BACKGROUND: Portal hypertension is the strongest predictor of virological response to pegylated interferon (IFN)/ribavirin in patients with chronic hepatitis C (CHC)-related cirrhosis. AIM: To investigate the effects of portal pressure assessed by hepatic venous pressure gradient (HVPG) measurement on virological responses in patients treated with IFN-free regimens outside of clinical trials. METHODS: Fifty-six patients with CHC and cirrhosis who underwent HVPG measurement before starting an IFN-free therapy were retrospectively studied. Patients were treated with sofosbuvir in combination with daclatasvir (n = 32), ribavirin (n = 12) or simeprevir (n = 11), or the combination of simeprevir/daclatasvir (n = 1), for 12-24 weeks. RESULTS: Hepatic venous pressure gradient values ≥10 mmHg and ≥16 mmHg were observed in 41 (73%) and 31 (55%) patients respectively. The distributions of treatment regimens and durations were comparable between patients with or without portal hypertension. Patients with portal hypertension had lower platelet counts and albumin levels, while bilirubin levels, INR, MELD and Child-Pugh scores were higher than in patients without portal hypertension. Importantly, rates of on-treatment virological response and viral kinetics, as well as the rates of sustained virological response 12 weeks after the end of therapy [96% (54/56)] were not affected by portal hypertension. Anti-viral therapy improved liver stiffness, platelet count, serum albumin and bilirubin levels, as well as prothrombin time. CONCLUSIONS: This is the first study to demonstrate that IFN-free regimens overcome the negative effect of portal hypertension on virological responses and viral kinetics. Improvements in liver stiffness and platelet count might reflect an anti-portal hypertensive effect of IFN-free treatments.
BACKGROUND: Portal hypertension is the strongest predictor of virological response to pegylated interferon (IFN)/ribavirin in patients with chronic hepatitis C (CHC)-related cirrhosis. AIM: To investigate the effects of portal pressure assessed by hepatic venous pressure gradient (HVPG) measurement on virological responses in patients treated with IFN-free regimens outside of clinical trials. METHODS: Fifty-six patients with CHC and cirrhosis who underwent HVPG measurement before starting an IFN-free therapy were retrospectively studied. Patients were treated with sofosbuvir in combination with daclatasvir (n = 32), ribavirin (n = 12) or simeprevir (n = 11), or the combination of simeprevir/daclatasvir (n = 1), for 12-24 weeks. RESULTS: Hepatic venous pressure gradient values ≥10 mmHg and ≥16 mmHg were observed in 41 (73%) and 31 (55%) patients respectively. The distributions of treatment regimens and durations were comparable between patients with or without portal hypertension. Patients with portal hypertension had lower platelet counts and albumin levels, while bilirubin levels, INR, MELD and Child-Pugh scores were higher than in patients without portal hypertension. Importantly, rates of on-treatment virological response and viral kinetics, as well as the rates of sustained virological response 12 weeks after the end of therapy [96% (54/56)] were not affected by portal hypertension. Anti-viral therapy improved liver stiffness, platelet count, serum albumin and bilirubin levels, as well as prothrombin time. CONCLUSIONS: This is the first study to demonstrate that IFN-free regimens overcome the negative effect of portal hypertension on virological responses and viral kinetics. Improvements in liver stiffness and platelet count might reflect an anti-portal hypertensive effect of IFN-free treatments.
Authors: Mattias Mandorfer; Philipp Schwabl; Sebastian Steiner; Thomas Reiberger; Markus Peck-Radosavljevic Journal: Hepatol Int Date: 2016-01-12 Impact factor: 6.047
Authors: K Neukam; L E Morano-Amado; A Rivero-Juárez; J Macías; R Granados; A Romero-Palacios; M Márquez; D Merino; E Ortega; J C Alados-Arboledas; J Cucurull; M Omar; P Ryan-Murua; J A Pineda Journal: Eur J Clin Microbiol Infect Dis Date: 2016-12-21 Impact factor: 3.267
Authors: David Chromy; Mattias Mandorfer; Theresa Bucsics; Philipp Schwabl; Bernhard Scheiner; Caroline Schmidbauer; Maximilian Christopher Aichelburg; Peter Ferenci; Michael Trauner; Markus Peck-Radosavljevic; Thomas Reiberger Journal: United European Gastroenterol J Date: 2019-03-06 Impact factor: 4.623
Authors: Lukas Haider; Mattias Mandorfer; Zeynep Güngören; Thomas Reiberger; Nina Bastati; Jacqueline C Hodge; David Chromy; Michael Trauner; Christian Herold; Markus Peck-Radosavljevic; Ahmed Ba-Ssalamah Journal: Contrast Media Mol Imaging Date: 2018-07-12 Impact factor: 3.161
Authors: Lucian Beer; Mattias Mandorfer; Nina Bastati; Sarah Poetter-Lang; Dietmar Tamandl; Dilyana Plamenova Stoyanova; Michael Christoph Elmer; Georg Semmler; Benedikt Simbrunner; Jacqueline C Hodge; Claude B Sirlin; Thomas Reiberger; Ahmed Ba-Ssalamah Journal: Eur Radiol Date: 2019-04-18 Impact factor: 5.315