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Lower SVR rates, more death with DAA therapy in high MELD setting
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BARCELONA — Physicians need to counsel patients with hepatitis C virus and MELD score higher than 18 prior to treatment with direct-acting antivirals, according to a presenter at the International Liver Congress.
“Treating patients with MELD 18 or greater may be an issue due to their high mortality during or within 12 weeks after treatment,” Carlos Fernández-Carillo, junior consultant at Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, said during his presentation. “Honest discussion with the patient and decisions on a case-by-case basis is warranted.”
Fernández-Carillo presented a retrospective, observational, non-randomized study derived from the HEPA-C registry. The study included 843 patients either not on a transplantation list or on the list while treated with DAA therapy; 673 of these patients finished 12 weeks of therapy by the time of presentation.
Breaking the patients down by Child Pugh status, he showed that 94% of Child Pugh A patients achieved SVR whereas 78% of Child Pugh B/C patients did the same (P < .001). Similarly, less Child Pugh A patients relapsed compared with Child Pugh B/C (4% vs. 13%, respectively; P = .001). When looking at safety, more patients in the Child Pugh B/C category suffered severe adverse events (11.7% CPT A vs. 50% CPT B/C; P < .001). Deaths reflected a similar outcome with 0.9% of Child Pugh A patients dying and 11% of Child Pugh B/C patients (P < .001). Cirrhosis status, MELD and platelets were predictive of deaths.
“Decompensated patients have a worse virological response, more severe adverse events and more deaths than compensated ones,” Fernández-Carillo said. “This information may also be applicable to patients on the transplant waiting list.” – by Katrina Altersitz
Reference:
Fernández-Carillo, C. GS01. Presented at: International Liver Congress. April 13-17, 2016; Barcelona.
Disclosure: Fernández-Carillo reports no relevant financial disclosures. Please see the abstract for a full list of other researchers’ disclosures.