6533b7dcfe1ef96bd1272105
RESEARCH PRODUCT
High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma
Elisabetta DegasperiBarbara CocoFabio ContiMassimo ZuinAndrea GiorginiM. RendinaSimona BollaniV. BoccaccioA. Di LeoPatrick MaisonneuveAndrea AglittiErica VillaMarcello PersicoPietro LamperticoGiulia TroshinaL. MarziAlessio AghemoV. Di MarcoPietro AndreoneA. CiancioAna LleoSavino BrunoMaurizia Rossana BrunettoVincenza Calvarusosubject
Liver CirrhosisMaleSimeprevirPyrrolidinesSustained Virologic ResponseSofosbuvirHepacivirusAged; Antiviral Agents; Benzimidazoles; Carcinoma Hepatocellular; Cohort Studies; Drug Therapy Combination; Female; Fluorenes; Genotype; Hepacivirus; Hepatic Encephalopathy; Hepatitis C Chronic; Humans; Imidazoles; Interferons; Italy; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged; Prospective Studies; Ribavirin; Simeprevir; Sofosbuvir; Sustained Virologic Response; Uridine Monophosphatemedicine.disease_causeGastroenterologyCohort Studieschemistry.chemical_compound0302 clinical medicineSimeprevirPharmacology (medical)Prospective Studies030212 general & internal medicineChronicLiver NeoplasmsImidazolesGastroenterologyValineHepatitis CMiddle AgedHepatitis CItalyHepatocellular carcinomaCombinationHCVDrug Therapy CombinationFemale030211 gastroenterology & hepatologyUridine Monophosphatemedicine.drugLedipasvirmedicine.medical_specialtyCarcinoma HepatocellularDaclatasvirGenotypeHepatitis C virusAntiviral Agents03 medical and health sciencesDrug TherapyInternal medicineRibavirinmedicineHumansAgedFluorenesHepatologybusiness.industryCarcinomaHepatocellularHepatitis C Chronicmedicine.diseasedigestive system diseasesRegimenchemistryHepatic EncephalopathyBenzimidazolesCarbamatesInterferonsSofosbuvirbusinessdescription
Background: The efficacy of direct-acting anti-viral (DAA) therapy in patients with a history of hepatocellular carcinoma (HCC) is unknown. Aim: We prospectively evaluated whether previously treated HCC affects DAA efficacy in a large real-life cohort of cirrhotic patients. Methods: From January to December 2015 all consecutive HCV mono-infected patients with cirrhosis and/or history of HCC attending 10 Italian tertiary liver centres were enrolled. Baseline characteristics and response to therapy were recorded. 1927 patients were enrolled (mean age: 62.1 10.9 years; 1.205 males). Genotype 1 was the most frequent (67.9%) followed by genotypes 3 (12.4%), 2 (11.2%) and 4 (8.6%). 88.4% and 10.9% of cases were classified Child A and B, respectively, and 14 (<1%) cases were classified Child C. Ascites and hepatic encephalopathy occurred in 10.7% and 3.2% of patients, respectively. Varices were detected in 39.3% of patients. Suboptimal and optimal treatment was prescribed: 15.9% of patients received sofosbuvir/simeprevir, 33.4% sofosbuvir/ledipasvir, 20.2% a Viekirax + Exviera regimen, 15.7% sofosbuvir/ribavirin, 9.9% sofosbuvir/daclatasvir and 3.4% Viekirax; 1.3% of patients received an interferon-based regimen. Results: The sustained virologic response (SVR) rate at intention-to-treat analysis was 95.1%. It differed significantly across Child classes, that is, 96.3%, 86.1% and 71.4% Child A, B and C, respectively (P < 0.0001) and across genotypes (P = 0.002). The SVR rate did not differ between patients with (95.0%) and those without previous HCC (95.1%). At multivariable analysis, SVR was significantly associated with HCV genotype, Child class. Conclusion: This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2018-01-01 | Alimentary Pharmacology & Therapeutics |