Clinical outcomes following DAA therapy in patients with HCV-related cirrhosis depend on disease severity
HCV-infected patients with cirrhosis achieve high sustained virological response (SVR) rates with direct-acting antivirals (DAAs) even after hepatic decompensation. We aimed to assess the clinical outcome following DAAs among patients with compensated and decompensated cirrhosis in relation to SVR a...
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| Veröffentlicht in: | Journal of hepatology 2021-05, Vol.74 (5), p.1053-1063 |
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| creator | Krassenburg, Lisette A.P. Maan, Raoel Ramji, Alnoor Manns, Michael P. Cornberg, Markus Wedemeyer, Heiner de Knegt, Robert J. Hansen, Bettina E. Janssen, Harry L.A. de Man, Robert A. Feld, Jordan J. van der Meer, Adriaan J. |
| description | HCV-infected patients with cirrhosis achieve high sustained virological response (SVR) rates with direct-acting antivirals (DAAs) even after hepatic decompensation. We aimed to assess the clinical outcome following DAAs among patients with compensated and decompensated cirrhosis in relation to SVR and changes in model for end-stage liver disease (MELD) score.
Consecutive DAA-treated chronic HCV-infected patients with cirrhosis from 4 hepatology clinics were included. The primary endpoint in survival analyses was clinical disease progression, defined as liver failure, hepatocellular carcinoma, liver transplantation or death.
In total, 868 patients were included with a median age of 59 (IQR 54–65) years; 719 (83%) with Child-Pugh A cirrhosis and 149 (17%) with Child-Pugh B/C cirrhosis. SVR was attained by 647 (90%) Child-Pugh A patients and 120 (81%) Child-Pugh B/C patients. During a median follow-up of 28 (IQR 20–36) months, 102 (14%) Child-Pugh A patients and 96 (64%) Child-Pugh B/C patients experienced clinical disease progression. SVR was independently associated with an improved event-free survival in patients with Child-Pugh A cirrhosis (adjusted hazard ratio [HR] 0.47; 95% CI 0.27–0.82, p = 0.007), but not in patients with Child-Pugh B/C cirrhosis (adjusted HR 1.23; 95% CI 0.67–2.26; p = 0.51). Twelve weeks post-DAAs, 28 (19%) patients with Child-Pugh B/C cirrhosis had ≥2-point MELD decline, but their 2-year event-free survival did not differ from those with a stable MELD (47.9%; 95% CI 28.7–67.1 vs. 48.9%; 95% CI 38.1–59.7, respectively, p = 0.99).
Among patients with chronic HCV infection, DAA-induced SVR was associated with a reduced risk of clinical disease progression in patients with Child-Pugh A cirrhosis but not in patients with Child-Pugh B/C cirrhosis. In Child-Pugh B/C cirrhosis, a ≥2-point MELD decline did not translate into improved clinical outcome.
Chronic HCV infection can be cured with antiviral therapy. In this study, we evaluated the long-term effects of antiviral therapy on liver-related complications in patients with cirrhosis. Our results suggest that patients with compensated cirrhosis who were cured of their HCV infection have a lower rate of complications. In contrast, the rate of complications was not related to virological cure among those with decompensated cirrhosis. While these patients seem to remain in need of liver transplantation, antiviral therapy may lower their priority on the liver transplantation waiting list.
