Baloxavir safety and clinical and virologic outcomes in influenza virus-infected pediatric patients by age group: age-based pooled analysis of two pediatric studies conducted in Japan.

BACKGROUND: Anti-influenza treatment is important for children and is recommended in many countries. This study assessed safety, clinical, and virologic outcomes of baloxavir marboxil (baloxavir) treatment in children based on age and influenza virus type/subtype. METHODS: This was a post hoc pooled analysis of two open-label non-controlled studies of a single weight-based oral dose of baloxavir (day 1) in influenza virus-infected Japanese patients aged < 6 years (n = 56) and ≥ 6 to < 12 years (n = 81). Safety, time to illness alleviation (TTIA), time to resolution of fever (TTRF), recurrence of influenza illness symptoms and fever (after day 4), virus titer, and outcomes by polymerase acidic protein variants at position I38 (PA/I38X) were evaluated. RESULTS: Adverse events were reported in 39.0 and 39.5% of patients < 6 years and ≥ 6 to < 12 years, respectively. Median (95% confidence interval) TTIA was 43.2 (36.3-68.4) and 45.4 (38.9-61.0) hours, and TTRF was 32.2 (26.8-37.8) and 20.7 (19.2-23.8) hours, for patients < 6 years and ≥ 6 to < 12 years, respectively. Symptom and fever recurrence was more common in patients < 6 years with influenza B (54.5 and 50.0%, respectively) compared with older patients (0 and 25.0%, respectively). Virus titers declined (day 2) for both age groups. Transient virus titer increase and PA/I38X-variants were more common for patients < 6 years. CONCLUSIONS: The safety and effectiveness of single-dose baloxavir were observed in children across all age groups and influenza virus types. Higher rates of fever recurrence and transient virus titer increase were observed in children < 6 years. TRIAL REGISTRATION: Japan Pharmaceutical Information Center Clinical Trials Information JapicCTI-163,417 (registered 02 November 2016) and JapicCTI-173,811 (registered 15 December 2017).

Efficacy and Safety of Ensitrelvir in Patients With Mild-to-Moderate Coronavirus Disease 2019: The Phase 2b Part of a Randomized, Placebo-Controlled, Phase 2/3 Study.

BACKGROUND: This phase 2b part of a randomized phase 2/3 study assessed the efficacy and safety of ensitrelvir for mild-to-moderate coronavirus disease 2019 (COVID-19) during the Omicron epidemic. METHODS: Patients were randomized (1:1:1) to orally receive ensitrelvir fumaric acid 125 mg (375 mg on day 1) or 250 mg (750 mg on day 1) or placebo once daily for 5 days. The co-primary endpoints were the change from baseline in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) titer on day 4 and time-weighted average change from baseline up to 120 hours in the total score of predefined 12 COVID-19 symptoms. Safety was assessed through adverse events. RESULTS: A total of 341 patients (ensitrelvir 125-mg group: 114; ensitrelvir 250-mg group: 116; and placebo group: 111; male: 53.5-64.9%; mean age: 35.3-37.3 years) were included in the efficacy analyses. The change from baseline in SARS-CoV-2 titer on day 4 was significantly greater with both ensitrelvir doses than with placebo (differences from placebo: -0.41 log10 50% tissue-culture infectious dose/mL; P < .0001 for both). The total score of the 12 COVID-19 symptoms did not show a significant difference between the ensitrelvir groups and placebo group. The time-weighted average change from baseline up to 120 hours was significantly greater with ensitrelvir versus placebo in several subtotal scores, including acute symptoms and respiratory symptoms. Most adverse events were mild in severity. CONCLUSIONS: Ensitrelvir treatment demonstrated a favorable antiviral efficacy and potential clinical benefit with an acceptable safety profile. CLINICAL TRIALS REGISTRATION: Japan Registry of Clinical Trials: jRCT2031210350 (https://jrct.niph.go.jp/en-latest-detail/jRCT2031210350).

Impact of Low Temperatures on the Lithiation and Delithiation Properties of Si-Based Electrodes in Ionic Liquid Electrolytes.

Lithium-ion batteries are used in various extreme environments, such as cold regions and outer space; thus, improvements in energy density, safety, and cycle life in these environments are urgently required. We investigated changes in the charge and discharge properties of Si-based electrodes in ionic liquid electrolytes with decreasing temperature and the cycle life at low temperature. The reversible capacity at low temperature was determined by the properties of the surface film on the electrodes and/or the ionic conductivity of the electrolytes. The electrode coated with a surface film formed at a low temperature exhibited insufficient capacity. In contrast, a Si-only electrode precoated with the surface film at room temperature exhibited a cycle life at low temperatures in ionic liquid electrolytes longer than that in conventional organic liquid electrolytes. Doping phosphorus into Si led to improved cycling performance, and its impact was more noticeable at lower temperatures.

