Liver-related events after direct-acting antiviral therapy in patients with hepatitis C virus-associated cirrhosis.

Abstract

BACKGROUND:

Direct-acting antiviral (DAA) therapy enables a high rate of sustained virologic response (SVR) in patients with hepatitis C virus associated cirrhosis. However, the impact of DAA therapy on liver-related events in patients with cirrhosis is unclear.

METHODS:

A total of 350 patients with compensated and decompensated cirrhosis administered DAA therapy at 29 Japanese hospitals were enrolled (Child-Pugh class A [CP-A]: 195 patients, CP-B: 131 patients and CP-C: 24 patients).

RESULTS:

The SVR rates of patients with CP-A, CP-B and CP-C were 96.9%, 93.1% and 83.3%, respectively (p = 0.006). Seventy patients developed hepatocellular carcinoma (HCC), and male sex, previous HCC treatment, platelet counts < 10.0 × 104/µl, alpha-fetoprotein levels ≥ 5.0 ng/ml and CP-C were identified as significant factors in the multivariate analysis. The cumulative HCC occurrence/recurrence rates at 1 year were 6.6%/45.2%. The cumulative rate of decompensated cirrhotic events requiring hospital admission at 1 year was 9.1%. In the multivariate analysis, CP-B and CP-C were identified as significant factors. During the median observation period of 14.9 months, 13 patients died and one patient received liver transplant. The overall survival rates at 1 year were 98.4% in patients with CP-A, 96.4% in those with CP-B and 85.6% in those with CP-C (CP-A vs. CP-B: p = 0.759, CP-A vs. CP-C: p = 0.001 and CP-B vs. CP-C: p = 0.005).

CONCLUSIONS:

HCC development and mortality in patients with CP-B were not different from those with CP-A. On the other hand, in patients with CP-C, the development of HCC and decompensated cirrhotic events requiring hospital admission, and death were frequent.

TRIAL REGISTRATION:

University Hospital Medical Information Network (UMIN000036150).

• Authors: Yuki Tahata, Hayato Hikita, Satoshi Mochida, Nobuyuki Enomoto, Norifumi Kawada, Masayuki Kurosaki, Akio Ido, Daiki Miki, Hitoshi Yoshiji, Yasuhiro Takikawa, Ryotaro Sakamori, Yoichi Hiasa, Kazuhiko Nakao, Naoya Kato, Yoshiyuki Ueno, Hiroshi Yatsuhashi, Yoshito Itoh, Ryosuke Tateishi, Goki Suda, Taro Takami, Yasunari Nakamoto, Yasuhiro Asahina, Kentaro Matsuura, Taro Yamashita, Tatsuya Kanto, Norio Akuta, Shuji Terai, Masahito Shimizu, Satoshi Sobue, Tomokatsu Miyaki, Akihiro Moriuchi, Ryoko Yamada, Takahiro Kodama, Tomohide Tatsumi, Tomomi Yamada, Tetsuo Takehara
• Journal: Journal of gastroenterology (J Gastroenterol) Vol. 57 Issue 2 Pg. 120-132 (02 2022) ISSN: 1435-5922 [Electronic] Japan
• PMID: 35059853 (Publication Type: Journal Article)
• Copyright: © 2022. Japanese Society of Gastroenterology.

Chemical References

• Antiviral Agents

Topics

• Antiviral Agents (therapeutic use)
• Carcinoma, Hepatocellular (pathology)
• Hepacivirus
• Hepatitis C, Chronic (complications, drug therapy)
• Humans
• Liver Cirrhosis (drug therapy)
• Liver Neoplasms (pathology)
• Male
• Sustained Virologic Response