Hepatitis C cirrhosis: New perspectives for diagnosis and treatment

Khullar, Vikas; Firpi, Roberto J.

doi:10.4254/wjh.v7.i14.1843

Cited by 48 publications

(36 citation statements)

References 59 publications

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“…Thus, it is of clinical interest to investigate antiviral efficacy in patients with fibrosis and early‐stage cirrhosis. When SVR rates were evaluated in patients with and without cirrhosis, lower rates were reported in the cirrhotic counterpart with SVR between 40‐50% in Child‐Pugh class A and 7‐26% in Child‐Pugh class C . In our study, irrespective of shorter (8 weeks) or longer (16 weeks) duration, all F4 patients achieved 100% SVR in agreement with previous findings from the Surveyor II (Part 3) and the NAVIGATORE network analysis .…”

Section: Discussionsupporting

confidence: 91%

Real‐life glecaprevir/pibrentasvir in a large cohort of patients with hepatitis C virus infection: The MISTRAL study

Persico

Aglitti

Milella

et al. 2019

Liver International

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Background and aims:It is paramount to identify predictors of treatment failure with direct antiviral agents in 'field-practice' patients, including people who inject drugs (PWID). Data on the efficacy of glecaprevir/pibrentasvir (GLE/PIB) in a field-practice scenario are scant. The multicentre MISTRAL study enrolled 1177 patients, including PWID, to assess real-life efficacy and safety of GLE/PIB and to identify the predictive factors for this treatment. Methods:This was a prospective, longitudinal study. The outcome variable was the rate of sustained virological response (SVR) at week 12.Results: A total of 123 patients (10%) were infected from hepatitis C virus (HCV) 3.METAVIR fibrosis score was F4 in 104 subjects (9%); 118 patients (10%) were PWID.Overall, 1163/1177 (99%) patients achieved SVR. The baseline clinical factors discriminating between treatment success and treatment failure were age at treatment (P = 0.031) and creatinine level (P = 0.034). SVR rates were not influenced by gender, substance abuse, previous treatment, treatment duration, fibrosis or chronic kidney disease stage. Compared with non-substance users, the 118 PWID exhibited a significantly different genotype pattern distribution (χ 2 < 0.001). A total of 40/118 (33.9%) of substance users were HCV3 compared to 83/1056 (7.9%) non-substance users.Only 6 patients (0.5%) reported a serious adverse event. Conclusions:The MISTRAL study provides evidence of GLE/PIB efficacy in a fieldpractice scenario in a highly epidemic HCV area in southern Italy; it unveiled significant differences in genotype distribution among the most underserved and difficult-to-treat patient subgroups including PWID. K E Y W O R D S cirrhosis, direct-acting antiviral, efficacy, HCV genotype, substance abuse Keypoints • The MISTRAL study shows that glecaprevir/pibrentasvir is effective for the treatment of hepatitis C virus in a field-practice scenario in a highly epidemic area in southern Italy. Handling editor: Alessio Aghemo S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Persico M, Aglitti A, Milella M, et al. Real-life glecaprevir/pibrentasvir in a large cohort of patients with hepatitis C virus infection: The MISTRAL study. Liver Int.

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Section: Discussionsupporting

confidence: 91%

Real‐life glecaprevir/pibrentasvir in a large cohort of patients with hepatitis C virus infection: The MISTRAL study

Persico

Aglitti

Milella

et al. 2019

Liver International

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“…Hepatitis C virus (HCV) has been the leading cause of cirrhosis in the United States for several decades [1]. Until recently, the standard of care for HCV treatment was interferon based therapy (IFN), which was wrought with intolerable side effects, long treatment duration, and suboptimal sustained virologic response (SVR) rates of approximately 40% for patients with genotype 1 [2,3].…”

Section: Introductionmentioning

confidence: 99%

Hepatocellular carcinoma decreases the chance of successful hepatitis C virus therapy with direct-acting antivirals

Prenner

VanWagner

Flamm

et al. 2017

Journal of Hepatology

143

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Background & Aims The approval of all-oral direct-acting antiviral (DAA) regimens for the treatment of hepatitis C virus (HCV) has led to the expansion of therapy to include patients with cirrhosis who have hepatocellular carcinoma (HCC). Data on the use of DAAs in HCV+ patients with HCC is limited. The aim of this study was to assess the efficacy of all-oral-DAA regimens in HCV+ cirrhotic patients who have or had HCC compared to those without HCC. Methods A retrospective cohort study was conducted on all cirrhotic patients who were treated for HCV with DAAs at our institution between January 2014 and November 2015. Results A total of 421 HCV+ patients with cirrhosis were identified, of whom 33% had active or a history of HCC. Failure to achieve sustained virologic response (SVR) occurred in 21% of patients with HCC compared to 12% of patients without HCC (p = 0.009). Of the 29 patients with HCC who did not achieve SVR, 27 (93%) occurred when an active tumor was present. DAA therapy in the presence of an inactive tumor or after removal of tumor (resection/transplant) resulted in excellent SVR rates, similar to those without HCC (p <0.0001). In multivariable analysis, the primary predictor of DAA treatment failure was the presence of active HCC at the time of HCV treatment initiation (adjusted odds ratio = 8.5, 95% confidence interval = 3.90–18.49). Conclusions The presence of active HCC tumor at the initiation of HCV therapy is significantly associated with all-oral DAA treatment failure. HCV treatment after curative therapies for HCC resulted in excellent SVR. Lay summary The new medications for hepatitis C have excellent cure rates. However, our study shows that in patients with both liver cancer and hepatitis C, they do not achieve these cure rates. Patients with liver cancer are almost 8 times more likely to fail hepatitis C treatment than patients without liver cancer.

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“…Sofosbuvir has activity against all six major HCV genotypes and stops HCV from multiplying and infecting new cells [5][6][7]. Daclatasvir is effective against genotype 1-4 [7,8].…”

Section: Indicationmentioning

confidence: 99%

“…Daclatasvir is effective against genotype 1-4 [7,8]. Sofosbuvir is used in combination with peginterferon and/or ribavirin but is also approved for use without interferon treatment, in combination with daclatasvir with or without ribavirin [5][6][7][8].…”

Section: Indicationmentioning

confidence: 99%