290 - Long-Term Follow-Up of Patients with Chronic HCV Infection and Compensated or Decompensated Cirrhosis Following Treatment with Sofosbuvir-Based Regimens

Muir, Andrew J.; Mangia, Alessandra; Lawitz, Eric; Gane, Edward; Conway, Brian; Ruane, Peter; Abergel, A.; Cheinquer, Nelson; McNabb, Brian; Osinusi, Anu; Chen, Frances S.; Dvory‐Sobol, Hadas; Brainard, Diana M.; Subramanian, Mani; Leggett, Barbara; Calleja, José Luís; Agarwal, Kosh; Younes, Ziad

doi:10.1016/s0016-5085(18)33603-5

Cited by 3 publications

(9 citation statements)

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“…Epidemiological data from the USA on the causes of liver-related death showed a decrease in mortality from HCV infection with the introduction of DAA treatments [26]. In our cohort, deaths occurred only among the CP-A patients, contradicting not only the literature [4,18,19,27] but also the natural Real-World Follow-Up after DAA-Induced SVR history of the disease [28]. Our findings may be explained by the low number of CP-B and -C patients at baseline.…”

Section: Discussioncontrasting

confidence: 74%

“…In our cohort, the diagnosis of HCC during treatment on average occurred 19 weeks after treatment initiation. Early detection of HCC in these patients suggests the likely presence of undetectable dysplastic nodules prior to treatment initiation [19]. The occurrence of HCC during treatment with DAA does not appear to be associated with greater tumor aggressiveness, and, in this study, all the patients diagnosed during treatment were BCLC-A [40].…”

Section: Discussionmentioning

confidence: 53%

“…The patients included did not present significant differences regarding the demographic characteristics and comorbidity prevalence when compared with other cohorts [4,[18][19][20]. The most prevalent HCV genotype was genotype 1, followed by genotype 3, matching recent epidemiological studies on the geographical distribution of HCV in Portugal [21,22].…”

Section: Discussionmentioning

confidence: 66%

“…Regarding our CP-B or -C patients, 57.1% sustainedly evolved to CP-A at the end of the follow-up period. Recent studies have reported sustained conversion rates to CP-A above 50% among decompensated patients after DAA-induced SVR [4,19,31].…”

Section: Discussionmentioning

confidence: 99%

“…With the emergence of pangenotypic DAA with shorter treatment regimens, higher completion rates are expected [19]. Applying these characteristics to the intention-to-treat population (n = 237), 79.3% could have undergone shorter treatments.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Follow-Up of Advanced Liver Disease after Sustained Virological Response to Treatment of Hepatitis C with Direct-Acting Antivirals: Outcomes from a Real-World Portuguese Cohort

Guedes

Fragoso

Lemos

et al. 2019

GE Port J Gastroenterol

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Background: Direct-acting antivirals (DAA) have revolutionized hepatitis C treatment, with high sustained virological response (SVR) rates reported, even in historically difficultto-treat groups. SVR is associated with a decreased risk of hepatocellular carcinoma (HCC), need for transplantation, and overall and liver-related mortality. Data from real-life cohorts on the medium-to long-term outcomes of patients with advanced liver disease and DAA-induced SVR are still missing. Objectives: To report and analyze the long-term Seguimento a longo prazo da doença hepática avançada após cura do vírus C com antivíricos de ação direta: dados de uma coorte Portuguesa Palavras ChaveAgentes antivirais · Carcinoma hepatocelular · Cirrose hepática · Hepatite C · Resposta virológica sustentada Resumo Introdução: Os antivíricos de ação direta (AAD) revolucionaram o tratamento da hepatite C ao atingirem elevadas taxas de resposta virológica sustentada (RVS), mesmo em grupos historicamente difíceis de tratar. A RVS associa-se a uma diminuição do risco de carcinoma hepatocelular (CHC), necessidade de transplantação e mortalidade, global e de causa hepática. São ainda insuficientes de coortes reais na literatura dados que permitam avaliar a extensão dos benefícios clínicos a médio-longo prazo do atingimento de uma RVS com os AAD. Objetivos: Reportar e analisar o impacto a longo prazo da RVS numa coorte real de doentes com doença hepática avançada, tratados com AAD. Métodos: Estudo unicêntrico, retrospetivo, longitudinal com inclusão de doentes com hepatite C crónica com cirrose ou fibrose avançada, que iniciaram tratamento com AAD de fevereiro de 2015 a janeiro de 2017. Resultados: Foram incluídos 237 doentes. Verificou-se uma taxa de retenção no tratamento de 98.7% com uma taxa de RVS de 97.8% (intention to treat: 96.6%). Dos 229 doentes curados, 67.2% eram cirróticos (64.2% Child-Pugh A, 3.1% Child-Pugh B) e 32.8% F3, com um seguimento médio de 28 meses. A taxa de mortalidade global foi de 19/1,000 pessoas-ano e de mortalidade associada à doença hepática de 9.5/1,000 pessoasano. A incidência de eventos de descompensação hepática foi de 25/1,000 pessoas-ano e a de CHC foi de 11.6/1,000 pessoas-ano. Verificou-se um aumento sustentado dos valores séricos de plaquetas até 2 anos de seguimento. A história de eventos de descompensação hepática, concentração de plaquetas e albumina prétratamento encontrou-se significativamente associada a eventos adversos hepáticos durante o seguimento. Conclusões: A cura virológica após tratamento com AAD é sustentada no tempo, encontrando-se associada a um excelente prognóstico clínico em doentes com doença hepática avançada compensada, e a uma melhoria ou estabilização da doença em doentes descompensados. O atingimento de RVS associa-se a um baixo risco de CHC, não o eliminando, e de progressão da doença, sobretudo perante a presença de outros cofatores de agressão hepática, recomendando-se a manutenção do seguimento destes doentes.

