The EBR/GZR regimen yielded high virological efficacy with acceptable safety. Patients with a history of failure to IFN-free DAA therapy or with double RASs in HCV-NS5A remained difficult to treat with this regimen.
Background
We investigated changes in patient characteristics, rate of sustained virologic response (SVR), and factors associated with SVR after anti-hepatitis C virus (HCV) therapy with direct-acting antiviral (DAA) regimens in real-world practice in Japan, where patients with HCV are characterized by older age and high prevalence of cirrhosis and hepatocellular carcinoma (HCC).
Methods
Changes in patient characteristics and SVR rates were evaluated from medical records among 10 688 patients who started interferon (IFN)-free DAA therapy between September 2014 and June 2018 in a nationwide, multicenter study. Factors associated with failure of SVR were analyzed. In particular, effects of cirrhosis or history of HCC on SVR were assessed by exact matching.
Results
Patient age was becoming younger and baseline liver fibrosis was becoming milder over time. Overall SVR rate was 95.4%. The SVR rates increased over time in patients without a history of IFN-free DAA therapy. Multivariate analysis revealed that cirrhosis was unfavorably associated with achievement of SVR in both patients with genotype 1 (odds ratio, 1.68; 95% confidence interval [CI], 1.27–2.21) and genotype 2 (odds ratio, 1.69; 95% CI, 1.01–2.78). Comparisons after exact matching showed that the SVR rate was significantly lower in patients with cirrhosis than without it, whereas patients with and without a history of HCC had similar SVR rates.
Conclusions
Background characteristics of patients who undergo IFN-free DAA therapy are changing in Japan. Patients without a history of IFN-free DAA therapy have high SVR rates. Exact matching confirmed that cirrhosis significantly influences the achievement of SVR in real-world settings.
Immediate EST can be as safe as elective EST for patients with ASC associated with choledocholithiasis provided they are not under anticoagulant therapy, or do not have a coagulopathy or a platelet count < 50000 × 10(3)/μL. Moreover, the procedure was safely performed by a trainee under the supervision of an experienced specialist.
Background and AimThe prognosis of cirrhotic patients with hepatic edema is poor. Although several short‐term predictors of tolvaptan (novel diuretic agent) treatment for such patients have been reported, the factors related to long‐term survival are still unclear.MethodsAmong 459 patients with hepatic edema enrolled in a retrospective, multicenter collaborative study, we analyzed 407 patients who received tolvaptan.ResultsPatients consisted of 266 men and 141 women, with the median age of 68 years (range, 28–93 years). The frequency of short‐term responders to tolvaptan was 59.7% (243/407). In the Cox regression analysis, short‐term response to tolvaptan, low average dosages of furosemide and spironolactone during tolvaptan treatment, Child–Pugh classification A and B, and absence of hepatocellular carcinoma were independent factors contributed to 1‐year survival. The 1‐year and long‐term cumulative survival rates in short‐term responders were significantly higher than those in non‐responders (P = 0.011 and 0.010, respectively). Using a receiver operating characteristic curve analysis, the optimal cut‐off values of average daily dosages of furosemide and spironolactone for predicting 1‐year survival were 19 and 23 mg/day, respectively. The long‐term cumulative survival rates in patients who received a mean dosage of spironolactone < 23 mg/day during tolvaptan treatment were significantly higher than those receiving a mean dosage of ≥ 23 mg/day (P = 0.001).ConclusionsThe present study suggests that the short‐term response to tolvaptan and low dosages of conventional diuretics during tolvaptan treatment might improve the 1‐year and long‐term survival rates in cirrhotic patients with hepatic edema.
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