HCV: DAAs yield ~60% switch in CTP-B to CTP-A cirrhosis

  • Gentile I & al.
  • Hepatol Int
  • 6 Dec 2018

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • HCV treatment with direct-acting antivirals (DAAs) yields a 95.5% clearance rate, accompanied by recompensation in 61.8% of patients with Child-Turcotte-Pugh (CTP)-B cirrhosis.

Why this matters

  • At 1 month of treatment, only 45.5% had switched from CTP-B to CTP-A, suggesting a growing effect over time. 

Study design

  • Subcohort of 89 patients with CTP-B cirrhosis receiving DAA therapy in the real-world prospective multicenter Italian LINA cohort; 41.6% were treatment-experienced.
  • HCV genotypes: 1b (61.8%), 2 (22.5%), 1a (11.2%), 4 (3.4%), and 3 (1.1%).
  • A 24-week course of ledipasvir/sofosbuvir (Harvoni) was most common (38.2%). 
  • Funding: None.   

Key results

  • 95.5% rate of sustained virologic response at 12 weeks posttreatment (SVR12).
    • There were no discontinuations.
  • At 12 weeks posttherapy, 50.6%, 48.3%, and 1.1% were downgraded to CTP-A, remained at CTP-B, or worsened to CTP-C, respectively.
  • At last observation (median, 11 months; interquartile range, 6-21 months):
    • 61.8% were downgraded to CTP-A.
    • 33.7% remained CTP-B.
    • 4.5% worsened to CTP-C.
  • In multivariate analysis, decompensated cirrhosis at 1 month of treatment (OR, 67.28; P<.001 and prior antiviral therapy p predicted decompensated cirrhosis at last observation after adjusting for genotype viral load.>

Limitations

  • Small sample size.

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