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DAA therapy and long-term hepatic function in advanced/decompensated cirrhosis: Real-world experience from HCV-TARGET cohort.
DAA therapy and long-term hepatic function in advanced/decompensated cirrhosis: Real-world experience from HCV-TARGET cohort. Journal of hepatology Verna, E. C., Morelli, G. n., Terrault, N. A., Lok, A. S., Lim, J. K., Di Bisceglie, A. M., Zeuzem, S. n., Landis, C. S., Kwo, P. n., Hassan, M. n., Manns, M. P., Vainorius, M. n., Akushevich, L. n., Nelson, D. R., Fried M, M. W., Reddy, K. R. 2020Abstract
Direct-acting antiviral (DAA) HCV therapy is used in decompensated cirrhosis with the expectation of improvement in hepatic function. Little is known about the long-term benefit of successful treatment.Patients with advanced/decompensated cirrhosis (MELD =10) in HCV-TARGET who initiated NS5A-containing DAA therapy prior to September, 2018, were included. Treatment outcomes and the impact of treatment on short-term and long-term hepatic function were examined.642 patients were analyzed. The mean age was 60 years, 68% were male. The median baseline MELD was 12 (range 10-39) and 64% had prior decompensation. Among patients with available virologic outcomes, 90.5% achieved SVR12. Twenty-four % achieved a clinically significant decrease in MELD by =3 points during short term follow-up (9-26 weeks after the end of treatment). However, in long-term follow up (median of 4 years after treatment), mean changes in MELD (-0.30 points), total bilirubin (+0.23 mg/dl) and albumin (+0.36 g/dl) were marginal. Fifty-one patients died and 22 underwent liver transplant. In long term follow up, a clinically meaningful decrease in MELD of =3 occurred in 29% and a final MELD score of <10 was achieved in 25%.In a large real-world experience of patients with advanced/decompensated HCV cirrhosis treated with DAA, there were only marginal improvements in MELD, total bilirubin, or albumin in long-term follow up (median of 4 years after treatment) after achieving SVR; a clinically meaningful decrease in MELD of =3 occurred in 29% and a final MELD score of <10 was achieved in 25%. These patients may remain at high risk of decompensation and must continue to be closely followed.
View details for DOI 10.1016/j.jhep.2020.03.031
View details for PubMedID 32243960