Peripheral neuropathy after viral eradication with direct‐acting antivirals in chronic HCV hepatitis: A prospective study

Abstract

Background HCV‐related extra‐hepatic complications include peripheral neuropathies, with important prevalence and impact. A recent metanalysis of previous intervention trials concluded for insufficient data to support evidence‐based treatments for this complication. In this longitudinal study, we assessed for the first time prevalence and outcome of neuropathy in a cohort of patients with chronic HCV, before and after direct‐acting antiviral agent (DAA) treatment. Method Ninety‐four patients (mean age 58.5 ± 9.9, infection duration 22.2 ± 6.3 years) without systemic and metabolic diseases, underwent neurological examination and electroneurography studies before (T0) and 10.4 ± 1.7 months after the end of DAA therapy (T1), and cryoglobulins (CG) assessment. Muscle strength was evaluated by Medical Research Council (MRC) score; neuropathic pain, sensory function, disability, quality of life were assessed by validated questionnaires (DN4, NPSI, SSS, INCAT and Euro‐QoL). Results At T0, sensory‐motor neuropathy was detected in 22 patients (23%), reflexes were depressed in 32 (34%) with no association with infection duration, viral load, age, CG. Neuropathic pain (DN4 ≥4) was present in 37 patients (39%). At T1, out of the 22 patients with altered electroneurography, 3 had died or developed HCC, 4 showed normal electroneurography, and nerve amplitude parameters tended to improve in the whole group. Only 11 patients (12%) had depressed reflexes and 10 (11%) DN4 ≥4 (P < .05 compared to T0). Scores for MRC, questionnaires and Euro‐QoL improved significantly (P < .05). Conclusion Our study confirms the high prevalence of clinical and subclinical peripheral sensory‐motor neuropathy in patients with HCV infection and indicates improvement after eradication by DAA. These results support the need for larger intervention studies.

A Review on Extrahepatic Manifestations of Chronic Hepatitis C Virus Infection and the Impact of Direct-Acting Antiviral Therapy

“…The authors studied 37 HCV patients with neuropathic pain, 22 with sensory and motor neuropathy, and 32 with depressed reflexes. At the end of the post-DAA treatment follow-up, improvements were observed in both clinical and subclinical peripheral sensorimotor neuropathy [94].…”

Current standard values of health utility scores for evaluating cost-effectiveness in liver disease: A meta-analysis

“…The EQ-5D-5L has been widely investigated as a tool for evaluating general health in normal populations and patients with different stages of liver disease (Table 3 )[ 17 , 18 , 22 , 25 - 27 , 30 , 32 ]. Health utility indices should be affected by age, sex, ethics, religion, and geography.…”

“…In this meta-analysis, we describe the scores obtained with various health utility indexes (HUIs) in normal healthy populations or patients with different types of liver disease (Table 2 )[ 16 - 32 ].…”

Therapy of Chronic Viral Hepatitis: The Light at the End of the Tunnel?

“…In contrast to PN, symptoms of central nervous system impairment (anxiety, depression, fatigue, attention and memory deficits, sleep disturbances, and confusion) are rarely due to CV; a direct neurotoxic effect has been hypothesized thanks to the finding of brain neuro-invasion by HCV and intrathecal replication [129,130]. Studies published so far [106,109,111,115,[131][132][133][134][135] on the impact of DAA-based treatment on neurologic disorders have shown a significant reduction of neuropathic pain, even though PN demonstrated a lower clinical response [127] compared to cutaneous and articular manifestations (30-70% vs. 75-100%). A beneficial effect on neuropsychiatric and cognitive affections related to HCV infection was also found [136,137], with the improvement of fatigue, sleep disturbances, vitality, mental component summary, general health, and in the activity of cerebral cortex profiles.…”