investigate the effect of OBV/PTV/r ± DSV on bile acid levels and to correlate them to the emergence of pruritus during treatment.


Twenty patients with chronic hepatitis C genotype 1 or 4 were treated for 12 or 24 weeks with OBV/PTV/r ± DSV with or without ribavirin. Side effects including pruritus were assessed every 4 weeks during treatment or on demand. Blood was collected in fasting state at baseline and at treatment week 4 for determination of bile acid concentrations by high-resolution mass spectrometry.


Pruritus developed in 5 out of 20 patients during the first 4 weeks of DAA treatment. Pruritus was self-limiting during DAA treatment in 4 patients while one patient required cholestyramine treatment and responded well. Total bile acid levels increased approximately 4‑fold by treatment week 4.


Pruritus observed during OBV/PTV/r ± DSV treatment of chronic hepatitis C is associated with increased on-treatment serum bile acid levels, possibly due to ritonavir-induced alterations of bile acid transport.

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Supplemental Table 1 Serum levels of total bile acids, bilirubin and cholestasis markers before and during OBV/PTV/r ± DSV treatment (n = 20); Supplemental table 2. Serum levels of total bile acids, bilirubin and cholestasis markers before and during OBV/PTV/r ± DSV treatment in patients who reported pruritus (n = 5)
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