Predictors of functional benefit of hepatitis C therapy in a 'real-life' cohort

• Published in: World journal of gastroenterology : WJG Vol. 24; no. 7; pp. 852 - 861
• Main Authors: Steinebrunner, Niels, Stein, Kerstin, Sandig, Catharina, Bruckner, Thomas, Stremmel, Wolfgang, Pathil, Anita
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21.02.2018
• Subjects: Adult; Aged; Aged, 80 and over; Antiviral Agents - therapeutic use; Drug Therapy, Combination - methods; End Stage Liver Disease - blood; End Stage Liver Disease - drug therapy; End Stage Liver Disease - virology; Female; Follow-Up Studies; Germany; Hepacivirus - drug effects; Hepatitis C, Chronic - blood; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - virology; Humans; Liver Cirrhosis - blood; Liver Cirrhosis - drug therapy; Liver Cirrhosis - virology; Liver Function Tests; Longitudinal Studies; Male; Middle Aged; Patient Selection; Platelet Count; Retrospective Studies; Retrospective Study; Severity of Illness Index; Sustained Virologic Response; Cirrhosis; Functional benefit; Hepatitis C; Direct acting antiviral; Real-life data
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v24.i7.852

To define predictors of functional benefit of direct-acting antivirals (DAAs) in patients with chronic hepatitis C virus (HCV) infection and liver cirrhosis. We analysed a cohort of 199 patients with chronic HCV genotype 1, 2, 3 and 4 infection involving previously treated and untreated patients with compensated (76%) and decompensated (24%) liver cirrhosis at two tertiary centres in Germany. Patients were included with treatment initiation between February 2014 and August 2016. All patients received a combination regimen of one or more DAAs for either 12 or 24 wk. Predictors of functional benefit were assessed in a univariable as well as multivariable model by binary logistic regression analysis. Viral clearance was achieved in 88% (175/199) of patients. Sustained virological response (SVR) 12 rates were as follows: among 156 patients with genotype 1 infection the SVR 12 rate was 90% ( = 141); among 7 patients with genotype 2 infection the SVR 12 rate was 57% ( = 4); among 30 patients with genotype 3 infection the SVR 12 rate was 87% ( = 26); and among 6 patients with genotype 4 infection the SVR 12 rate was 67% ( = 4). Follow-up MELD scores were available for 179 patients. A MELD score improvement was observed in 37% (65/179) of patients, no change of MELD score in 41% (74/179) of patients, and an aggravation was observed in 22% (40/179) of patients. We analysed predictors of functional benefit from antiviral therapy in our patients beyond viral eradication. We identified the Child-Pugh score, the MELD score, the number of platelets and the levels of albumin and bilirubin as significant factors for functional benefit. Our data may contribute to the discussion of potential risks and benefits of antiviral therapy with individual patients infected with HCV and with advanced liver disease.