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Interferon-free therapies improve liver function in HCV patients

Antiviral therapy without interferon improved liver function in patients with hepatitis C virus infection-related advanced cirrhosis, according to data from an observational cohort study.

Researchers analyzed data of 80 patients with HCV-associated liver cirrhosis undergoing treatment with a combination of direct-acting antivirals without interferon. Of these patients, 43% had Child-Pugh B/C cirrhosis (n = 34), and 53% had platelet counts of less than 90,000/μL (n = 42). The combination regimens included Sovaldi (sofosbuvir, Gilead Sciences) with ribavirin (n = 56), Olysio (sofosbuvir/simeprevir, Janssen Therapeutics) with or without ribavirin (n = 15) and sofosbuvir and Daklinza (daclatasvir, Bristol-Myers Squibb) with or without ribavirin (n = 9). Most patients had HCV genotype 1 (n = 50), followed by 24 with genotype 3, four with HCV genotype 2 and two patients with genotype 4.

Overall, all patients became HCV RNA negative during therapy, and 63% achieved a sustained virologic response. MELD scores improved up until 12 weeks posttreatment in 44% of the patients, but worsened in 15%. Albumin, bilirubin, cholinesterase and prothrombin time improved among all patients during therapy.

Twenty-three of the patients experienced HCV RNA relapse after completion of antiviral treatment. Ninety-one percent of patients who relapsed showed signs of detectable HCV RNA at 4 weeks posttreatment. HCV RNA relapse led to moderate ALT increases in 15 patients, but this was not associated with hepatic decompensations, according to the data.

None of the patients had a Child-Pugh C score 12 weeks after completing antiviral treatment.

“The present study supports an extended usage of novel interferon-free therapies in patients with advanced HCV-associated liver cirrhosis,” the researchers concluded. “It is likely that hepatic function may at least partially be restored in the majority of patients if HCV RNA replication is blocked — potentially reducing the need for liver transplantations. However, further follow-up is needed, and patients should be screened in particular for the development of [hepatocellular carcinoma].” – by Melinda Stevens

Disclosure: Deterding reports receiving speaker fees from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen-Cilaq and MSD/Merck; and receiving travel grants from Gilead Sciences and MSD/Merck. Please see the full study for a list of all other authors’ relevant financial disclosures.