Eiichi Ogawa1, Akira Kawano2, Aritsune Ooho3, Norihiro Furusyo4, Takeaki Satoh5, Kazuhiro Takahashi6, Eiji Kajiwara7, Kazufumi Dohmen8, Makoto Nakamuta9, Koichi Azuma10, Toshimasa Koyanagi11, Nobuyuki Yamashita12, Kimihiko Yanagita13, Yasunori Ichiki14, Masami Kuniyoshi15, Naoki Yamashita9, Chie Morita16, Rie Sugimoto17, Masaki Kato18,19, Shinji Shimoda20, Hideyuki Nomura21, Jun Hayashi22. 1. Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan. 2. Department of Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan. 3. Department of Hepatology, Steel Memorial Yawata Hospital, Kitakyushu, Japan. 4. General Internal Medicine, Taihaku Avenue Clinic, Fukuoka, Japan. 5. Center for Liver Disease, Kokura Medical Center, National Hospital Organization, Kitakyushu, Japan. 6. Department of Medicine, Hamanomachi Hospital, Fukuoka, Japan. 7. Kajiwara Clinic, Kitakyushu, Japan. 8. Department of Internal Medicine, Chihaya Hospital, Fukuoka, Japan. 9. Department of Gastroenterology, Kyushu Medical Center, National Hospital Organization, Fukuoka, Japan. 10. Department of Medicine, Kyushu Central Hospital, Fukuoka, Japan. 11. Department of Medicine, Fukuoka City Hospital, Fukuoka, Japan. 12. The Center for Liver Disease, Shin-Kokura Hospital, Kitakyushu, Japan. 13. Department of Internal Medicine, Saiseikai Karatsu Hospital, Karatsu, Japan. 14. Department of Internal Medicine, JCHO Kyushu Hospital, Kitakyushu, Japan. 15. Department of Gastroenterology, Kyushu Rosai Hospital, Kitakyushu, Japan. 16. Department of Internal Medicine, Kyushu Railway Memorial Hospital, Kitakyushu, Japan. 17. Department of Gastroenterology, Kyushu Cancer Center, Fukuoka, Japan. 18. Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 19. Graduate School of Nutritional Sciences, Nakamura Gakuen University, Fukuoka, Japan. 20. Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 21. Department of Internal Medicine, Haradoi Hospital, Fukuoka, Japan. 22. Kyushu General Internal Medicine Center, Haradoi Hospital, Fukuoka, Japan.
Abstract
BACKGROUND AND AIM: Direct-acting antivirals (DAAs) have contributed to the improvement of outcomes for all patients with chronic hepatitis C. The aim of this study was to evaluate the long-term hepatic benefits of hepatitis C virus (HCV) cure by DAAs in patients with compensated cirrhosis. METHODS: This multicenter cohort study consisted of consecutive patients with compensated cirrhosis who initiated interferon-free DAA treatment before September 2016. The impact of treatment on long-term hepatic function was followed for at least 4 years after the end of treatment, and the progression to decompensation was evaluated. RESULTS: The data of 394 patients were available for study. The median age was 70, and 41% had modified albumin-bilirubin (ALBI) grade 2b. During a short-term follow-up 1 year after the end of treatment, FIB-4 index and ALBI score significantly improved. The achievement rates of FIB-4 < 3.25 (40%) and ALBI grade 1 (70%) reached their plateau in the first year; however, there were significant further improvements in platelet count and α-fetoprotein level after the first year. The annual incidence of decompensation was 1.30 (95% confidence interval 0.83-2.02) per 100 person-years. In multivariable analysis, male sex and modified ALBI grade 2b at baseline were associated with decompensation. CONCLUSIONS: In a large real-world cohort of patients with compensated cirrhosis treated with a DAA, remarkable improvement in hepatic function was seen after HCV cure, especially during the first year after the end of treatment. Treatment in the early stage of cirrhosis would be of great benefit for preventing liver deterioration to decompensation.
BACKGROUND AND AIM: Direct-acting antivirals (DAAs) have contributed to the improvement of outcomes for all patients with chronic hepatitis C. The aim of this study was to evaluate the long-term hepatic benefits of hepatitis C virus (HCV) cure by DAAs in patients with compensated cirrhosis. METHODS: This multicenter cohort study consisted of consecutive patients with compensated cirrhosis who initiated interferon-free DAA treatment before September 2016. The impact of treatment on long-term hepatic function was followed for at least 4 years after the end of treatment, and the progression to decompensation was evaluated. RESULTS: The data of 394 patients were available for study. The median age was 70, and 41% had modified albumin-bilirubin (ALBI) grade 2b. During a short-term follow-up 1 year after the end of treatment, FIB-4 index and ALBI score significantly improved. The achievement rates of FIB-4 < 3.25 (40%) and ALBI grade 1 (70%) reached their plateau in the first year; however, there were significant further improvements in platelet count and α-fetoprotein level after the first year. The annual incidence of decompensation was 1.30 (95% confidence interval 0.83-2.02) per 100 person-years. In multivariable analysis, male sex and modified ALBI grade 2b at baseline were associated with decompensation. CONCLUSIONS: In a large real-world cohort of patients with compensated cirrhosis treated with a DAA, remarkable improvement in hepatic function was seen after HCV cure, especially during the first year after the end of treatment. Treatment in the early stage of cirrhosis would be of great benefit for preventing liver deterioration to decompensation.