[D |
| doi_str_mv | 10.1016/j.jhep.2020.11.021 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2465441414</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0168827820338058</els_id><sourcerecordid>2553569109</sourcerecordid><originalsourceid>FETCH-LOGICAL-c428t-2079969ce848886af289d9b3478399375bea5b0796b113222b1e6b6b3588b8b13</originalsourceid><addsrcrecordid>eNp9kU9rGzEQxUVpaNy0X6CHIugll3X1b2UJcjFO2hQCvbS9Ckk7rrWsVxtJm-BvHxmnPeQQ5jAw_N5jeA-hT5QsKaHya7_sdzAtGWH1QJeE0TdoQSUhDZGCvkWLCqlGsZU6R-9z7gkhnGjxDp1zzgRrCV2gsBnCGLwdcJyLj3vIeBuHIT6G8S--Xq9x2UGy0wGHEU-2BBhLxo-h7PDt5k-TYLAFOuxDSruYQ8YdTDB2OI64CxlsBpzhAVIohw_obGuHDB-f9wX6_e3m1-a2ufv5_cdmfdd4wVRpGFlpLbUHJZRS0m6Z0p12XKwU15qvWge2dRWSjlLOGHMUpJOOt0o55Si_QJcn3ynF-xlyMfuQPQyDHSHO2TAhWyFonYp-eYH2cU5j_c6wtuWt1JToSrET5VPMOcHWTCnsbToYSsyxCNObYxHmWISh1NQiqujzs_Xs9tD9l_xLvgJXJwBqFg8Bksm-puuhCwl8MV0Mr_k_AWYDmDA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2553569109</pqid></control><display><type>article</type><title>Clinical outcomes following DAA therapy in patients with HCV-related cirrhosis depend on disease severity</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><creator>Krassenburg, Lisette A.P. ; Maan, Raoel ; Ramji, Alnoor ; Manns, Michael P. ; Cornberg, Markus ; Wedemeyer, Heiner ; de Knegt, Robert J. ; Hansen, Bettina E. ; Janssen, Harry L.A. ; de Man, Robert A. ; Feld, Jordan J. ; van der Meer, Adriaan J.</creator><creatorcontrib>Krassenburg, Lisette A.P. ; Maan, Raoel ; Ramji, Alnoor ; Manns, Michael P. ; Cornberg, Markus ; Wedemeyer, Heiner ; de Knegt, Robert J. ; Hansen, Bettina E. ; Janssen, Harry L.A. ; de Man, Robert A. ; Feld, Jordan J. ; van der Meer, Adriaan J.</creatorcontrib><description>HCV-infected patients with cirrhosis achieve high sustained virological response (SVR) rates with direct-acting antivirals (DAAs) even after hepatic decompensation. We aimed to assess the clinical outcome following DAAs among patients with compensated and decompensated cirrhosis in relation to SVR and changes in model for end-stage liver disease (MELD) score.
Consecutive DAA-treated chronic HCV-infected patients with cirrhosis from 4 hepatology clinics were included. The primary endpoint in survival analyses was clinical disease progression, defined as liver failure, hepatocellular carcinoma, liver transplantation or death.
In total, 868 patients were included with a median age of 59 (IQR 54–65) years; 719 (83%) with Child-Pugh A cirrhosis and 149 (17%) with Child-Pugh B/C cirrhosis. SVR was attained by 647 (90%) Child-Pugh A patients and 120 (81%) Child-Pugh B/C patients. During a median follow-up of 28 (IQR 20–36) months, 102 (14%) Child-Pugh A patients and 96 (64%) Child-Pugh B/C patients experienced clinical disease progression. SVR was independently associated with an improved event-free survival in patients with Child-Pugh A cirrhosis (adjusted hazard ratio [HR] 0.47; 95% CI 0.27–0.82, p = 0.007), but not in patients with Child-Pugh B/C cirrhosis (adjusted HR 1.23; 95% CI 0.67–2.26; p = 0.51). Twelve weeks post-DAAs, 28 (19%) patients with Child-Pugh B/C cirrhosis had ≥2-point MELD decline, but their 2-year event-free survival did not differ from those with a stable MELD (47.9%; 95% CI 28.7–67.1 vs. 48.9%; 95% CI 38.1–59.7, respectively, p = 0.99).
Among patients with chronic HCV infection, DAA-induced SVR was associated with a reduced risk of clinical disease progression in patients with Child-Pugh A cirrhosis but not in patients with Child-Pugh B/C cirrhosis. In Child-Pugh B/C cirrhosis, a ≥2-point MELD decline did not translate into improved clinical outcome.
Chronic HCV infection can be cured with antiviral therapy. In this study, we evaluated the long-term effects of antiviral therapy on liver-related complications in patients with cirrhosis. Our results suggest that patients with compensated cirrhosis who were cured of their HCV infection have a lower rate of complications. In contrast, the rate of complications was not related to virological cure among those with decompensated cirrhosis. While these patients seem to remain in need of liver transplantation, antiviral therapy may lower their priority on the liver transplantation waiting list.
