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Treatment with direct-acting antivirals improves the clinical outcome in patients with HCV-related decompensated cirrhosis: results from an Italian real-life cohort (Liver Network Activity—LINA cohort)

  • Ivan Gentile
  • Riccardo Scotto
  • Carmine Coppola
  • Laura Staiano
  • Daniela Caterina Amoruso
  • Teresa De Simone
  • Federica Portunato
  • Stefania De Pascalis
  • Salvatore Martini
  • Margherita Macera
  • Giulio Viceconte
  • Grazia Tosone
  • Antonio Riccardo Buonomo
  • Guglielmo Borgia
  • Nicola Coppola
Original Article
  • 17 Downloads

Abstract

Background

Direct-acting antivirals (DAAs) are safe and effective for the treatment of HCV infection. However, data regarding their efficacy in patients with Child–Pugh B cirrhosis are scarce and their capability in improving liver function is debated. The aim of our study was to assess the clinical benefits of treatment with DAA in subjects with Child–Pugh B cirrhosis.

Methods

We conducted a prospective multicentre study among patients with Child–Pugh B cirrhosis of an Italian real-life HCV cohort (LINA cohort) who received treatment with DAAs.

Results

Among 89 patients enrolled, the rate of sustained virologic response 12 was 95.5%. No discontinuation occurred, no patient died during treatment. Most patients had Genotype 1 (1b 61.8%, 1a 11.2%). Conversely, 22.5%, 1.1% and 3.4% of patients had Genotype 2, 3 and 4, respectively. At last observation, 61.8% of patients switched to a Class A cirrhosis, 33.7% remained in Class B and 4.5 worsened to Child C (p < 0.001). Liver parameters significantly improved from baseline to 12 weeks after the end of treatment. Previous anti-HCV treatments and the presence of decompensated cirrhosis at 1 month of treatment were significantly associated with a decompensated cirrhosis at the last observation.

Conclusions

Treatment with DAA in patients with Child–Pugh B cirrhosis is safe and leads to a very high rate of viral clearance, a significant rate of re-compensation and an improvement in liver function. Further studies are needed to assess the impact of treatment on survival and quality of life in long-term follow-up.

Keywords

Direct-acting antivirals Hepatitis C virus Decompensated cirrhosis 

Notes

Funding

Not applicable.

Compliance with ethical standards

Conflict of interest

Ivan Gentile was consultant for Abbvie, Merck Sharp & Dohme and Cardiome. He received a grant (in the framework of Fellowship program) from Gilead Sciences. Guglielmo Borgia was consultant for Abbvie. He received grants from Abbvie, Merck Sharp & Dohme, Pfizer. Nicola Coppola received grants from ViiV Healthcare, Janssen-Cilag, and Gilead Sciences; personal fees from Gilead Sciences, Abbvie, Bristol-Myers Squibb and Merck Sharp & Dohme. Riccardo Scotto, Carmine Coppola, Laura Staiano, Daniela Caterina Amoruso, Teresa De Simone, Federica Portunato, Stefania De Pascalis, Salvatore Martini, Margherita Macera, Giulio Viceconte, Grazia Tosone and Antonio Riccardo Buonomo have no conflict of interest to declare.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

Informed consent was obtained from all patients for being included in the study.

Supplementary material

12072_2018_9914_MOESM1_ESM.pdf (54 kb)
Longitudinal changes in laboratory parameters through the different follow-up visits (PDF 54 kb)

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Copyright information

© Asian Pacific Association for the Study of the Liver 2018

Authors and Affiliations

  • Ivan Gentile
    • 1
  • Riccardo Scotto
    • 1
  • Carmine Coppola
    • 2
  • Laura Staiano
    • 2
  • Daniela Caterina Amoruso
    • 2
  • Teresa De Simone
    • 2
  • Federica Portunato
    • 3
  • Stefania De Pascalis
    • 3
  • Salvatore Martini
    • 3
  • Margherita Macera
    • 3
  • Giulio Viceconte
    • 1
  • Grazia Tosone
    • 1
  • Antonio Riccardo Buonomo
    • 1
  • Guglielmo Borgia
    • 1
  • Nicola Coppola
    • 3
  1. 1.Section of Infectious Diseases, Department of Clinical Medicine and SurgeryUniversity of Naples Federico IINaplesItaly
  2. 2.Unit of Hepatology and Interventional Ultrasonography, Department of Internal MedicineOORR Area Stabiese, Plesso Nuovo GragnanoNaplesItaly
  3. 3.Infectious Diseases Unit, Department of Mental Health and Public MedicineUniversity of Campania Luigi VanvitelliCasertaItaly

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