Liver stiffness predicts the response to direct-acting antiviral-based therapy against chronic hepatitis C in cirrhotic patients

Abstract

The purpose of this investigation was to evaluate the impact of liver stiffness (LS) on the response to direct-acting antiviral (DAA)-based therapy against hepatitis C virus (HCV) infection in cirrhotic patients. Those patients included in two Spanish prospective cohorts of patients receiving therapy based on at least one DAA, who showed a baseline LS ≥ 12.5 kPa and who had reached the scheduled time point for sustained virological response evaluation 12 weeks after completing therapy (SVR12) were analysed. Pegylated interferon/ribavirin-based therapy plus an HCV NS3/4A protease inhibitor (PR-PI group) was administered to 198 subjects, while 146 received interferon-free regimens (IFN-free group). The numbers of patients with SVR12 according to an LS < 21 kPa versus ≥21 kPa were 59/99 (59.6%) versus 46/99 (46.5%) in the PR-PI group (p = 0.064) and 41/43 (95.3%) versus 90/103 (87.4%) in the IFN-free group (p = 0.232). Corresponding figures for the relapse rates in those who presented end-of-treatment response (ETR) were 3/62 (4.8%) versus 10/56 (17.9%, p = 0.024) and 1/42 (2.4%) versus 8/98 (8.2%, p = 0.278), respectively. In a multivariate analysis adjusted for age, sex and use of interferon, a baseline LS ≥ 21 kPa was identified as an independent predictor of relapse [adjusted odds ratio, AOR (95% confidence interval, CI): 4.228 (1.344-13.306); p = 0.014] in those patients with ETR. LS above 21 kPa is associated with higher rates of relapse to DAA-based therapy in HCV-infected patients with cirrhosis in clinical practice. LS could help us to tailor the duration and composition of DAA-based combinations in cirrhotic subjects, in order to minimise the likelihood of relapse.

Elastography as a predictor of liver cirrhosis complications after hepatitis C virus eradication in the era of direct-acting antivirals

“…In particular, a LS value higher than 16.7 kPa resulted as an unfavorable prognostic factor for treatment response (relapse rate 13%), probably related to an impaired immune-mediated HCV clearance that is worsened in advanced liver fibrosis. Similar considerations were drawn by Neukam et al [ 29 ] in patients treated with pegylated interferon/ribavirin-based therapy associated with NS3/4A protease inhibitor (PR-PI) and patients under DAAs therapy. In the PR-PI group, SVR12 was obtained in 59.6% of patients with LS < 21 kPa and in 46.5% of subjects with LS ≥ 21 kPa ( P = 0.064); in the DAAs group, SVR12 was reached by 95.3% of patients with LS < 21 kPa and 87.4% of patients with ≥ 21 kPa.…”

Baseline resistance-guided therapy does not enhance the response to interferon-free treatment of HCV infection in real life

“…This is a prospective study conducted in two cohorts of DAA-treated patients attending Infectious Diseases Units of 17 hospitals across Spain: the HEPAVIR (clinicaltrials.gov ID: NCT02057003) cohort, which recruits HIV/HCV-coinfected patients and the GEHEP-MONO (clinicaltrials.gov ID: NCT02333292), which enrols HCV-monoinfected patients 28 . As inclusion criteria in this study, all individuals participating in these cohorts who initiated treatment with all-oral DAA-based regimens between March 2016 and May 2017, and who had never been treated before with DAAs, with the exception of sofosbuvir with or without ribavirin alone or plus interferon, were included.…”

Liver Stiffness Predicts Relapse after Direct Acting Antiviral Therapy Against Chronic Hepatitis C Virus Infection

“…Our study results revealed that high Liver Stiffness (LS) was able to predict relapse among DAA treated patients with a cutoff value 12Kpa and this was in agreement with Neukam et al, who declared that the degree of LS impacts on the relapse rate to DAA-based therapy in the clinical practice. However in Neukam et al, 2017 study, LS measurements more than 2 1Kpa was associated with relapse which can be explained by the large number of cirrhotic patients who were included in his study [29] . We also found that each of ALT, AST and baseline liver status (cirrhotic or noncirrhotic) can predict relapse in HCV treated patients.…”