[Display omitted]
•SVR following DAA therapy was associated with lower risk of cirrhosis-related complications in patients with compensated but not decompensated cirrhosis.•A proportion of patients with decompensated cirrhosis showed a sustained MELD score decline following DAA-induced SVR.•A MELD score decline following DAAs did not translate into a beneficial clinical outcome among patients with decompensated cirrhosis.•HCV-infected patients with decompensated cirrhosis who are successfully treated with DAAs may be at risk of a persisting need of LT at a lower priority on the LT waiting list.</description><identifier>ISSN: 0168-8278</identifier><identifier>EISSN: 1600-0641</identifier><identifier>DOI: 10.1016/j.jhep.2020.11.021</identifier><identifier>PMID: 33242501</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Antiviral agents ; Antiviral Agents - therapeutic use ; Carcinoma, Hepatocellular - etiology ; Carcinoma, Hepatocellular - pathology ; Chronic infection ; Cirrhosis ; Clinical outcome ; Clinical outcomes ; DAAs ; Decompensated cirrhosis ; Delta MELD ; Disease Progression ; Female ; HCV ; Hepatitis C, Chronic - complications ; Hepatitis C, Chronic - diagnosis ; Hepatitis C, Chronic - drug therapy ; Hepatocellular carcinoma ; Humans ; Infections ; Kidney Failure, Chronic - diagnosis ; Kidney Failure, Chronic - etiology ; Kidney Failure, Chronic - surgery ; Kidney Failure, Chronic - virology ; Liver ; Liver cirrhosis ; Liver Cirrhosis - diagnosis ; Liver Cirrhosis - etiology ; Liver Cirrhosis - surgery ; Liver diseases ; Liver Failure - diagnosis ; Liver Failure - etiology ; Liver Neoplasms - etiology ; Liver Neoplasms - pathology ; Liver transplantation ; Liver Transplantation - methods ; Liver Transplantation - statistics & numerical data ; Long-term effects ; Male ; MELD score ; Middle Aged ; Patients ; Severity of Illness Index ; Survival ; Survival Analysis ; Sustained Virologic Response ; Time ; Treatment Outcome</subject><ispartof>Journal of hepatology, 2021-05, Vol.74 (5), p.1053-1063</ispartof><rights>2020 European Association for the Study of the Liver</rights><rights>Copyright © 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.</rights><rights>Copyright Elsevier Science Ltd. May 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-2079969ce848886af289d9b3478399375bea5b0796b113222b1e6b6b3588b8b13</citedby><cites>FETCH-LOGICAL-c428t-2079969ce848886af289d9b3478399375bea5b0796b113222b1e6b6b3588b8b13</cites><orcidid>0000-0002-9141-8001 ; 0000-0002-4485-8856 ; 0000-0002-6680-3792</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0168827820338058$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33242501$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Krassenburg, Lisette A.P.</creatorcontrib><creatorcontrib>Maan, Raoel</creatorcontrib><creatorcontrib>Ramji, Alnoor</creatorcontrib><creatorcontrib>Manns, Michael P.</creatorcontrib><creatorcontrib>Cornberg, Markus</creatorcontrib><creatorcontrib>Wedemeyer, Heiner</creatorcontrib><creatorcontrib>de Knegt, Robert J.</creatorcontrib><creatorcontrib>Hansen, Bettina E.</creatorcontrib><creatorcontrib>Janssen, Harry L.A.</creatorcontrib><creatorcontrib>de Man, Robert A.</creatorcontrib><creatorcontrib>Feld, Jordan J.</creatorcontrib><creatorcontrib>van der Meer, Adriaan J.</creatorcontrib><title>Clinical outcomes following DAA therapy in patients with HCV-related cirrhosis depend on disease severity</title><title>Journal of hepatology</title><addtitle>J Hepatol</addtitle><description>HCV-infected patients with cirrhosis achieve high sustained virological response (SVR) rates with direct-acting antivirals (DAAs) even after hepatic decompensation. We aimed to assess the clinical outcome following DAAs among patients with compensated and decompensated cirrhosis in relation to SVR and changes in model for end-stage liver disease (MELD) score.
