title: Liver stiffness predicts the response to direct-acting antiviral-based therapy against chronic hepatitis C in cirrhotic patients.
abstract: The purpose of this investigation was to evaluate the impact of liver stiffness (LS) on the response to direct-acting antiviral (DAA)-based therapy against hepatitis C virus (HCV) infection in cirrhotic patients. Those patients included in two Spanish prospective cohorts of patients receiving therapy based on at least one DAA, who showed a baseline LS ≥ 12.5 kPa and who had reached the scheduled time point for sustained virological response evaluation 12 weeks after completing therapy (SVR12) were analysed. Pegylated interferon/ribavirin-based therapy plus an HCV NS3/4A protease inhibitor (PR-PI group) was administered to 198 subjects, while 146 received interferon-free regimens (IFN-free group). The numbers of patients with SVR12 according to an LS < 21 kPa versus ≥21 kPa were 59/99 (59.6%) versus 46/99 (46.5%) in the PR-PI group (p = 0.064) and 41/43 (95.3%) versus 90/103 (87.4%) in the IFN-free group (p = 0.232). Corresponding figures for the relapse rates in those who presented end-of-treatment response (ETR) were 3/62 (4.8%) versus 10/56 (17.9%, p = 0.024) and 1/42 (2.4%) versus 8/98 (8.2%, p = 0.278), respectively. In a multivariate analysis adjusted for age, sex and use of interferon, a baseline LS ≥ 21 kPa was identified as an independent predictor of relapse [adjusted odds ratio, AOR (95% confidence interval, CI): 4.228 (1.344-13.306); p = 0.014] in those patients with ETR. LS above 21 kPa is associated with higher rates of relapse to DAA-based therapy in HCV-infected patients with cirrhosis in clinical practice. LS could help us to tailor the duration and composition of DAA-based combinations in cirrhotic subjects, in order to minimise the likelihood of relapse.
authors.affiliation: Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain. karin.neukam@gmail.com.
authors.forename: K
authors.initials: K
authors.lastname: Neukam
authors.affiliation: Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain.
authors.forename: L E
authors.initials: LE
authors.lastname: Morano-Amado
authors.affiliation: Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Maimónides Institute of Biomedical Investigation of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Rivero-Juárez
authors.affiliation: Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Macías
authors.affiliation: Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Granados
authors.affiliation: Unit of Infectious Diseases, Hospital Universitario Puerto Real, Puerto Real, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Romero-Palacios
authors.affiliation: Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Malaga, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Márquez
authors.affiliation: Unit of Infectious Diseases, Complejo Hospitalario Universitario de Huelva, Huelva, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Merino
authors.affiliation: Unit of Infectious Diseases, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Ortega
authors.affiliation: Unit of Infectious Diseases and Microbiology, AGS Norte de Cádiz, Jerez de la Frontera, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Alados-Arboledas
authors.affiliation: Service of Internal Medicine, Hospital de Figueres-Fundació Salut Empordà, Figueres, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Cucurull
authors.affiliation: Unit of Infectious Diseases, Complejo Hospitalario de Jaén, Jaen, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Omar
authors.affiliation: Internal Medicine Service, Hospital Universitario Infanta Leonor, Madrid, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Ryan-Murua
authors.affiliation: Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Pineda
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003661:Decision Support Techniques; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000627:therapeutic use*; D012008:Recurrence; D013030:Spain; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D011480:Protease Inhibitors