DAA therapy and long-term hepatic function in advanced/decompensated cirrhosis: Real-world experience from HCV-TARGET cohort

Verna, Elizabeth C.; Morelli, Giuseppe; Terrault, Norah A.; Lok, Anna S.; Lim, Joseph K.; Bisceglie, Adrian M. Di; Zeuzem, Stefan; Landis, Charles; Kwo, Paul Y.; Hassan, Mohamed A.; Manns, Michael P.; Vainorius, Monika; Akushevich, Lucy; Nelson, David R.; Fried, Michael; Reddy, K. Rajender

doi:10.1016/j.jhep.2020.03.031

Cited by 103 publications

(101 citation statements)

References 22 publications

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“…In parallel to other reports, the patients with CP-B/C cirrhosis in our study showed a modest decrease in MELD score following DAA therapy (13)(14)(15)(16)(17)37). In almost 20% of patients the MELD score decline was at least 2 points at 12 weeks following the end of therapy.…”

Section: Belli Et Al and Pascasio Et Al Reported Their Experience Witsupporting

confidence: 88%

“…While the need for LT may thus persist, biochemical improvements could lower the patient's chance of receiving a donor liver in MELD-based allocation systems. This potential downside of antiviral therapy appears to be more relevant for those J o u r n a l P r e -p r o o f in higher need of LT, because patients with higher MELD scores were more likely to achieve a profound MELD score decline in line with prior reports (16,37). Yet, patients with high MELD scores at baseline were also most likely to have subsequent clinical events after therapy.…”

Section: Belli Et Al and Pascasio Et Al Reported Their Experience Witsupporting

confidence: 51%

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Clinical outcomes following DAA therapy in patients with HCV-related cirrhosis depend on disease severity

Krassenburg

Maan

Ramji

et al. 2021

Journal of Hepatology

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Section: Belli Et Al and Pascasio Et Al Reported Their Experience Witsupporting

confidence: 88%

Section: Belli Et Al and Pascasio Et Al Reported Their Experience Witsupporting

confidence: 51%

Clinical outcomes following DAA therapy in patients with HCV-related cirrhosis depend on disease severity

Krassenburg

Maan

Ramji

et al. 2021

Journal of Hepatology

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“…21 In addition, overall mortality in patients with CP class C was extremely high, being estimated at 55% in 1 year. 22,23 Verna et al 24 reported that the SVR12 rate dropped from 97% to 78% when patients who died during the study period were counted. In our study, all patients with CP class C showed a CP score of ≤11.…”

Section: Discussionmentioning

confidence: 99%

Real‐world efficacy and safety of 12‐week sofosbuvir/velpatasvir treatment for patients with decompensated liver cirrhosis caused by hepatitis C virus infection

Takaoka

Miura

Morimoto

et al. 2020

Hepatology Research

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This study aimed to evaluate the real world efficacy and safety of 12 week sofosbuvir/velpatasvir (SOF/VEL) treatment for patients with decompensated liver cirrhosis caused by hepatitis C virus (HCV) infection. Methods: A total 72 of patients with Child-Pugh (CP) class B or C were enrolled. We evaluated the sustained virologic response at 12 weeks after the end of treatment (SVR12), adverse events (AEs), and changes in the liver function. Results: All participants had genotype 1 or 2 HCV infection. At baseline, the numbers of patients with CP class B and C were 59 and 13, respectively. The overall SVR12 rate was 95.8% (69/72); 94.9% (56/59) in CP class B and 100% (13/13) in CP class C. The serum albumin level, prothrombin time and ascites were significantly improved (P<0.01); however, the serum bilirubin level and encephalopathy did not improve. Among patients who achieved SVR12, 75.0% showed an improvement in their CP score, while 5.9% showed a worsening. The presence of large portosystemic shunt (diameter ≥6 mm) and hyperbilirubinemia (≥2.0 mg/dL) were independent factors that interfered with the improvement in the CP score (P<0.

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“…A long-term analysis of patients with MELD > − 10 included in the TARGET cohort has just been published by Verna et al 40 Over a median follow-up of 4 years, a decline of at least 3 MELD points occurred in less than one-third of patients, with a final MELD score <10 only achieved in 25% of cases. The presence of ascites at baseline (OR 0.49; 95% CI 0.24-1.01; p = 0,057) was negatively associated with MELD improvement and baseline MELD <16 was predictive of overall survival (log-rank, p <0.0001).…”

Section: Key Pointmentioning

confidence: 99%

Hepatic benefits of HCV cure

Calvaruso

2020

Journal of Hepatology

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Direct-acting antiviral (DAA)-induced HCV clearance conceivably leads to improved outcomes at all stages of liver disease. However, available data suggest that the maximum measurable benefit is obtained by treating patients before they reach the stage of compensated advanced chronic liver disease (cACLD). Ideally, all patients with chronic hepatitis C should be treated before they develop advanced fibrosis or cirrhosis, since even if sustained virologic response (SVR) reduces the risk of hepatic events (e.g. decompensation and hepatocellular carcinoma [HCC]) and improves survival, further progression of liver disease and adverse outcomes, including hepatic deaths, cannot be entirely avoided. The hepatic venous pressure gradient (HVPG) correlates closely with the stage of liver disease. Measurements of HVPG in patients with severe fibrosis or cirrhosis treated with DAAs show that those with the highest degree of portal hypertension have the lowest probability of a meaningful reduction of portal pressure after SVR, and remain at significant risk of decompensation. Reduced liver stiffness is commonly observed in patients with cACLD but its role in predicting prognosis is yet to be demonstrated. In patients with decompensated cirrhosis, prevention of further decompensation and of HCC is only weakly associated with SVR. Overall, the main clinical predictors of a high risk of HCC in patients who obtain SVR on DAAs are all indexes strongly reflecting advanced fibrosis and impaired hepatic function. Long-term follow-up of large real-life cohorts of patients treated at all stages of liver disease, but mainly those with mild to moderate fibrosis, will be needed to confirm the impact of SVR among diverse HCV-infected populations and, more importantly, to better stratify patients at higher risk of complications in order to define their correct surveillance.

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DAA therapy and long-term hepatic function in advanced/decompensated cirrhosis: Real-world experience from HCV-TARGET cohort

Cited by 103 publications

References 22 publications

Clinical outcomes following DAA therapy in patients with HCV-related cirrhosis depend on disease severity

Clinical outcomes following DAA therapy in patients with HCV-related cirrhosis depend on disease severity

Real‐world efficacy and safety of 12‐week sofosbuvir/velpatasvir treatment for patients with decompensated liver cirrhosis caused by hepatitis C virus infection

Hepatic benefits of HCV cure

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