Effects of All-Oral Anti-Viral Therapy on HVPG and Systemic Hemodynamics in Patients With Hepatitis C Virus-Associated Cirrhosis

Lens, Sabela; Alvarado‐Tapias, Edilmar; Mariñó, Zoe; Londoño, María-Carlota; Llop, Elba; Martínez, Javier; Fortea, José Ignacio; Ibáñez, Luis; Ariza, Xavier; Baiges, Anna; Gallego, Adolfo; Bañares, Rafael; Puente, Ángela; Albillos, Agustı́n; Calleja, José Luís; Torras, Xavier; Hernández‐Gea, Virginia; Bosch, Jaume; Villanueva, Càndid; Forns, Xavier; García‐Pagán, Juan Carlos

doi:10.1053/j.gastro.2017.07.016

Cited by 216 publications

(189 citation statements)

References 27 publications

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“…CHC patients who achieved SVR after DAA therapy might have decreased hepatic venous pressure gradient (HVPG) measurements and LS compared to baseline . This was also observed in CHC patients with cirrhosis who achieved SVR, because DAA therapy significantly reduced HVPG when compared to the baseline …”

Section: Discussionmentioning

confidence: 87%

Safety and efficacy of sofosbuvir‐based direct‐acting antiviral regimens for hepatitis C virus genotype 6 in Southwest China: Real‐world experience of a retrospective study

Jiang

Wang

et al. 2018

Journal of Viral Hepatitis

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Summary Optional treatments for patients with chronic hepatitis C virus (HCV) genotype (GT) 6 infection have not been extensively studied. This study aimed to evaluate the safety and efficacy of sofosbuvir (SOF)‐based direct‐acting antiviral agents (DAAs) for HCV GT6. We performed a retrospective study at the West China Hospital of Sichuan University in Southwest China from January 2016 to May 2017. Our study screened 130 treatment‐naïve patients with chronic HCV GT6 and without liver cirrhosis. A total of 60 HCV GT6 patients were ultimately enrolled. All patients received SOF‐based DAAs therapy, including SOF 400 mg plus daclatasvir (DCV) 60 mg daily or SOF 400 mg plus velpatasvir (VEL) 100 mg daily for 12 weeks. The sustained virological response 12 weeks after treatment (SVR12) was 100% (60/60) in treatment‐naïve patients with HCV GT6, including 100% (37/37) of patients receiving SOF plus DCV therapy and 100% (23/23) of patients receiving SOF plus VEL therapy. Measurements of liver stiffness were significantly decreased in patients at week 12 (P = 0.014) and week 24 (P < 0.001) of DAAs treatment compared to baseline values. The serum biomarker aspartate aminotransferase‐to‐platelet ratio index (APRI) and fibrosis‐4 score were also significantly reduced at week 12 and week 24 compared to before treatment (both P < 0.001). SOF‐based therapy was well‐tolerated, and no serious adverse events were reported. In conclusion, SOF plus DCV and SOF plus VEL were safe and achieved a high SVR12 rate for treatment‐naïve patients with HCV GT6 without liver cirrhosis.

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Section: Discussionmentioning

confidence: 87%

Safety and efficacy of sofosbuvir‐based direct‐acting antiviral regimens for hepatitis C virus genotype 6 in Southwest China: Real‐world experience of a retrospective study

Jiang

Wang

et al. 2018

Journal of Viral Hepatitis

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“…However, intrahepatic inflammatory stimuli and portal hypertension can persist [13,14]. Larger trials are required to investigate whether patients successfully treated for hepatitis B and hepatitis C infections and those with non-alcoholic steatohepatitis with persistent metabolic damage can profit from adjuvant medications, such as non-selective beta blockers (NSBB) [15], renin-angiotensin system inhibitors [16], statins [17] or rifaximin [18], alone or in combination [19,20].…”

