Portal pressure and liver stiffness measurements in the prediction of fibrosis regression after sustained virological response in recurrent hepatitis C

Mauro, Ezequiel; Crespo, Gonzalo; Montironi, Carla; Londoño, María-Carlota; Hernández‐Gea, Virginia; Ruíz, Pablo; Sastre, Lydia; Lombardo, Julissa; Mariñó, Zoe; Díaz, Alba; Colmenero, Jordi; Rimola, Antoni; García‐Pagán, Juan Carlos; Brunet, Mercè; Forns, Xavier; Navasa, Miquel

doi:10.1002/hep.29557

Cited by 137 publications

(120 citation statements)

References 47 publications

(95 reference statements)

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“…Our results were in good agreement with those of Martini et al and Seifert et al, who reported that early improvement of TE values at SVR24 may be attributed to a great extent to resolution in liver inflammation and edema in LT patients who were treated with sofosbuvir‐based therapy; however, paired biopsies were not performed in both studies . Similarly, a recent study comparing paired biopsies has shown LT patients who remained with persistent necroinflammation in the follow‐up biopsy despite SVR not being associated with fibrosis regression …”

Section: Discussionsupporting

confidence: 92%

Improvement of liver stiffness measurement, acoustic radiation force impulse measurements, and noninvasive fibrosis markers after direct‐acting antivirals for hepatitis C virus G4 recurrence post living donor liver transplantation: Egyptian cohort

Alem

Said

Anwar

et al. 2018

Journal of Medical Virology

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Progression of recurrent hepatitis C is accelerated in liver transplant (LT) recipients. Direct-acting antivirals (DAAs) have recently emerged as a promising therapeutic regimen for the treatment of hepatitis C virus infection. Rates of sustained virological response (SVR) have drastically improved since the introduction of DAAs. The aim is to elucidate the changes in liver stiffness measurement (LSM) by transient elastography (TE) as well as acoustic radiation force impulse (ARFI) elastography and fibrosis scores after DAA treatment in LT recipients with hepatitis C virus recurrence. A single-center, prospective study including 58 LT recipients with hepatitis C recurrence who received different sofosbuvir-based treatment regimens. Transient elastography and ARFI elastography values were recorded as well as fibrosis 4 score (FIB-4) and aspartate aminotransferase-to-platelet ratio index were calculated at baseline and SVR at week 24 (SVR24). The outcome was improvement in LSM and at least a 20% decrease in LSM at SVR24 compared with baseline. The sustained virological response was 98.1%. There was improvement of platelet counts, alanine aminotransferase, and aspartate aminotransferase, which in turn caused improvement in fibrosis scores at SVR24. LSM by TE and ARFI elastography decreased from the baseline median value of 6.3 kPa (interquartile range [IQR]; 4.6 to 8.8 kPa) and 1.28 m/s (IQR; 1.07 to 1.53 m/s) to an SVR24 median value of 6.2 kPa (IQR; 4.85 to 8.9 kPa) and 1.12 (IQR; 0.97 to 1.30 m/s), respectively. Logistic regression analysis showed that baseline viral load was the only significant predictor of improvement in LS after DAA therapy at SVR24. Sofosbuvir-based treatment resulted in an early improvement in parameters of liver fibrosis in post-LT patients with hepatitis C recurrence.

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Section: Discussionsupporting

confidence: 92%

Improvement of liver stiffness measurement, acoustic radiation force impulse measurements, and noninvasive fibrosis markers after direct‐acting antivirals for hepatitis C virus G4 recurrence post living donor liver transplantation: Egyptian cohort

Alem

Said

Anwar

et al. 2018

Journal of Medical Virology

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“…Fibrosis regression has been investigated extensively in chronic hepatitis B patients after nucleoside treatment and in CHC patients after interferon treatments with results pointing towards a potential for regression or even resolution at longer follow‐up . A similar effect of DAA therapies is becoming evident and fibrosis regression may also lead to diminished portal hypertension with discrete improvements in portal pressure after DAA therapy . In a small number of patients (n = 4), we observed a trend towards reduced portal hypertension.…”

Section: Discussionmentioning

confidence: 62%

“…The limitations of the study, though, pertain to the lack of histological verification of liver inflammation and fibrosis. However, we and others have previously shown very good associations between the macrophage activation markers and liver inflammation as well as between liver stiffness and fibrosis, even after SVR . Another limitation is that not all patients underwent transient elastography by the same method being either the FibroScan or the ARFI method, however, as the combined and separate associations seem similar, we consider the results valid.…”

Section: Discussionmentioning

confidence: 63%

Time‐dependent improvement of liver inflammation, fibrosis and metabolic liver function after successful direct‐acting antiviral therapy of chronic hepatitis C

