Liver stiffness regression after sustained virological response by direct-acting antivirals reduces the risk of outcomes

Abstract

The role of liver stiffness measurement (LSM) after sustained virological response (SVR) in HCV patients treated by direct-acting antivirals (DAAs) remains unclear. We aimed to evaluate LSM regression value after SVR and to identify risk factors associated with liver related complications (LRC) or death. This retrospective study analyzed patients with LSM ≥ 10 kPa with LSM by transient elastography pre-DAAs and post-SVR. Patients with previous hepatic decompensation were excluded. Medical records were reviewed to identify primary outcomes. Kaplan–Meier curves and time-to-event Cox proportional-hazard models were performed. 456 patients [65% female, 62 years (IQR 57–68)] were included. During a follow-up of 2.3 years (IQR 1.6–2.7), 28 patients developed 37 outcomes [rate = 29.0 (95% CI 20.0–42.0) per 1000 person-years]. The cumulative incidence of outcomes was significantly lower in patients who regressed LSM ≥ 20% [3.4% (95% CI 1.8–7.0) vs. 9.0% (5.5–14.5), p = 0.028]. In a multivariate Cox-model [HR(95% CI)], male gender [HR = 3.00 (1.30–6.95), p = 0.010], baseline albumin < 3.5 mg/dL [HR = 4.49 (1.95–10.34), p < 0.001] and baseline unfavorable Baveno-VI [HR = 4.72 (1.32–16.83), p = 0.017] were independently associated and LSM regression ≥ 20% after SVR had a trend to reduce the risk of LRC or death [HR = 0.45 (0.21–1.02), p = 0.058]. The use of simple parameters before DAAs and repetition of LSM post-SVR can identify patients with different risks for severe outcome after HCV eradication.

Are We on the Right Track for HCV Micro-Elimination? HCV Management Practices in Dialysis Centers in Poland—A National Cross-Sectional Survey

“…Given the above and the multitude of barriers reported in our survey preventing HD-dependent patients from receiving AVT, many individuals may be left untreated without accurate liver fibrosis assessment, despite continued HCV-related abnormalities accumulation. Importantly, fibrosis may serve as a predictor of decompensation or of HCC in patients with CHC, which is why it is important to monitor liver stiffness as recommended by KDIGO [ 11 , 16 , 17 ].…”

“…This can be achieved through the evaluation of fibrosis. It has been documented that liver fibrosis can be utilized for the prognostication of adverse outcomes, patient mortality and as a predictor of decompensation or hepatocellular carcinoma (HCC) occurrence [ 16 , 17 ]. It has also been reflected in the most recent Kidney Disease: Improving Global Outcomes (KDIGO) Work Group guidelines which recommend that all patients with chronic kidney disease (CKD) and CHC be evaluated for fibrosis using noninvasive biomarkers, such as fibrosis-4 (FIB-4), aspartate transaminase-to-platelet ratio index (APRI), or transient elastography [ 11 ].…”

Impact of direct-acting antiviral regimens on hepatic and extrahepatic manifestations of hepatitis C virus infection

“…Several studies have reported the significant regression of LSM after treatment of HCV infection with DAAs[ 37 ]. However, it is still debatable whether the decrease of LSM and post-DAA HCV eradication are due to the suppression of viral necro-inflammatory activity or regression of liver fibrosis[ 38 ]. It is recommended that assessing the fibrosis stage after therapy using non-invasive tools should not be endorsed as they are unreliable in this setting[ 29 ].…”

Fibrosis regression following hepatitis C antiviral therapy

“…The proper interpretation of LSM in patients after SVR remains unclear. Many studies have shown a substantial reduction in LSM following SVR in HCV patients treated with DAAs[ 50 - 52 ]. It's still unclear if the drop in LSM after HCV eradication is due to HCV's necro-inflammatory activity being suppressed and changes in hepatic inflammation, rather than the regression of liver fibrosis.…”