title: All-oral direct-acting antiviral therapy in HCV-advanced liver disease is effective in real-world practice: observations through HCV-TARGET database.
abstract: Chronic hepatitis C virus therapy in patients with advanced liver disease remains a clinical challenge. HCV-TARGET collects data in patients treated at tertiary academic and community centres.
  
  
  
  To assess efficacy of all-oral HCV therapy in advanced liver disease.
  
  
  
  Between December 2013 and October 2014, 240 patients with a MELD score of ≥10 initiated HCV treatment with an all-oral regimen. Data from the 220 patients who completed 12-week follow-up were analysed.
  
  
  
  Genotype 1 (GT1) patients had higher sustained virological response (SVR) when treated with sofosbuvir plus simeprevir ± ribavirin than with sofosbuvir plus ribavirin (66-74% vs. 54%); GT1b vs GT1a (84% vs. 64%). SVR for GT2 was 72% with sofosbuvir plus ribavirin, while GT3 patients had a substantially lower response (35%). A decrease in MELD score was not clearly related to SVR over the short course of follow-up although some had improvements in MELD score, serum bilirubin and albumin. A predictor of virological response was albumin level while negative predictors were elevated bilirubin level and GT1a. Most patients with GT1 were treated with approximately 12-week duration of sofosbuvir and simeprevir ± ribavirin therapy while GT2 and GT3 patients were treated with approximately 12 and 24 weeks of sofosbuvir plus ribavirin respectively.
  
  
  
  All-oral therapies are effective among patients with advanced liver disease with high levels of success in GT2 and GT1b, and may serve to reduce the severity of liver disease after SVR. Treatment for GT3 patients remains an unmet need. Clinical trial number: NCT01474811.
authors: Philadelphia, PA, USA.
authors: K R
authors: KR
authors: Reddy
authors: New Haven, CT, USA.
authors: J K
authors: JK
authors: Lim
authors: San Diego, CA, USA.
authors: A
authors: A
authors: Kuo
authors: Saint Louis, MO, USA.
authors: A M
authors: AM
authors: Di Bisceglie
authors: Houston, TX, USA.
authors: J S
authors: JS
authors: Galati
authors: Gainesville, FL, USA.
authors: G
authors: G
authors: Morelli
authors: Aurora, CO, USA.
authors: G T
authors: GT
authors: Everson
authors: Indianapolis, IN, USA.
authors: P Y
authors: PY
authors: Kwo
authors: New York, NY, USA.
authors: R S
authors: RS
authors: Brown
authors: Baltimore, MD, USA.
authors: M S
authors: MS
authors: Sulkowski
authors: Chapel Hill, NC, USA.
authors: L
authors: L
authors: Akuschevich
authors: Ann Arbor, MI, USA.
authors: A S
authors: AS
authors: Lok
authors: La Jolla, CA, USA.
authors: P J
authors: PJ
authors: Pockros
authors: Chapel Hill, NC, USA.
authors: M
authors: M
authors: Vainorius
authors: San Francisco, CA, USA.
authors: N A
authors: NA
authors: Terrault
authors: Gainesville, FL, USA.
authors: D R
authors: DR
authors: Nelson
authors: Chapel Hill, NC, USA.
authors: M W
authors: MW
authors: Fried
authors: Hannover, Germany.
authors: M P
authors: MP
authors: Manns
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage*; D016208:Databases, Factual; D004359:Drug Therapy, Combination; D005260:Female; D016174:Hepacivirus / Q000187:drug effects; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D038622:Internationality; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012254:Ribavirin / Q000008:administration & dosage; D000069616:Simeprevir / Q000008:administration & dosage; D000069474:Sofosbuvir / Q000008:administration & dosage
chemical_list: D000998:Antiviral Agents; D012254:Ribavirin; D000069616:Simeprevir; D000069474:Sofosbuvir