Section: Blunting Formation Of Varicesmentioning

confidence: 99%

Treatment of Oesophageal Varices in Liver Cirrhosis

Sauerbruch

2018

Digestion

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Background: The development of cirrhosis with resultant portal hypertension can lead to oesophageal varices at a rate of 7% per annum. Bleeding from varices happens when the portal pressure is ≥12 mm Hg and can threaten life. Summary: Eliminating the aetiology of cirrhosis is a pivotal step to prevent the formation of varices. In patients with established varices, primary prophylaxis with non-selective beta blockers (NSBB) may slow down the progression of varices and prevent the first variceal bleed. NSBB, similar to other agents such as renin/angiotensin blockers, statins, and rifaximin, may have the additional advantage of blunting inflammatory stimuli, which can contribute to the progression of varices. Variceal band ligation is an alternative for primary bleeding prophylaxis with excellent results. Any acute variceal bleed should be managed with band ligation after careful resuscitation. Early pre-emptive transjugular intrahepatic portosystemic shunt (TIPS) in decompensated cirrhotic patients is very effective in controlling the bleeding and improves survival. Secondary prophylaxis against further variceal bleeding using NSBB and band ligation is recommended in most other patients. TIPS may be considered in appropriate patients as a secondary prophylaxis against recurrent variceal bleed. Future research should be directed towards the prevention of varices and targeting inflammation to reduce cirrhotic complications. Key Messages: Treatment strategies depend on the stage the patient is at along the natural history of varices: NSBB or band ligation for primary prophylaxis; band ligation or early TIPS for acute bleed; and a combination of NSBB + band ligation or TIPS for secondary prophylaxis (Fig. 1).

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“…With the caveat that follow-up time for DAA-treated patients is still limited, evidence is accumulating that SVR may be associated with fibrosis regression (25), improvement in portal pressures (26, 27), improvement in extrahepatic manifestations of HCV (28, 29), and reduced risk of mortality (30, 31). However, enthusiasm for DAAs was tempered after a series of publications reported potentially higher than expected rates of HCC following DAA treatment.…”

Section: Daa Treatment and De Novo Hccmentioning

confidence: 99%

The Impact of Direct-acting Antiviral Therapy for Hepatitis C on Hepatocellular Carcinoma Risk

Ioannou

2018

Curr Hepatology Rep

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Purpose of review Direct-acting antiviral agents (DAAs) eradicate hepatitis C virus (HCV) infection in the majority of patients. We critically evaluated the impact of DAAs on hepatocellular carcinoma (HCC) risk, a major complication of HCV infection. Recent findings Large cohort studies show that patients who achieve sustained virologic response (SVR) with DAAs have a significantly lower risk of developing de novo HCC than patients who fail treatment or remain untreated. Furthermore, reduction in HCC risk is similar whether SVR is achieved with DAAs or interferon (IFN). However, DAA-induced SVR does not eliminate HCC risk entirely. Therefore, patients with pre-existing cirrhosis require ongoing surveillance even after SVR is achieved. Early, descriptive, uncontrolled reports suggested that DAAs may increase the risk of recurrent HCC. While studying HCC recurrence presents major methodologic challenges, larger studies containing appropriate comparison control groups largely refuted these concerns. Summary Recent studies provide evidence that DAA-induced SVR reduces HCC risk.

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Effects of All-Oral Anti-Viral Therapy on HVPG and Systemic Hemodynamics in Patients With Hepatitis C Virus-Associated Cirrhosis

Cited by 216 publications

References 27 publications

Safety and efficacy of sofosbuvir‐based direct‐acting antiviral regimens for hepatitis C virus genotype 6 in Southwest China: Real‐world experience of a retrospective study

Safety and efficacy of sofosbuvir‐based direct‐acting antiviral regimens for hepatitis C virus genotype 6 in Southwest China: Real‐world experience of a retrospective study

Treatment of Oesophageal Varices in Liver Cirrhosis

The Impact of Direct-acting Antiviral Therapy for Hepatitis C on Hepatocellular Carcinoma Risk

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