Consecutive DAA-treated chronic HCV-infected patients with cirrhosis from 4 hepatology clinics were included. The primary endpoint in survival analyses was clinical disease progression, defined as liver failure, hepatocellular carcinoma, liver transplantation or death.
In total, 868 patients were included with a median age of 59 (IQR 54–65) years; 719 (83%) with Child-Pugh A cirrhosis and 149 (17%) with Child-Pugh B/C cirrhosis. SVR was attained by 647 (90%) Child-Pugh A patients and 120 (81%) Child-Pugh B/C patients. During a median follow-up of 28 (IQR 20–36) months, 102 (14%) Child-Pugh A patients and 96 (64%) Child-Pugh B/C patients experienced clinical disease progression. SVR was independently associated with an improved event-free survival in patients with Child-Pugh A cirrhosis (adjusted hazard ratio [HR] 0.47; 95% CI 0.27–0.82, p = 0.007), but not in patients with Child-Pugh B/C cirrhosis (adjusted HR 1.23; 95% CI 0.67–2.26; p = 0.51). Twelve weeks post-DAAs, 28 (19%) patients with Child-Pugh B/C cirrhosis had ≥2-point MELD decline, but their 2-year event-free survival did not differ from those with a stable MELD (47.9%; 95% CI 28.7–67.1 vs. 48.9%; 95% CI 38.1–59.7, respectively, p = 0.99).
Among patients with chronic HCV infection, DAA-induced SVR was associated with a reduced risk of clinical disease progression in patients with Child-Pugh A cirrhosis but not in patients with Child-Pugh B/C cirrhosis. In Child-Pugh B/C cirrhosis, a ≥2-point MELD decline did not translate into improved clinical outcome.
Chronic HCV infection can be cured with antiviral therapy. In this study, we evaluated the long-term effects of antiviral therapy on liver-related complications in patients with cirrhosis. Our results suggest that patients with compensated cirrhosis who were cured of their HCV infection have a lower rate of complications. In contrast, the rate of complications was not related to virological cure among those with decompensated cirrhosis. While these patients seem to remain in need of liver transplantation, antiviral therapy may lower their priority on the liver transplantation waiting list.
[Display omitted]
•SVR following DAA therapy was associated with lower risk of cirrhosis-related complications in patients with compensated but not decompensated cirrhosis.•A proportion of patients with decompensated cirrhosis showed a sustained MELD score decline following DAA-induced SVR.•A MELD score decline following DAAs did not translate into a beneficial clinical outcome among patients with decompensated cirrhosis.•HCV-infected patients with decompensated cirrhosis who are successfully treated with DAAs may be at risk of a persisting need of LT at a lower priority on the LT waiting list.</description><subject>Antiviral agents</subject><subject>Antiviral Agents - therapeutic use</subject><subject>Carcinoma, Hepatocellular - etiology</subject><subject>Carcinoma, Hepatocellular - pathology</subject><subject>Chronic infection</subject><subject>Cirrhosis</subject><subject>Clinical outcome</subject><subject>Clinical outcomes</subject><subject>DAAs</subject><subject>Decompensated cirrhosis</subject><subject>Delta MELD</subject><subject>Disease Progression</subject><subject>Female</subject><subject>HCV</subject><subject>Hepatitis C, Chronic - complications</subject><subject>Hepatitis C, Chronic - diagnosis</subject><subject>Hepatitis C, Chronic - drug therapy</subject><subject>Hepatocellular carcinoma</subject><subject>Humans</subject><subject>Infections</subject><subject>Kidney Failure, Chronic - diagnosis</subject><subject>Kidney Failure, Chronic - etiology</subject><subject>Kidney Failure, Chronic - surgery</subject><subject>Kidney Failure, Chronic - virology</subject><subject>Liver</subject><subject>Liver