title: Impact of direct acting antiviral therapy in patients with chronic hepatitis C and decompensated cirrhosis.
abstract: All oral direct acting antivirals (DAAs) effectively treat chronic hepatitis C virus (HCV) infection, but the benefits in advanced liver disease are unclear. We compared outcomes in treated and untreated patients with decompensated cirrhosis.
  
  
  
  Patients with HCV and decompensated cirrhosis or at risk of irreversible disease were treated in an expanded access programme (EAP) in 2014. Treatment, by clinician choice, was with sofosbuvir, ledipasvir or daclatasvir, with or without ribavirin. For functional outcome comparison, untreated patients with HCV and decompensated cirrhosis who were registered on a database 6months before treatment was available were retrospectively studied. Primary endpoint was sustained virological response 12weeks post antiviral treatment (treated cohort) and the secondary endpoint (both cohorts) was adverse outcomes (worsening in MELD score or serious adverse event) within 6months.
  
  
  
  467 patients received treatment (409 decompensated cirrhosis). Viral clearance was achieved in 381 patients (81.6%) - 209 from 231 (90.5%) with genotype 1 and 132 from 192 (68.8%) with genotype 3. MELD scores improved in treated patients (mean change -0.85) but worsened in untreated patients (mean+0.75) (p<0.0001). Patients with initial serum albumin <35g/L, aged >65 or with low (<135mmol/L) baseline serum sodium concentrations were least likely to benefit from therapy.
  
  
  
  All oral DAAs effectively cured HCV in patients with advanced liver disease. Viral clearance was associated with improvement in liver function within 6months compared to untreated patients. The longer term impact of HCV treatment in patients with decompensated cirrhosis remains to be determined.
authors.affiliation: Queen Mary University of London, London, United Kingdom. Electronic address: g.r.foster@qmul.ac.uk.
authors.forename: Graham R
authors.initials: GR
authors.lastname: Foster
authors.affiliation: NIHR Nottingham Digestive Diseases Biomedical Research Unit, United Kingdom. Electronic address: Will.irving@nottingham.ac.uk.
authors.forename: William L
authors.initials: WL
authors.lastname: Irving
authors.affiliation: Liver Unit, Blizard Institute, Queen Mary University of London, United Kingdom.
authors.forename: Michelle C M
authors.initials: MC
authors.lastname: Cheung
authors.affiliation: Faculty of Medicine & Health Sciences, University of Nottingham, United Kingdom.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Walker
authors.affiliation: University Hospitals Bristol NHS Trust, United Kingdom.
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Hudson
authors.affiliation: Institute of Liver Studies, King's College London, United Kingdom.
authors.forename: Suman
authors.initials: S
authors.lastname: Verma
authors.affiliation: MRC-University of Glasgow Centre for Virus Research, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: McLauchlan
authors.affiliation: Centre for Liver Research and NIHR Biomedical Research Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors.forename: David J
authors.initials: DJ
authors.lastname: Mutimer
authors.affiliation: Department of Hepatology, St Mary's Hospital, Imperial College London, United Kingdom.
authors.forename: Ashley
authors.initials: A
authors.lastname: Brown
authors.affiliation: Department of Hepatology, Cambridge University Hospitals NHS Foundation Trust, United Kingdom.
authors.forename: William T H
authors.initials: WT
authors.lastname: Gelson
authors.affiliation: UCL Institute for Liver and Digestive Health, University College London, United Kingdom.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: MacDonald
authors.affiliation: Institute of Liver Studies, King's College London, United Kingdom.
authors.forename: Kosh
authors.initials: K
authors.lastname: Agarwal
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008103:Liver Cirrhosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D000069474:Sofosbuvir / Q000627:therapeutic use; D000072230:Sustained Virologic Response
chemical_list: D000998:Antiviral Agents; D000069474:Sofosbuvir
keywords: Daclatasvir; Decompensated cirrhosis; Hepatitis C virus; Ledipasvir; MELD score; Sofosbuvir