Improvement of the Anode Properties of Lithium-Ion Batteries for SiO x with a Third Element.

Silicon oxide (SiO x ) has been placed into practical use as an anode active material for next-generation Li-ion batteries because it has a higher theoretical capacity than graphite anodes. However, the synthesis method is typically vapor deposition, which is expensive, and the poor electron conductivity of SiO x restricts high performance. In this study, we prepared M/SiO x active materials consisting of SiO x and a third element (M = Al, B, Sn) using a low-cost mechanical milling (MM) method and investigated their electrode properties as Li-ion battery anodes. Also, the authors added a third element to improve the conductivity of the SiO2 matrix. Al, B, and Sn were selected as elements that do not form a compound with Si, exist as a simple substance, and can be dispersed in SiO2. As a result, we confirmed that SiO x has a nanostructure of nanocrystalline Si dispersed in an amorphous-like SiO2 matrix and that the third element M exists not in the nanocrystalline Si but in the SiO2 matrix. The electron conductivity of SiO x was improved by the addition of B and Sn. However, it was not improved by the addition of Al. This is because Al2O3 was formed in the insulator due to the oxidization of Al. The charge-discharge cycle tests revealed that the cycle life was improved from 170 cycles to 330 or 360 cycles with the addition of B or Sn, respectively. The improvement in electron conductivity is assumed to make it possible for SiO2 to react with Li ions more uniformly and form a structure that can avoid the concentration of stress due to the volume changes of Si, thereby suppressing the electrode disintegration.

Open-label study of the safety, pharmacokinetics, and effectiveness of a 2 mg/kg dose of baloxavir marboxil 2% granules in children <20 kg with influenza.

INTRODUCTION: Baloxavir marboxil is an oral anti-influenza drug with demonstrated safety and efficacy in pediatric patients when a 2% granules formulation is administered at 1 mg/kg. This study assessed safety, effectiveness, and pharmacokinetics of a higher dose (2 mg/kg) of baloxavir marboxil 2% granules in pediatric patients weighing <20 kg. METHODS: This multicenter, open-label, noncontrolled study was conducted at 15 sites in Japan (January 2019-March 2020; JapicCTI-194577). Patients aged <12 years with confirmed influenza received a single oral dose of baloxavir marboxil at 2 mg/kg if body weight was <10 kg or 20 mg if ≥ 10 to <20 kg. Safety, pharmacokinetics, effectiveness (time to illness alleviation [TTIA] of influenza; time to resolution of fever; virus titer), and polymerase acidic protein (PA) substituted viruses were assessed over 22 days. RESULTS: 45 patients, all aged ≤6 years, were enrolled. Adverse events were reported in 24 (53.3%) patients, most commonly nasopharyngitis, diarrhea, and upper respiratory tract infection. Median (95% confidence interval [CI]) TTIA was 37.8 (27.5-46.7) hours; median (95% CI) time to resolution of fever was 22.0 (20.2-28.6) hours. A >4 log decrease in mean viral titer occurred at day 2 and a subsequent temporary 1-2 log increase in patients with influenza A(H3N2) and B. Treatment-emergent PA/I38X-substituted virus was detected in 16/39 (41.0%) patients, but no prolonged TTIA or time to resolution of fever was associated with its presence. CONCLUSIONS: Baloxavir granules administered at 2 mg/kg in children <20 kg were well tolerated, with symptom alleviation similar to 1 mg/kg.

Anode Properties of Cr x V1-x Si2/Si Composite Electrodes for Lithium-Ion Batteries.

We have reported the effects of substituting a transition metal in silicide on the electrochemical performance of the silicide/Si composite anode for lithium-ion batteries (LIBs); the Cr0.5V0.5Si2/Si electrode exhibited much better cyclability compared with CrSi2/Si and VSi2/Si electrodes. Herein, we investigated the electrochemical performance of a Cr x V1-x Si2/Si slurry electrode for its application in LIBs, and the results obtained were compared to those of a gas deposition (GD) electrode, which was comprised of only active materials. The slurry electrode exhibited a superior cycling life as with the GD electrode. After charge-discharge cycles, the expansion of the electrode thickness of CrSi2/Si and Cr0.5V0.5Si2/Si was smaller than that of VSi2/Si, and VSi2 was significantly pulverized compared with the other silicides. It is considered that VSi2 deformed easily by the stress from Si expansion and pulverized because the hardness of VSi2 was the smallest among the silicides used in this study. These results reveal that Cr0.5V0.5Si2/Si has great potential as an anode material for next-generation LIBs and hardness is an important property for compositing silicide with Si.