cirrhosis</subject><subject>Liver Cirrhosis - diagnosis</subject><subject>Liver Cirrhosis - etiology</subject><subject>Liver Cirrhosis - surgery</subject><subject>Liver diseases</subject><subject>Liver Failure - diagnosis</subject><subject>Liver Failure - etiology</subject><subject>Liver Neoplasms - etiology</subject><subject>Liver Neoplasms - pathology</subject><subject>Liver transplantation</subject><subject>Liver Transplantation - methods</subject><subject>Liver Transplantation - statistics & numerical data</subject><subject>Long-term effects</subject><subject>Male</subject><subject>MELD score</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Severity of Illness Index</subject><subject>Survival</subject><subject>Survival Analysis</subject><subject>Sustained Virologic Response</subject><subject>Time</subject><subject>Treatment Outcome</subject><issn>0168-8278</issn><issn>1600-0641</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9rGzEQxUVpaNy0X6CHIugll3X1b2UJcjFO2hQCvbS9Ckk7rrWsVxtJm-BvHxmnPeQQ5jAw_N5jeA-hT5QsKaHya7_sdzAtGWH1QJeE0TdoQSUhDZGCvkWLCqlGsZU6R-9z7gkhnGjxDp1zzgRrCV2gsBnCGLwdcJyLj3vIeBuHIT6G8S--Xq9x2UGy0wGHEU-2BBhLxo-h7PDt5k-TYLAFOuxDSruYQ8YdTDB2OI64CxlsBpzhAVIohw_obGuHDB-f9wX6_e3m1-a2ufv5_cdmfdd4wVRpGFlpLbUHJZRS0m6Z0p12XKwU15qvWge2dRWSjlLOGHMUpJOOt0o55Si_QJcn3ynF-xlyMfuQPQyDHSHO2TAhWyFonYp-eYH2cU5j_c6wtuWt1JToSrET5VPMOcHWTCnsbToYSsyxCNObYxHmWISh1NQiqujzs_Xs9tD9l_xLvgJXJwBqFg8Bksm-puuhCwl8MV0Mr_k_AWYDmDA</recordid><startdate>202105</startdate><enddate>202105</enddate><creator>Krassenburg, Lisette A.P.</creator><creator>Maan, Raoel</creator><creator>Ramji, Alnoor</creator><creator>Manns, Michael P.</creator><creator>Cornberg, Markus</creator><creator>Wedemeyer, Heiner</creator><creator>de Knegt, Robert J.</creator><creator>Hansen, Bettina E.</creator><creator>Janssen, Harry L.A.</creator><creator>de Man, Robert A.</creator><creator>Feld, Jordan J.</creator><creator>van der Meer, Adriaan J.</creator><general>Elsevier B.V</general><general>Elsevier Science Ltd</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9141-8001</orcidid><orcidid>https://orcid.org/0000-0002-4485-8856</orcidid><orcidid>https://orcid.org/0000-0002-6680-3792</orcidid></search><sort><creationdate>202105</creationdate><title>Clinical outcomes following DAA therapy in patients with HCV-related cirrhosis depend on disease severity</title><author>Krassenburg, Lisette A.P. ; Maan, Raoel ; Ramji, Alnoor ; Manns, Michael P. ; Cornberg, Markus ; Wedemeyer, Heiner ; de Knegt, Robert J. ; Hansen, Bettina E. ; Janssen, Harry L.A. ; de Man, Robert A. ; Feld, Jordan J. ; van der Meer, Adriaan J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-2079969ce848886af289d9b3478399375bea5b0796b113222b1e6b6b3588b8b13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Antiviral agents</topic><topic>Antiviral Agents - therapeutic use</topic><topic>Carcinoma, Hepatocellular - etiology</topic><topic>Carcinoma, Hepatocellular - pathology</topic><topic>Chronic infection</topic><topic>Cirrhosis</topic><topic>Clinical outcome</topic><topic>Clinical outcomes</topic><topic>DAAs</topic><topic>Decompensated cirrhosis</topic><topic>Delta MELD</topic><topic>Disease Progression</topic><topic>Female</topic><topic>HCV</topic><topic>Hepatitis C, Chronic - complications</topic><topic>Hepatitis C, Chronic - diagnosis</topic><topic>Hepatitis C, Chronic - drug therapy</topic><topic>Hepatocellular carcinoma</topic><topic>Humans</topic><topic>Infections</topic><topic>Kidney Failure, Chronic - diagnosis</topic><topic>Kidney Failure, Chronic - etiology</topic><topic>Kidney Failure, Chronic - surgery</topic><topic>Kidney Failure, Chronic - virology</topic><topic>Liver</topic><topic>Liver cirrhosis</topic><topic>Liver Cirrhosis - diagnosis</topic><topic>Liver Cirrhosis - etiology</topic><topic>Liver Cirrhosis - surgery</topic><topic>Liver diseases</topic><topic>Liver Failure - diagnosis</topic><topic>Liver Failure - etiology</topic><topic>Liver Neoplasms - etiology</topic><topic>Liver Neoplasms - pathology</topic><topic>Liver transplantation</topic><topic>Liver Transplantation - methods</topic><topic>Liver Transplantation - statistics & numerical data</topic><topic>Long-term effects</topic><topic>Male</topic><topic>MELD score</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Severity of Illness Index</topic><topic>Survival</topic><topic>Survival Analysis</topic><topic>Sustained Virologic Response</topic><topic>Time</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Krassenburg, Lisette A.P.</creatorcontrib><creatorcontrib>Maan, Raoel</creatorcontrib><creatorcontrib>Ramji, Alnoor</creatorcontrib><creatorcontrib>Manns, Michael P.</creatorcontrib><creatorcontrib>Cornberg, Markus</creatorcontrib><creatorcontrib>Wedemeyer, Heiner</creatorcontrib><creatorcontrib>de Knegt, Robert J.</creatorcontrib><creatorcontrib>Hansen, Bettina E.</creatorcontrib><creatorcontrib>Janssen, Harry L.A.</creatorcontrib><creatorcontrib>de Man, Robert A.</creatorcontrib><creatorcontrib>Feld, Jordan J.</creatorcontrib><creatorcontrib>van der Meer, Adriaan J.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of hepatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Krassenburg, Lisette A.P.</au><au>Maan, Raoel</au><au>Ramji, Alnoor</au><au>Manns, Michael P.</au><au>Cornberg, Markus</au><au>Wedemeyer, Heiner</au><au>de Knegt, Robert J.</au><au>Hansen, Bettina E.</au><au>Janssen, Harry L.A.</au><au>de Man, Robert A.</au><au>Feld, Jordan J.</au><au>van der Meer, Adriaan J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical outcomes following DAA therapy in patients with HCV-related cirrhosis depend on disease severity</atitle><jtitle>Journal of hepatology</jtitle><addtitle>J Hepatol</addtitle><date>2021-05</date><risdate>2021</risdate><volume>74</volume><issue>5</issue><spage>1053</spage><epage>1063</epage><pages>1053-1063</pages><issn>0168-8278</issn><eissn>1600-0641</eissn><abstract>HCV-infected patients with cirrhosis achieve high sustained virological response (SVR) rates with direct-acting antivirals (DAAs) even after hepatic decompensation. We aimed to assess the clinical outcome following DAAs among patients with compensated and decompensated cirrhosis in relation to SVR and changes in model for end-stage liver disease (MELD) score.
Consecutive DAA-treated chronic HCV-infected patients with cirrhosis from 4 hepatology clinics were included. The primary endpoint in survival analyses was clinical disease progression, defined as liver failure, hepatocellular carcinoma, liver transplantation or death.
In total, 868 patients were included with a median age of 59 (IQR 54–65) years; 719 (83%) with Child-Pugh A cirrhosis and 149 (17%) with Child-Pugh B/C cirrhosis. SVR was attained by 647 (90%) Child-Pugh A patients and 120 (81%) Child-Pugh B/C patients. During a median follow-up of 28 (IQR 20–36) months, 102 (14%) Child-Pugh A patients and 96 (64%) Child-Pugh B/C patients experienced clinical disease progression. SVR was independently associated with an improved event-free survival in patients with Child-Pugh A cirrhosis (adjusted hazard ratio [HR] 0.47; 95% CI 0.27–0.82, p = 0.007), but not in patients with Child-Pugh B/C cirrhosis (adjusted HR 1.23; 95% CI 0.67–2.26; p = 0.51). Twelve weeks post-DAAs, 28 (19%) patients with Child-Pugh B/C cirrhosis had ≥2-point MELD decline, but their 2-year event-free survival did not differ from those with a stable MELD (47.9%; 95% CI 28.7–67.1 vs. 48.9%; 95% CI 38.1–59.7, respectively, p = 0.99).
