Amr Shaaban Hanafy1,2, Mohamed A Bassiony3, Mohammad Abd Alkhalik Basha4. 1. Internal Medicine Department, Hepatology Division, Zagazig University, Sharkia, Zagazig, 44519, Egypt. Dr_amr_hanafy@yahoo.com. 2. , 40 Mostafa Fouad st, Zagazig, Egypt. Dr_amr_hanafy@yahoo.com. 3. Internal Medicine Department, Hepatology Division, Zagazig University, Sharkia, Zagazig, 44519, Egypt. 4. Diagnostic Radiology, Zagazig University, Zagazig, Egypt.
Abstract
BACKGROUND: Medical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a clinical challenge even in the era of direct-acting antiviral drugs (DAAs). We evaluated the efficacy and safety of DAAs in the management of HCV genotype 4-related decompensated cirrhosis. METHODS: The study included a treatment group (n = 160) composed of HCV patients with decompensated cirrhosis who received DAAs for 3 months and a matched control group (n = 80) who preferred not to receive DAAs, follow-up was for 24-31 months. RESULTS: In treatment group; there were improvements in platelet count, albumin, CTP (p = 0.001) and MELD scores (p = 0.03), a significant reduction in the frequency of hepatic encephalopathy (HE). SVR was achieved in 90%. Hepatocellular carcinoma (HCC) developed in 10% (n = 18) within 6.8 ± 2.5 months after DAAs, survival was higher in the treated vs. the control group (28.9 ± 0.95 vs. 11.4 ± 2.2 months, p = 0.001). Liver volume by ultrasound at a cutoff 495 ml was predictive of complications after DAAs therapy mainly HCC and reduced survival with sensitivity 93.2%, specificity 72%. CONCLUSION: HCV with decompensated cirrhosis and adequate liver volume had a 90% SVR with improved CTP&MELD and survival. CLINICAL TRIAL: (NCT03547895).
BACKGROUND: Medical treatment of decompensated cirrhosis due to hepatitis C virus (HCV) remains a clinical challenge even in the era of direct-acting antiviral drugs (DAAs). We evaluated the efficacy and safety of DAAs in the management of HCV genotype 4-related decompensated cirrhosis. METHODS: The study included a treatment group (n = 160) composed of HCVpatients with decompensated cirrhosis who received DAAs for 3 months and a matched control group (n = 80) who preferred not to receive DAAs, follow-up was for 24-31 months. RESULTS: In treatment group; there were improvements in platelet count, albumin, CTP (p = 0.001) and MELD scores (p = 0.03), a significant reduction in the frequency of hepatic encephalopathy (HE). SVR was achieved in 90%. Hepatocellular carcinoma (HCC) developed in 10% (n = 18) within 6.8 ± 2.5 months after DAAs, survival was higher in the treated vs. the control group (28.9 ± 0.95 vs. 11.4 ± 2.2 months, p = 0.001). Liver volume by ultrasound at a cutoff 495 ml was predictive of complications after DAAs therapy mainly HCC and reduced survival with sensitivity 93.2%, specificity 72%. CONCLUSION:HCV with decompensated cirrhosis and adequate liver volume had a 90% SVR with improved CTP&MELD and survival. CLINICAL TRIAL: (NCT03547895).
Authors: Cristina Maria Muzica; Carol Stanciu; Laura Huiban; Ana-Maria Singeap; Catalin Sfarti; Sebastian Zenovia; Camelia Cojocariu; Anca Trifan Journal: World J Gastroenterol Date: 2020-11-21 Impact factor: 5.742