Lithiation/Delithiation Properties of Lithium Silicide Electrodes in Ionic-Liquid Electrolytes.

We investigated the impact of electrolyte difference on lithiation and delithiation properties of a Li1.00Si electrode to improve the Coulombic efficiency (CE) of Si-based electrodes. The results of X-ray diffraction, Raman spectroscopy, and soft X-ray emission spectroscopy demonstrated that a portion of the Li in Li1.00Si desorbed by simply immersing the electrode in an ionic-liquid electrolyte, that is, the phase transition of Li1.00Si to Si occurred. In contrast, this phenomenon was not confirmed in an organic-liquid electrolyte. Instead, the desorbed Li was consumed for the formation of a surface film; thus, the Li in Li1.00Si did not elute into the electrolyte. The addition of vinylene carbonate (VC) to the ionic-liquid electrolyte suppressed the phase transition of Li1.00Si to Si. Although the Li1.00Si electrode showed a low initial CE and poor cycling performance in a VC-free electrolyte, the electrode exhibited a high CE and a remarkable cycle life in the VC-added electrolyte. It was considered that no desorption of the mechanically added Li in Li1.00Si contributed to the superior cycle life; thus, the characteristic ductility, malleability, and high electrical conductivity of lithium silicide should improve the electrochemical performance.

Regeneration of Nicotinamide Adenine Dinucleotide Phosphate by a Chlorophyll a-Coated TiO2 Film Electrode.

A TiO2 electrode was coated with chlorophyll a to regenerate nicotinamide adenine dinucleotide phosphate (NADPH), which can enhance the photovoltages of the electrodes for photoelectrochemical capacitors. The photovoltage of an uncoated TiO2 electrode was high during the first cycle but then steadily reduced owing to the oxidization of NADPH in the electrolyte during the photo-charge-discharge cycling. By contrast, a chlorophyll a-coated TiO2 electrode maintained high photovoltages for 100 cycles. Residual NADPH concentrations after 100 cycles increased from 73% to 90% because of the coating, demonstrating that NADPH was regenerated by photoexcited chlorophyll a similar to a photosynthetic reaction in nature.

Serum surfactant protein D as a predictive biomarker for the efficacy of pirfenidone in patients with idiopathic pulmonary fibrosis: a post-hoc analysis of the phase 3 trial in Japan.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a progressive, fatal disorder with a variable disease course. The recent advancement of antifibrotic therapy has increased the need for reliable and specific biomarkers. This study aimed to assess alveolar epithelial biomarkers as predictors for the efficacy of the antifibrotic drug pirfenidone. METHODS: We conducted a post-hoc analysis of the prospective, multicenter, randomized, placebo-controlled, phase 3 trial of pirfenidone in Japan (total, n = 267; pirfenidone, n = 163; placebo, n = 104). Logistic regression analysis was performed to extract parameters that predicted disease progression, defined by a ≥ 10% relative decline in vital capacity (VC) from baseline and/or death, at week 52. For assessment of serum surfactant protein (SP)-D, SP-A and Krebs von den Lungen (KL)-6, all patients were dichotomized by the median concentration of each biomarker at baseline to the high and low biomarker subgroups. Associations of these concentrations were examined with changes in VC at each time point from baseline up to week 52, along with progression-free survival (PFS). Additionally, the effect of pirfenidone treatment on serial longitudinal concentrations of these biomarkers were evaluated. RESULTS: In the multivariate logistic regression analysis, body mass index (BMI), %VC and SP-D in the pirfenidone group, and BMI and %VC in the placebo group were indicated as predictors of disease progression. Pirfenidone treatment reduced the decline in VC with statistical significance in the low SP-D and low SP-A subgroups over most of the treatment period, and also prolonged PFS in the low SP-D and low KL-6 subgroups. Furthermore, SP-D levels over time course were reduced in the pirfenidone group from as early as week 8 until the 52-week treatment period compared with the placebo group. CONCLUSIONS: Serum SP-D was the most consistent biomarker for the efficacy of pirfenidone in the cohort trial of IPF. Serial measurements of SP-D might have a potential for application as a pharmacodynamic biomarker. Trial registration The clinical trial was registered with the Japan Pharmaceutical Information Center (JAPIC) on September 13, 2005 (registration No. JapicCTI-050121; http://Clinicaltrials.jp ).

