Effectiveness of direct‐acting agents for hepatitis C and liver stiffness changing after sustained virological response

Abstract

Background and AimFew studies have evaluated sustained virological response (SVR) rates by direct‐acting agents (DAAs) and liver stiffness measurement (LSM) changing post‐SVR in limited‐resource settings. We aimed to describe the effectiveness of DAAs for hepatitis C virus treatment and to assess the changing of LSM post‐SVR.MethodsThis retrospective study analyzed data of consecutive hepatitis C virus‐infected patients treated by DAAs from 2015 to 2017 in two tertiary centers in Brazil. SVR rates were reported by intention‐to‐treat and per‐protocol analyses. LSM by transient elastography performed before treatment and post‐SVR was compared, and logistic regression models were performed.ResultsSix hundred seventy‐one patients (63% female, 62 years [55–68], 89% genotype 1, 8% HIV co‐infected, and 64% with cirrhosis) were included. Most patients were treated by sofosbuvir/daclatasvir ± ribavirin (74%) and sofosbuvir/simeprevir ± ribavirin (21%). SVR rates (95% confidence interval [CI]) were 94.6% (92.7–96.1) and 97.8% (96.4–98.7) for intention‐to‐treat and per‐protocol analyses, respectively. The leading adverse event was anemia (9.6% [95% CI 7.6–12.1]). Pretreatment and post‐SVR12 LSM were available in 400 patients. LSM had significantly decreased after SVR (13.6 kPa [interquartile range, 10.0–21.6] vs 10.2 kPa [7.0–17.6], P < 0.001). A total of 167 patients (42%) decreased at least 30% of LSM post‐SVR. The absence of type 2 diabetes (odds ratio = 1.52 [95% CI 1.05–2.21], P = 0.028) and presence of platelet count ≥ 150 × 109/mm3 (odds ratio = 1.75 [1.23–2.50], P = 0.002) were independently associated with a significant LSM regression (≥ 30%) post‐SVR.ConclusionDAAs were highly effective and safe, and LSM significantly decreased after SVR in a real‐life cohort in Brazil. The absence of type 2 diabetes and presence of high platelet count were independently associated with LSM decrease post‐SVR.

Improvement of liver disease and inflammation in patients with advanced HCV-related cirrhosis after antiviral therapy

“…In our study overall, HCV clearance after DAA therapy promoted a signi cant improvement in severity scores of liver cirrhosis and many plasma biomarkers linked to in ammation (bacterial translocation, in ammatory response, and endothelial dysfunction) and coagulopathy. Our data are in concordance with a large number of previous studies that found a signi cant decrease in liver disease scores of HIV/HCV-coinfected patients [6,7,32,[43][44][45] and HCV-monoinfected patients [6][7][8][9][10][11][12][13][14] after HCV eradiation with DAA therapy; and also in plasma biomarkers of HIV/HCV-coinfected patients [18,[30][31][32][33][34] and HCV-monoinfected patients [15][16][17][18][19][20]. However, there is an important lack of consistency in these previous publications regarding the plasma biomarkers and liver severity scores evaluated, time-points used to take data or samples after the end of HCV treatment, statistical analysis used, and liver brosis stages included.…”

“…Additionally, signi cant decreases in liver disease scores [liver stiffness measurement (LSM), hepatic venous pressure gradient (HVPG) or Child-Pugh-Turcotte (CTP)] [6][7][8][9][10][11][12][13][14] and plasma biomarkers related to in ammation and immune activation [15][16][17][18][19][20] have been described in HCV-monoinfected patients after SVR with all-oral DAAs.…”

Effectiveness of implementing a decentralized delivery of hepatitis C virus treatment with direct-acting antivirals: A systematic review with meta-analysis

“…The evidence on the effectiveness and safety of DAAs was showed in real-world studies conducted at different settings and subsequent meta-analyses [1,[29][30][31][32][33][34][35][36]. However, to our knowledge, this is the first systematic review and meta-analysis that evaluates the effectiveness of the delivery of HCV treatment with DAAs by non-specialized health personnel at primary care.…”

Diabetes impacts liver stiffness in chronic hepatitis C patients with and without virological cure: a longitudinal study

“…Diabetes has clearly been described as risk factor for brosis progression in nonalcoholic liver disease patients but its impact on chronic hepatitis C patients has not been prospectively evaluated [15]. Fernandes et al have found a similar impact of diabetes in CHC patients but on a retrospective study that included only SVR patients, without the possibility to compare SVR patients with NR or naïve patients [9]. The prognostic impact of DM observed in our study has great relevance in clinical practice since it might further be the basis to recommend that in daily clinic patients with DM should be kept under care despite virological cure.…”

“…So far, most published studies have focused speci cally in the follow-up of SVR patients group [6,8,9,18,20],describing the straight relationship of SVR and improvement of liver brosis with several non-invasive methods like TE and acoustic radiation force impulse. Currently, HCV treatment is effective in most of treated patients, however, assess to treatment is still an issue in many countries, mainly those underdeveloped countries.…”