Long-term outcome of chronic hepatitis C virus infection in a real-world setting: The German LOTOS study

Autor:	Kurt Gruengreiff, H Pfeiffer-Vornkahl, Dietrich Hueppe, Petra Sandow, Joerg Goelz, Heiner Wedemeyer, Thomas A. Lutz, Jens Reimer, Stefan Christensen, Ulrich Alshuth, Michael P. Manns
Rok vydání:	2017
Předmět:	Adult Male 0301 basic medicine medicine.medical_specialty Carcinoma Hepatocellular Time Factors Cirrhosis Databases Factual Sustained Virologic Response Antiviral Agents Polyethylene Glycols 03 medical and health sciences 0302 clinical medicine Recurrence Risk Factors Germany Internal medicine Ascites Product Surveillance Postmarketing medicine Clinical endpoint Humans Decompensation Prospective Studies Prospective cohort study Aged Hepatology business.industry Liver Neoplasms Interferon-alpha Hepatitis C Hepatitis C Chronic Middle Aged medicine.disease Recombinant Proteins Liver Transplantation Surgery Treatment Outcome 030104 developmental biology Hepatocellular carcinoma Cohort Female 030211 gastroenterology & hepatology medicine.symptom business Liver Failure
Zdroj:	Liver International. 37:1468-1475
ISSN:	1478-3223
DOI:	10.1111/liv.13399
Popis:	Background & Aims There are few large-scale, prospective studies comparing liver-associated events in treated and untreated patients with CHC managed in routine clinical practice. Methods Patients with CHC were prospectively enrolled in a non-interventional study. Data from patients with available documentation who had either achieved a sustained virological response, or were non-responders, relapsers, or had virological breakthrough following treatment with peginterferon alfa-2a±ribavirin, or who had been diagnosed but never treated at least 3 years previously, and who remained under medical observation were analyzed. Primary endpoint was liver-associated events (composite of decompensation/liver failure, ascites, hepatocellular carcinoma, or liver transplant/placement on a transplant list). Results In all, 1444 eligible patients were identified. Mean follow-up was 4.7 (standard deviation; SD 1.1) years. Patients with sustained virological response had a lower incidence of liver-associated events vs non-responders, relapsers, or virological breakthrough and never treated patients (1.7% vs 4.7% and 4.7% respectively). The proportion of patients with cirrhosis increased from baseline in the non-responders, relapsers, or virological breakthrough (6.8%-10.5%) and never treated group (3.7%-8.4%), with an associated increase in severity, but was unchanged in the sustained virological response group (2.1%). Event-free survival was significantly higher in sustained virological response patients (P=.0082). Conclusions In this “real-world” cohort, the achievement of sustained virological response almost eliminated liver-related morbidity and mortality compared with patients who failed to achieve sustained virological response and those who were untreated. Overall, the LOTOS cohort highlights the importance of timely and effective treatment for patients with CHC.
Databáze:	OpenAIRE
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