title: Evaluation of advanced fibrosis measured by transient elastography after hepatitis C virus protease inhibitor-based triple therapy.
abstract: OBJECTIVE
  Few studies have investigated the course of liver stiffness after treatment with protease inhibitors. We evaluated the impact of this therapy on liver fibrosis measured by transient elastography.
  
  
  METHODS
  This multicenter observational, cohort, prospective study included 90 patients with hepatitis C genotype 1 treated with telaprevir or boceprevir who had advanced fibrosis evidenced by liver stiffness (≥9.5 kPa). Liver stiffness was measured at baseline and 24 weeks after treatment ended, and was compared with virological responses at week 12.
  
  
  RESULTS
  Liver stiffness decreased in 89% of patients who achieved sustained virological response. The median intrapatient liver stiffness value at the end of follow-up decreased by 5.1 kPa (35%) from baseline compared with 0.1 kPa (0.5%) in those who did not achieve a sustained virological response (P<0.001). The liver stiffness level fell below 9.5 kPa in 58% of patients with sustained virological response, and 71% of those with sustained virological response and cirrhosis evidenced by liver stiffness at baseline achieved regression below 12.5 kPa by the end of follow-up. Sustained virological response was the only variable associated with improved liver stiffness in multivariate analysis (odds ratio: 17.3; 95% confidence interval: 4.4-67.6; P<0.001).
  
  
  CONCLUSIONS
  In patients with advanced fibrosis measured by transient elastography at the beginning of protease inhibitor-based therapy with sustained virological response, liver stiffness was significantly reduced 24 weeks after treatment. This suggests the possibility of liver cirrhosis evidenced by liver stiffness regression after sustained virological response in a significant proportion of patients.
authors.affiliation: aDepartment of Gastroenterology and Hepatology bBurgos Foundation for Health Research, Hospital Universitario de Burgos, Burgos cDepartment of Gastroenterology and Hepatology, Complejo Asistencial Universitario León, León dDepartment of Hepatology, Hospital Universitario Rio Hortega eDepartment of Gastroenterology and Hepatology, Hospital Clínico Universitario de Valladolid, Valladolid fDepartment of Gastroenterology and Hepatology, Complejo Asistencial Palencia, Palencia gDepartment of Gastroenterology and Hepatology, Hospital El Bierzo, Ponferrada, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Sáez-Royuela
authors.forename: Pedro
authors.initials: P
authors.lastname: Linares
authors.forename: Luis A
authors.initials: LA
authors.lastname: Cervera
authors.forename: Carolina
authors.initials: C
authors.lastname: Almohalla
authors.forename: Francisco
authors.initials: F
authors.lastname: Jorquera
authors.forename: Sara
authors.initials: S
authors.lastname: Lorenzo
authors.forename: Isidro
authors.initials: I
authors.lastname: García
authors.forename: Guillermo
authors.initials: G
authors.lastname: Karpman
authors.forename: Ester
authors.initials: E
authors.lastname: Badia
authors.forename: María A
authors.initials: MA
authors.lastname: Vallecillo
authors.forename: Adriana
authors.initials: A
authors.lastname: Moncada
authors.forename: Sara
authors.initials: S
authors.lastname: Calvo
authors.forename: José L
authors.initials: JL
authors.lastname: Olcoz
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D054459:Elasticity Imaging Techniques; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use*; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D011480:Protease Inhibitors