Reaction Behavior of a Silicide Electrode with Lithium in an Ionic-Liquid Electrolyte.

Silicides are attractive novel active materials for use in the negative-electrodes of next-generation lithium-ion batteries that use certain ionic-liquid electrolytes; however, the reaction mechanism of the above combination is yet to be clarified. Possible reactions at the silicide electrode are as follows: deposition and dissolution of Li metal on the electrode, lithiation and delithiation of Si, which would result from the phase separation of the silicide, and alloying and dealloying of the silicide with Li. Herein, we examined these possibilities using various analysis methods. The results revealed that the lithiation and delithiation of silicide occurred.

Indium-Doped Rutile Titanium Oxide with Reduced Particle Length and Its Sodium Storage Properties.

We hydrothermally synthesized In-doped rutile TiO2 particles in an anionic surfactant solution and investigated the influences of In doping and the particle morphology on the Na+ storage properties. The solid solubility limit was found to be 0.8 atom % in In-doped TiO2. In the case where no surfactant was used, the best anode performance was obtained for 0.8 atom % In-doped TiO2 electrode by the benefits of three doping effects: (i) expanded diffusion-path size, (ii) improved electronic conductivity, and (iii) reduced electron charge density in the path. Further enhancement in the performance was achieved for the In-doped TiO2 with a reduced particle length by the synthesis in the surfactant solution. This electrode exhibited a better cycle stability and maintained a high discharge capacity of 240 mA h g-1 for 200 cycles. The reason is probably that Na+ can be inserted in the inner part of TiO2 particles because of its reduced particle length.

Baloxavir Marboxil 2% Granules in Japanese Children With Influenza: An Open-label Phase 3 Study.

BACKGROUND: A granule formulation of baloxavir marboxil, a selective inhibitor of influenza cap-dependent endonuclease, was newly developed for children with difficulty swallowing tablets. METHODS: A multicenter open-label study was conducted during the 2017-2018 influenza season to assess the safety, pharmacokinetics and clinical/virologic outcomes of single, oral, weight-based doses of baloxavir granules in Japanese children infected with influenza virus. The primary clinical endpoint was the time to illness alleviation of influenza. RESULTS: All 33 enrolled children completed the study and received baloxavir (1 mg/kg for 12 children weighing <10 kg, 10 mg for 21 children weighing 10 to <20 kg). Detected viruses were influenza B (36.4%), A(H1N1)pdm09 (33.3%) and A(H3N2) (27.3%). Adverse events (AEs) were reported in 54.5% of children. No deaths, serious AEs or AEs leading to discontinuation were reported. The mean (SD) plasma concentrations of baloxavir acid at 24 hours post-dose were 72.8 (24.0) and 51.3 (19.3) ng/mL in the 1-mg/kg and 10-mg dose groups, respectively. The median time to illness alleviation (95% confidence interval) was 45.3 (28.5-64.1) hours. A >4-log decrease in infectious viral titer occurred on day 2 and a temporary 2-log increase on day 4. Polymerase acidic protein/I38T/M-substituted viruses were detected in 5 children infected with influenza A, but none with influenza B. CONCLUSIONS: Baloxavir granules and the weight-based dose regimen were considered to be well tolerated in children, with rapid influenza virus reduction and associated symptom alleviation. Evidence of baloxavir activity against influenza B was observed, but further data are required for confirmation.

Baloxavir Marboxil in Japanese Pediatric Patients With Influenza: Safety and Clinical and Virologic Outcomes.

