Comparison of Clinical and Patient Reported Outcomes of Treatment with Directly Acting Antivirals in Hepatitis C With and Without Cirrhosis: A Prospective Cohort Study

Abstract

Background Chronic hepatitis C including liver cirrhosis poses challenges in treatment despite the availability of direct acting antivirals. AimTo compare clinical and patient reported outcomes of routinely used pharmacotherapy in Hepatitis C infection (with or without cirrhosis). MethodsA prospective cohort study was undertaken recruiting outpatients from a large referral tertiary care hospital. Patients who were diagnosed of having Hepatitis C Virus (HCV) infection and presented with or without cirrhosis were included. A standard 12 weeks treatment comprising Sofosbuvir (SOF) 400mg O.D/ Daclatasvir (DCV) 60mg O.D with and without Ribavirin (RBV) 400mg B.D or T.I.D was used. The cure rate in terms of end-of-treatment response at the end of 12 weeks treatment and patient reported outcomes (PROs) in terms of health related quality of life using EQ-5D-3L and work productivity loss were determined. Results The treatment regimen was found to be effective treatment in non-cirrhotic group in terms of cure rate compared to the cirrhotic patients (92.6 % vs 53%; p value<0.05). Cirrhotic patients showed significantly low score of PROs before initiating the treatment. After 12 weeks’ treatment, significantly higher rate of improvement was observed in non-cirrhotic patients’ PROs compared to cirrhotic group (p-value; <0.05). Conclusion DAAs showed higher effectiveness in clinical outcomes and patient reported outcome measures in chronic hepatitis C patients without cirrhosis compared to those with cirrhosis. It is imperative to develop and optimize further effective treatment options for cirrhotic CHC patients.