Rapid liver and spleen stiffness improvement in compensated advanced chronic liver disease patients treated with oral antivirals

Abstract

BackgroundWe aimed to investigate the early changes in liver and spleen stiffness measurement (LSM, SSM) in hepatitis C virus (HCV) patients with compensated advanced chronic liver disease (cACLD) treated with new antivirals (DAA) to elucidate factors determining the initial change in stiffness and its implications for the long-term follow up of HCV-cured patients.Methods:A total of 41 patients with cACLD who started DAA therapy underwent LSM and SSM at baseline, week 4, end of treatment (EOT), 24 and 48 weeks of follow up using transient elastography.Results:LSM improved rapidly during the first 4 weeks of treatment (baseline: 20.8kPa; week 4: 17.5kPa, p = 0.002), with no significant changes between week 4 and EOT (18.3kPa, p = 0.444) and between EOT and 48-week follow up (14.3kPa, p = 0.148). Likewise, SSM improved rapidly (baseline: 45.7kPa; week 4: 33.8kPa, p = 0.047), with no significant changes between week 4 and EOT (30.8kPa, p = 0.153) and between EOT and 48-week follow up (31.2kPa, p = 0.317). A higher decrease in LSM was observed in patients with baseline ALT ⩾ twofold upper limit normal (2 × ULN) than in those with ALT < 2 × ULN (–5.7kPa versus –1.6kPa). Patients who presented a decrease in LSM ⩾ 10% during treatment compared with those with LSM < 10% decrease, showed lower SSM values, higher platelet counts and lower bilirubin levels at 24-week follow up. Those with decrease in SSM ⩾ 10%, presented a higher increase in platelets than those with SSM < 10% change (p = 0.015).Conclusions:LSM and SSM decrease very rapidly during DAA treatment in cACLD patients suggesting that it most probably reflects a reduction in inflammation rather than in fibrosis. cACLD patients should be maintained under surveillance independently of stiffness changes, because advanced fibrosis can still be present.

The Importance of Transaminases Flare in Liver Elastography: Characterization of the Probability of Liver Fibrosis Overestimation by Hepatitis C Virus-Induced Cytolysis

“…According to a recent meta-analysis which included 24 studies, six to twelve months after achieving SVR12, patients experience a median LSM decrease of 28%, and approximately 47% of patients with baseline values compatible with advanced liver fibrosis or cirrhosis show post-treatment values compatible with lower degrees of fibrosis [34]. Also, in light of recent findings, the decrease of LSM appears to be more evident in patients with baseline ALT ≥ 2ULN [35]. In our cohort of patients, LSM showed a median decrease of 35% from baseline values, and 67 (61%) patients showed post-treatment values compatible with lower fibrosis stages.…”

Liver stiffness reduction and serum fibrosis score improvement in HIV/hepatitis C virus‐coinfected patients treated with direct‐acting antivirals

“…With regard to liver disease after HCV treatment, a favourable effect on liver fibrosis or stiffness and on serum biomarkers has been widely documented, especially when an SVR is achieved [4][5][6][7][8][9][10][11][12][13]. Most studies investigated these dynamics in the HCV-monoinfected population or in patients treated with interferon plus ribavirin or first-generation DAAs.…”

Hepatitis C pretreatment profile and gender differences: Cognition and disease severity effects

“…The results were expressed in kPa. Only procedures with at least 10 validated measurements and > 60% success rate and an interquartile range inferior to 25% of the median value were considered reliable [35]. The standard 12.5 kPa for the diagnosis of cirrhosis and 7.1 kPa for F2, F3, and F4 were used [36].…”