BACKGROUND: We assessed the safety and effectiveness of baloxavir marboxil administration in Japanese children with influenza. METHODS: This open-label study administered 1 weight-adjusted dose of baloxavir to 107 children aged 1-11 years with laboratory-confirmed, febrile influenza virus infection of ≤48 hours duration. RESULTS: Adverse events (AEs) were reported in 34.6% of patients, most commonly vomiting (7.5%); no serious AEs or AEs causing discontinuation occurred. The median time to alleviation of influenza illness was 44.6 hours (95% confidence interval, 38.9-62.5 hours), to resolution of fever was 21.4 hours, and to sustained cessation of infectious viral shedding was 24.0 hours. However, viruses with amino acid substitutions in the viral polymerase acidic protein at position I38 (PA/I38T/M) emerged in 18 of 77 (23.4%) patients. Emergence was associated with longer infectious virus detectability (median time, 180.0 hours) and time to illness alleviation (median, 79.6 vs 42.8 hours in patients without PA/I38T/M-substituted viruses). Among patients with PA/I38T/M-substituted virus emergence, those with baseline hemagglutinin inhibition (HAI) antibody titer <40 experienced delay in time to illness alleviation (median, 85.4 vs 56.0 hours in patients with higher baseline HAI antibody titer). CONCLUSIONS: A single, oral dose of baloxavir marboxil was well tolerated and rapidly reduced viral titers, but the common emergence of PA/I38T/M-substituted viruses warrants consideration of alternative dosing regimens in young children. CLINICAL TRIALS REGISTRATION: Japan Pharmaceutical Information Center Clinical Trials Information (Japic CTI-163417).

Silicon-Based Anodes with Long Cycle Life for Lithium-Ion Batteries Achieved by Significant Suppression of Their Volume Expansion in Ionic-Liquid Electrolyte.

Elemental Si has a high theoretical capacity and has attracted attention as an anode material for high energy density lithium-ion batteries. Rapid capacity fading is the main problem with Si-based electrodes; this is mainly because of a massive volume change in Si during lithiation-delithiation. Here, we report that combining an ionic-liquid electrolyte with a charge capacity limit of 1000 mA h g-1 significantly suppresses Si volume expansion, improving the cycle life. Phosphorus-doping of Si also enhances the suppression and increases the Li+ diffusion coefficient. In contrast, the Si layer expands significantly in an organic electrolyte even with the charge capacity limit and even in an ionic-liquid electrolyte without the limit. We demonstrated that the homogeneously distributed Si lithiation-delithiation, phase-transition control from the Si to Li-rich Li-Si alloy phases, formation of a surface film with structural and/or mechanical stability, and faster Li+ diffusion contribute to suppressing Si volume expansion.

Effect of Phosphorus-Doping on Electrochemical Performance of Silicon Negative Electrodes in Lithium-Ion Batteries.

The effect of phosphorus (P)-doping on the electrochemical performance of Si negative electrodes in lithium-ion batteries was investigated. Field-emission scanning electron microscopy was used to observe changes in surface morphology. Surface crystallinity and the phase transition of Si negative electrodes before and after a charge-discharge cycle were investigated by Raman spectroscopy and X-ray diffraction. Li insertion energy into Si was also calculated based on computational chemistry. The results showed that a low P concentration of 124 ppm has a meaningful influence on the electrochemical properties of a Si negative electrode; the cycle performance is improved by P-doping of Si. P-doping suppresses the changes in the surface morphology of a Si negative electrode and the phase transition during a charge-discharge cycle. Li insertion energy increases with an increase in the P concentration; Li insertion into P-doped Si is energetically unfavorable, which indicates that the crystal lattice of Si shrinks as a result of the replacement of some Si atoms with smaller P atoms, and therefore, it is more difficult to insert Li into P-doped Si. These results reveal that suppression of the phase transition reduces the large change in the volume of Si and prevents a Si negative electrode from disintegrating, which helps to improve the otherwise poor cycle performance of a Si electrode.

Functional ionic liquids for enhancement of Li-ion transfer: the effect of cation structure on the charge-discharge performance of the Li4Ti5O12 electrode.

As the development of high energy-density Li-ion batteries moves ahead, ensuring safety of the batteries has become increasingly important. Among the unique physicochemical properties of ionic liquids, thermal stability can be one of the answers to the challenge. The use of ionic liquids, however, causes critical issues concerning the kinetics of Li-ion transfer at the electrode-electrolyte interface. In the present study, ionic liquids consisting of 1-((2-methoxyethoxy)methyl)-1-methylpiperidinium (PP1MEM) or 1-hexyl-1-methylpiperidinium (PP16) and bis(trifluoromethanesulfonyl)amide (TFSA) were applied to an electrolyte for Li-ion batteries, and we investigated the effect of cation structure on interfacial Li-ion transfer using Li4Ti5O12 as a model electrode by means of Raman spectroscopy and electrochemical impedance spectroscopy. It was found that the ether functional group in the PP1MEM cation has the meaningful function; the cation structure reduces the electrostatic interaction between the Li ion and TFSA anions in an ionic liquid electrolyte. The solvation number of the TFSA anion per Li ion consequently became smaller than that in PP16-TFSA, and the lower solvation number in PP1MEM-TFSA allowed the facile Li-ion diffusion in the electrolyte bulk rather than the interfacial Li-ion transfer and significantly improved the rate performance. The results offer the prospect of utilization of PP1MEM-TFSA as an electrolyte solvent. The knowledge obtained from this study contributes to the development of next-generation Li-ion batteries having both high energy density and high safety.

