The Course of Esophageal Varices in Patients with Hepatitis C Cirrhosis Responding to Interferon/ Ribavirin Therapy

D’Ambrosio, Roberta; Aghemo, Alessio; Rumi, Maria Grazia; Primignani, Massimo; Dell’Era, Alessandra; Lampertico, Pietro; Donato, Maria Francesca; Nicola, S. De; Prati, G.M.; Franchis, Roberto de; Colombo, Massimo

doi:10.3851/imp1807

Cited by 49 publications

(19 citation statements)

References 32 publications

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“…A lower incidence of de novo esophageal varices was also reported in cirrhotic patients who achieved SVR, although the progression of variceal size was not statistically different in patients with and without SVR[21], supporting the concept of the point of no return. Another prospective study by Di Marco et al[22] also showed that SVR was associated with a lower incidence of de novo esophageal varices in cirrhotic patients treated with PEG-INF and ribavirin (HR = 0.23, 95%CI: 0.11-0.48), although it was not associated with a decrease in variceal progression or liver decompensation in those with pre-existing varices[22].…”

Section: Impact Of Svr In Portal Hypertension Before Daasmentioning

confidence: 86%

Impact of hepatitis C oral therapy in portal hypertension

Libânio

Marinho

2017

WJG

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Chronic hepatitis C is a leading cause of morbidity and mortality, mainly related to fibrosis/cirrhosis and portal hypertension. Direct antiviral agents are highly effective and safe and can now cure > 90% of the patients. Sustained viral response (SVR) after interferon-based regimens has been associated with improvement in liver function, fibrosis and portal hypertension in a significant proportion of patients, although a point of no return seems to exist from which viral elimination is no longer capable of preventing portal hypertension progression and liver decompensation. Indeed, although SVR is associated with improvement of hepatic venous pressure gradients and therefore a decreased risk of de novo esophageal varices, several studies show that viral clearance does not eliminate the risk of variceal progression, liver decompensation and death in patients with pre-established portal hypertension. Although evidence about the effects of direct antiviral agents (DAAs) on clinically significant outcomes is still scarce and with short follow-up, DAAs can decrease the burden of the disease if patients are timely treated before significant fibrosis and portal hypertension develops. Studies with longer follow-up are waited to establish the real magnitude of hepatitis C treatment on portal hypertension. Future studies should also focus on predictors of portal hypertension resolution since it can influence management and avoid unnecessary monitoring

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Section: Impact Of Svr In Portal Hypertension Before Daasmentioning

confidence: 86%

Impact of hepatitis C oral therapy in portal hypertension

Libânio

Marinho

2017

WJG

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“…Two Italian studies [18][26] have prospectively investigated the role of a SVR on the course of portal hypertension, by using repeated esophagogastroduodenoscopies in patients who achieved a virological response, after treatment completion. Bruno et al [18] followed 218 patients for up to 18 years, and found a SVR was able to prevent the development of esophageal varices (EV) (0% for SVR vs. 39.1% for non-SVR, P < 0.0001).…”

Section: The Impact Of a Svr On The Natural History Of Hcv-relatedmentioning

confidence: 99%

“…Bruno et al [18] followed 218 patients for up to 18 years, and found a SVR was able to prevent the development of esophageal varices (EV) (0% for SVR vs. 39.1% for non-SVR, P < 0.0001). On the other hand, another Italian study [26], in which 127 patients were followed for up to 108 months after the end of IFN-based regimens, showed EV development both in SVR and non-SVR patients, although the incidence of de novo EV were reduced among patients with a SVR (2/57 vs. 8/53, 3.5% vs. 15.1%, P = 0.047). Interestingly, despite the small number of patients with pre-treatment EV at the EGDS baseline, a progression in the EV size was demonstrated, independently of the treatment outcome (SVR 1/5 vs. non-SVR 2/12, P = 0.87).…”