Laursen

Siggaard

Kazankov

et al. 2019

Journal of Viral Hepatitis

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Sofosbuvir‐based direct‐acting antiviral (DAA) therapy generally cures chronic hepatitis C (CHC) infections, however, the effects on the underlying liver disease and the potential rate of recovery are unclear. We aimed to investigate the effects of DAA therapy on liver inflammation, fibrosis, metabolic function and cognitive function and the time course in CHC patients with advanced liver disease. Seventy‐one CHC patients with advanced liver disease were studied before, during and one year after successful sofosbuvir‐based DAA therapy. Liver inflammation was assessed by plasma sCD163 and sMR levels (ELISA), fibrosis by liver stiffness (transient elastography), function by galactose elimination capacity (GEC) and cognitive performance by continuous reaction time (CRT). During DAA therapy, we observed a rapid sCD163 decline from baseline to end of treatment (6.9 vs 3.8 mg/L, P < .0001), whereas the change in sMR was more subtle (0.37 vs 0.30 mg/L, P < .0001). Liver stiffness decreased by 20% at end of treatment (17.8 vs 14.3 kPa, P < .0001), together suggesting rapid resolution of liver inflammation. One year after treatment, liver stiffness decreased by an additional 15% (P < .0001), suggestive of fibrosis regression. The GEC improved at follow‐up (all: 1.74 vs 1.98 mmol/min), mainly at 12 weeks post‐treatment, both in patients with cirrhosis (n = 56) and those with advanced liver fibrosis (n = 15) (P < .001). The CRT improved at one‐year follow‐up (1.86 vs 2.09, P = .04). In conclusion, successful DAA therapy of CHC proves beneficial in advanced liver disease, with an initial rapid resolution of liver inflammation and a subsequent gradual but steady improvement in liver fibrosis, metabolic liver function and reaction time.

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“…Other studies evaluated the response of IFN‐based therapy using non‐invasive assessments; Poynard et al, 2013 reported regression of cirrhosis in 56% of patients who achieved SVR evaluated by fibro test and TE, also, in another study of 10 year follow‐up there was significant reduction ( P < 0.0001) of fibrosis stage evaluated by FIB‐4 in 2290/4731 (48%) patients who had SVR . Fibrosis regression was also demonstrated in a proportion of patients with SVR post‐liver transplantation …”

Section: Discussionmentioning

confidence: 97%

Changes in hepatic fibrosis stages after achieving SVR following direct‐acting anti‐viral treatment: a prospective study

et al. 2020

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Summary Introduction Chronic hepatitis C (CHC) represents a major global health problem. The availability of direct‐acting anti‐virals (DAAs) allowed the treatment of many patients with liver cirrhosis (F4) and advanced hepatic fibrosis (F3). The impact of viral clearance following DAAs treatment on the natural history of liver cirrhosis is uncertain or not clearly evident in the literature as most studies were retrospective, including small number of patients and for short follow‐up duration; there is a need for a long follow‐up, large prospective study evaluating the changes in hepatic fibrosis after achieving sustained virological response (SVR) in cirrhotics. Patients and methods This is a prospective study including CHC patients with liver cirrhosis or advanced hepatic fibrosis who achieved SVR following DAAs from January 2015 until August 2017. Patients were followed up every 4‐6 months for at least 1 year from end of treatment. Staging of liver fibrosis was done using transient elastography and non‐invasive scores (FIB‐4, FIB‐5 and APRI). Results A total of 2326 CHC patients who achieved SVR were included. Follow‐up period was 23.51 ± 8.21 months (range 12‐45). In cirrhotic patients, 21.8% showed reversal of cirrhosis, 27.4% showed fibrosis regression while 50.8% remained stationary. About 26.5% of F3 patients showed reversal of fibrosis , 31.5% showed fibrosis regression and 30.6% remained stationary while 11.4% progressed to F4. Conclusion HCV clearance following DAAs treatment in CHC patients with liver cirrhosis or advanced hepatic fibrosis is associated with reversal of cirrhosis and regression of hepatic fibrosis in about 50% of patients.

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Portal pressure and liver stiffness measurements in the prediction of fibrosis regression after sustained virological response in recurrent hepatitis C

Cited by 137 publications

References 47 publications

Improvement of liver stiffness measurement, acoustic radiation force impulse measurements, and noninvasive fibrosis markers after direct‐acting antivirals for hepatitis C virus G4 recurrence post living donor liver transplantation: Egyptian cohort

Improvement of liver stiffness measurement, acoustic radiation force impulse measurements, and noninvasive fibrosis markers after direct‐acting antivirals for hepatitis C virus G4 recurrence post living donor liver transplantation: Egyptian cohort

Time‐dependent improvement of liver inflammation, fibrosis and metabolic liver function after successful direct‐acting antiviral therapy of chronic hepatitis C

Changes in hepatic fibrosis stages after achieving SVR following direct‐acting anti‐viral treatment: a prospective study

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