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Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Long-Term Follow-Up of Advanced Liver Disease after Sustained Virological Response to Treatment of Hepatitis C with Direct-Acting Antivirals: Outcomes from a Real-World Portuguese Cohort

Guedes

Fragoso

Lemos

et al. 2019

GE Port J Gastroenterol

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The Impact of Achieving Sustained Virological Response with Direct Acting Antivirals on Gastroesophageal Varices and Variceal Bleeding

Sarhan

Elhadidy

Mabrouk

et al. 2022

Al-Azhar International Medical Journal

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Liver Disease Outcomes after Sustained Virological Response in Patients with Chronic Hepatitis C Infection Treated with Generic Direct-Acting Antivirals

El‐Wahab

Elgawad

Abdel‐Aziz

et al. 2022

The American Journal of Tropical Medicine and Hygiene

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The introduction of generic direct-acting antivirals (DAAs) in Egypt is associated with a superior cure rate of hepatitis C virus (HCV) infection. However, the course of progressive liver damage and developing liver related complications in patients with sustained virologic response (SVR) remain unclear. This study was designed to examine the long-term outcomes of generic DAA-induced virological cure in a real-life cohort of HCV patients with or without comorbid schistosomiasis. We prospectively enrolled a cohort of 506 recently cured HCV patients (437 Child–Pugh class A [Child-A] and 69 Child–Pugh class B [Child-B]). All patients were clinically evaluated at different time points during a 2-year follow-up (November 2018 to February 2021). Over the course of treatment and follow-up, 77 (15.2%) patients (42 [9.6%] Child-A and 35 [50.7%] Child-B) experienced complications at different time points. The overall mortality rate was approximately 1/1,000 person-years. The incidence of hepatic insufficiency was approximately 5.5/1,000 person-years, and that of de novo hepatocellular carcinoma (HCC) was approximately 8.3/1,000 person-years. A sustained improvement in liver indices up to 2 years of follow-up was observed. In the Cox regression model, pretreatment decompensated cirrhosis predicted the occurrence of adverse liver events and HCC after therapy. In conclusion, in HCV patients with advanced cirrhosis or coexisting hepatic schistosomiasis, generic DAA-induced SVR remains robust with favorable clinical outcomes although the risk of hepatocarcinogenesis cannot be eliminated. Surveillance of patients with treated HCV infection is an important aspect of postcure care for early detection and management of liver disease-related adverse events.

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290 - Long-Term Follow-Up of Patients with Chronic HCV Infection and Compensated or Decompensated Cirrhosis Following Treatment with Sofosbuvir-Based Regimens

Cited by 3 publications

References 0 publications

Long-Term Follow-Up of Advanced Liver Disease after Sustained Virological Response to Treatment of Hepatitis C with Direct-Acting Antivirals: Outcomes from a Real-World Portuguese Cohort

Long-Term Follow-Up of Advanced Liver Disease after Sustained Virological Response to Treatment of Hepatitis C with Direct-Acting Antivirals: Outcomes from a Real-World Portuguese Cohort

The Impact of Achieving Sustained Virological Response with Direct Acting Antivirals on Gastroesophageal Varices and Variceal Bleeding

Liver Disease Outcomes after Sustained Virological Response in Patients with Chronic Hepatitis C Infection Treated with Generic Direct-Acting Antivirals

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