Section: The Impact Of a Svr On The Natural History Of Hcv-relatedmentioning

confidence: 99%

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Treatment of Patients With HCV Related Cirrhosis: Many Rewards With Very Few Risks

D’Ambrosio

Aghemo

2012

Hepat Mon

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Antiviral treatment of chronic hepatitis C virus (HCV) is aimed at the persistent eradication of the virus, the so-called sustained virological response (SVR), with the aim ultimately being to prevent the development of liver-related complications and improve patients’ survival. Patients with HCV-related compensated cirrhosis are the group most likely to benefit from viral clearance, as several retrospective studies have shown liver complications rates to be positively modified by the achievement of a SVR. Whether these benefits rely on viral clearance or on the histological improvements seen following successful interferon (IFn)-based therapies has recently been a matter for debate, as studies have shown cirrhosis to regress in some patients with a SVR. Whatever the mechanisms, cirrhosis has the uncanny ability to be both a dominant indication for therapy, as well as one of the strongest baseline factors associated with reduced efficacy of any IFn-based regimen. This has led to the development of alternative treatment strategies, such as low dose pegylated IFn (PegIFn) monotherapy, that unfortunately has proven to be of limited efficacy. For this reason regimens able to clear the virus without relying on the broad antiviral effect of IFN are eagerly awaited.

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“…In the USA, more than 1.3% of the population is chronically infected by HCV, generating a cost of $5.5 billion annually 1. Successful antiviral treatment (sustained virological response [SVR]) following interferon-based regimens is the only approach to halting fibrosis progression and the inherent risk of end-stage liver disease 2–10…”

Section: Introductionmentioning

confidence: 99%

Treatment of experienced and naïve patients with hepatitis C: focus on telaprevir

D’Ambrosio¹,

Aghemo²,

Colombo³

2012

BTT

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Telaprevir (TVR) is an orally available protease inhibitor of the hepatitis C virus that in association with pegylated interferon and ribavirin (PR) was shown to improve the rates of sustained virological response and potentially reduce treatment duration in adult patients with chronic hepatitis C genotype. Despite its robust activity in both treatment-naïve and experienced patients, the addition of TVR to PR is counterbalanced by increased costs and adverse events; moreover, there are still areas of uncertainty that regard treatment of patients with advanced liver disease, the role of patient stratification by genetic predictors, and the use/need for a lead-in phase with PR. Since TVR regimens have been associated with the risk of viral mutants that may cause treatment failure and jeopardize future therapeutic strategies with direct-acting antiviral agents, early stopping rules have been designed to protect patients with a poor virological response to TVR regimens against such a risk.

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The Course of Esophageal Varices in Patients with Hepatitis C Cirrhosis Responding to Interferon/ Ribavirin Therapy

Abstract: A successful IFN therapy prevents or delays the de novo onset of EV in patients with compensated cirrhosis due to HCV, but does not abrogate the need for continued endoscopic surveillance.

Cited by 49 publications

References 32 publications

Impact of hepatitis C oral therapy in portal hypertension

Impact of hepatitis C oral therapy in portal hypertension

Treatment of Patients With HCV Related Cirrhosis: Many Rewards With Very Few Risks

Treatment of experienced and naïve patients with hepatitis C: focus on telaprevir

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The Course of Esophageal Varices in Patients with Hepatitis C Cirrhosis Responding to Interferon/ Ribavirin Therapy

Abstract: A successful IFN therapy prevents or delays the de novo onset of EV in patients with compensated cirrhosis due to HCV, but does not abrogate the need for continued endoscopic surveillance.

Cited by 49 publications

References 32 publications

Impact of hepatitis C oral therapy in portal hypertension

Impact of hepatitis C oral therapy in portal hypertension

Treatment of Patients With HCV Related Cirrhosis: Many Rewards With Very Few Risks

Treatment of experienced and na&iuml;ve patients with hepatitis C: focus on telaprevir

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Product

Resources

About

Treatment of experienced and naïve patients with hepatitis C: focus on telaprevir