Treatment of hepatitis C virus infection in patients with cirrhosis and predictive value of model for end‐stage liver disease: Analysis of data from the Hepa‐C registry

Autor: Juan Manuel Pascasio, Maria Buti, José Ignacio Herrero, Inmaculada Fernández, Lluis Castells, Javier Crespo, Jose Luis Calleja, Carme Baliellas, José Javier Moreno-Palomares, Juan Arenas, Juan Turnes, Manuel L. Romero, Michel Ble, Elba Llop, Zoe Mariño, José A. Carrión, Sabela Lens, Magdalena Salcedo, Conrado M. Fernández-Rodríguez, Clara Pons, José María Moreno-Planas, Martín Prieto, Miguel Fernández Bermejo, Javier Salmerón, Ester Badia, Rafael Granados, Carlos Fernández Carrillo, Manuel de la Mata, Javier García-Samaniego, Agustín Albillos
Rok vydání: 2017
Předmět:
Liver Cirrhosis
Male
Cirrhosis
Hepacivirus
Kaplan-Meier Estimate
medicine.disease_cause
Severity of Illness Index
Gastroenterology
Cohort Studies
Liver disease
0302 clinical medicine
Model for End-Stage Liver Disease
Liver Function Tests
Cause of Death
Registries
030212 general & internal medicine
Aged
80 and over
medicine.diagnostic_test
Hepatitis C
Middle Aged
Prognosis
Treatment Outcome
Disease Progression
Female
030211 gastroenterology & hepatology
Adult
medicine.medical_specialty
Hepatitis C virus
Antiviral Agents
Risk Assessment
End Stage Liver Disease
03 medical and health sciences
Predictive Value of Tests
Internal medicine
Ribavirin
medicine
Humans
Decompensation
Aged
Proportional Hazards Models
Retrospective Studies
Hepatology
business.industry
Hepatitis C
Chronic
medicine.disease
Survival Analysis
Surgery
Logistic Models
Spain
Multivariate Analysis
Sofosbuvir
Liver function tests
business
Zdroj: HEPATOLOGY
r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe
instname
ISSN: 1527-3350
0270-9139
Popis: Direct-acting antiviral agents (DAAs) are highly effective and well tolerated in patients with chronic hepatitis C virus infection, including those with compensated cirrhosis. However, fewer data are available in patients with more advanced liver disease. Our retrospective, noninterventional, national, multicenter study in patients from the Spanish Hepa-C registry investigated the effectiveness and safety of interferon-free DAA regimens in patients with advanced liver disease, including those with decompensated cirrhosis, in routine practice (all currently approved regimens were registered). Patients transplanted during treatment or within 12 weeks of completing treatment were excluded. Among 843 patients with cirrhosis (Child-Turcotte-Pugh [CTP] class A, n = 564; CTP class B/C, n = 175), 90% achieved sustained virologic response 12 weeks after treatment (SVR12). Significant differences in SVR12 and relapse rates were observed between CTP class A and CTP class B/C patients (94% versus 78%, and 4% versus 14%, respectively; both P < 0.001). Serious adverse events (SAEs) were more common in CTP class B/C versus CTP class A patients (50% versus 12%, respectively; P < 0.001). Incident decompensation was the most common serious adverse event (7% overall). Death rate during the study period was 16/843 (2%), significantly higher among CTP class B/C versus CTP class A patients (6.4% versus 0.9%; P < 0.001). Baseline Model for End-Stage Liver Disease (MELD) score alone (cut-off 18) was the best predictor of survival. Conclusion: Patients with decompensated cirrhosis receiving DAAs present lower response rates and experience more SAEs. In this setting, a MELD score ≥18 may help clinicians to identify those patients with a higher risk of complications and to individualize treatment decisions. (Hepatology 2017;65:1810-1822).
Databáze: OpenAIRE
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