Nb-doped rutile TiO2: a potential anode material for Na-ion battery.

The electrochemical properties of the rutile-type TiO2 and Nb-doped TiO2 were investigated for the first time as Na-ion battery anodes. Ti(1-x)Nb(x)O2 thick-film electrodes without a binder and a conductive additive were prepared using a sol-gel method followed by a gas-deposition method. The TiO2 electrode showed reversible reactions of Na insertion/extraction accompanied by expansion/contraction of the TiO2 lattice. Among the Ti(1-x)Nb(x)O2 electrodes with x = 0-0.18, the Ti(0.94)Nb(0.06)O2 electrode exhibited the best cycling performance, with a reversible capacity of 160 mA h g(-1) at the 50th cycle. As the Li-ion battery anode, this electrode also attained an excellent rate capability, with a capacity of 120 mA h g(-1) even at the high current density of 16.75 A g(-1) (50C). The improvements in the performances are attributed to a 3 orders of magnitude higher electronic conductivity of Ti(0.94)Nb(0.06)O2 compared to that of TiO2. This offers the possibility of Nb-doped rutile TiO2 as a Na-ion battery anode as well as a Li-ion battery anode.

Mitotic UV irradiation induces a DNA replication-licensing defect that potentiates G1 arrest response.

Cdt1 begins to accumulate in M phase and has a key role in establishing replication licensing at the end of mitosis or in early G1 phase. Treatments that damage the DNA of cells, such as UV irradiation, induce Cdt1 degradation through PCNA-dependent CRL4-Cdt2 ubiquitin ligase. How Cdt1 degradation is linked to cell cycle progression, however, remains unclear. In G1 phase, when licensing is established, UV irradiation leads to Cdt1 degradation, but has little effect on the licensing state. In M phase, however, UV irradiation does not induce Cdt1 degradation. When mitotic UV-irradiated cells were released into G1 phase, Cdt1 was degraded before licensing was established. Thus, these cells exhibited both defective licensing and G1 cell cycle arrest. The frequency of G1 arrest increased in cells expressing extra copies of Cdt2, and thus in cells in which Cdt1 degradation was enhanced, whereas the frequency of G1 arrest was reduced in cell expressing an extra copy of Cdt1. The G1 arrest response of cells irradiated in mitosis was important for cell survival by preventing the induction of apoptosis. Based on these observations, we propose that mammalian cells have a DNA replication-licensing checkpoint response to DNA damage induced during mitosis.

Effects on anemia of drug adjustment in patients with chronic hepatitis C during telaprevir-combined therapy.

AIM: Anemia is the most common adverse event in patients with chronic hepatitis C virus (HCV) treated with telaprevir (TVR) combined triple therapy. We examined the effects of drug dose adjustment on anemia and a sustained viral response (SVR) during combination therapy. MATERIAL AND METHODS: This study enrolled 62 patients treated with TVR (2,250 mg) for 12 weeks plus pegylated interferon-alpha-2b and ribavirin for 24 weeks. The patients were assigned randomly to the TVR-standard or -reduced groups before treatment. At the occurrence of anemia (hemoglobin < 12 g/dL), the TVR-reduced group received 1500 mg TVR plus the standard dose of ribavirin, whereas the TVR-standard group received the standard TVR dose (2,250 mg) and a reduced dose of ribavirin (200 mg lower than prescribed originally). The safety and SVR at 24 weeks were compared between the TVR-standard (n = 28) and TVR-reduced (n = 25) groups. RESULTS: No differences in the proportion of patients who became HCV RNA-negative were detected between the TVR-standard and -reduced groups (72 and 72% at week 4, 79 and 84% at the end of treatment, and 76 and 80% at SVR24, respectively). Two groups had comparable numbers of adverse events, which led to the discontinuation of TVR in 14 patients of TVR-standard group and in 14 of TVR-reduced group. A lower incidence of renal impairment was observed in the TVR-reduced group (6%) than the TVR-standard group (11%, not statistically significant). CONCLUSIONS: TVR dose adjustment could prevent anemia progression without weakening the anti-viral effect during triple therapy in HCV-patients.