Among patients with chronic HCV infection, DAA-induced SVR was associated with a reduced risk of clinical disease progression in patients with Child-Pugh A cirrhosis but not in patients with Child-Pugh B/C cirrhosis. In Child-Pugh B/C cirrhosis, a ≥2-point MELD decline did not translate into improved clinical outcome.
Chronic HCV infection can be cured with antiviral therapy. In this study, we evaluated the long-term effects of antiviral therapy on liver-related complications in patients with cirrhosis. Our results suggest that patients with compensated cirrhosis who were cured of their HCV infection have a lower rate of complications. In contrast, the rate of complications was not related to virological cure among those with decompensated cirrhosis. While these patients seem to remain in need of liver transplantation, antiviral therapy may lower their priority on the liver transplantation waiting list.
[Display omitted]
•SVR following DAA therapy was associated with lower risk of cirrhosis-related complications in patients with compensated but not decompensated cirrhosis.•A proportion of patients with decompensated cirrhosis showed a sustained MELD score decline following DAA-induced SVR.•A MELD score decline following DAAs did not translate into a beneficial clinical outcome among patients with decompensated cirrhosis.•HCV-infected patients with decompensated cirrhosis who are successfully treated with DAAs may be at risk of a persisting need of LT at a lower priority on the LT waiting list.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>33242501</pmid><doi>10.1016/j.jhep.2020.11.021</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-9141-8001</orcidid><orcidid>https://orcid.org/0000-0002-4485-8856</orcidid><orcidid>https://orcid.org/0000-0002-6680-3792</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Journal of hepatology, 2021-05, Vol.74 (5), p.1053-1063 |
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| recordid | cdi_proquest_miscellaneous_2465441414 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Antiviral agents Antiviral Agents - therapeutic use Carcinoma, Hepatocellular - etiology Carcinoma, Hepatocellular - pathology Chronic infection Cirrhosis Clinical outcome Clinical outcomes DAAs Decompensated cirrhosis Delta MELD Disease Progression Female HCV Hepatitis C, Chronic - complications Hepatitis C, Chronic - diagnosis Hepatitis C, Chronic - drug therapy Hepatocellular carcinoma Humans Infections Kidney Failure, Chronic - diagnosis Kidney Failure, Chronic - etiology Kidney Failure, Chronic - surgery Kidney Failure, Chronic - virology Liver Liver cirrhosis Liver Cirrhosis - diagnosis Liver Cirrhosis - etiology Liver Cirrhosis - surgery Liver diseases Liver Failure - diagnosis Liver Failure - etiology Liver Neoplasms - etiology Liver Neoplasms - pathology Liver transplantation Liver Transplantation - methods Liver Transplantation - statistics & numerical data Long-term effects Male MELD score Middle Aged Patients Severity of Illness Index Survival Survival Analysis Sustained Virologic Response Time Treatment Outcome |
| title | Clinical outcomes following DAA therapy in patients with HCV-related cirrhosis depend on disease severity |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-21T20%3A35%3A41IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Clinical%20outcomes%20following%20DAA%20therapy%20in%20patients%20with%20HCV-related%20cirrhosis%20depend%20on%20disease%20severity&rft.jtitle=Journal%20of%20hepatology&rft.au=Krassenburg,%20Lisette%20A.P.&rft.date=2021-05&rft.volume=74&rft.issue=5&rft.spage=1053&rft.epage=1063&rft.pages=1053-1063&rft.issn=0168-8278&rft.eissn=1600-0641&rft_id=info:doi/10.1016/j.jhep.2020.11.021&rft_dat=%3Cproquest_cross%3E2553569109%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2553569109&rft_id=info:pmid/33242501&rft_els_id=S0168827820338058&rfr_iscdi=true |