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Long-Term Follow-Up of Advanced Liver Disease after Sustained Virological Response to Treatment of Hepatitis C with Direct-Acting Antivirals: Outcomes from a Real-World Portuguese Cohort

2020Journal article Open access
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dc.contributor.authorPereira Guedes, Tiago
dc.contributor.authorFragoso, Pedro
dc.contributor.authorLemos, Carolina
dc.contributor.authorGarrido, Mónica
dc.contributor.authorSilva, Joana
dc.contributor.authorFalcão, Daniela
dc.contributor.authorMaia, Luís
dc.contributor.authorMoreira, Teresa
dc.contributor.authorManuel Ferreira, José
dc.contributor.authorPedroto, Isabel
dc.date.accessioned2021-12-07T14:41:12Z
dc.date.available2021-12-07T14:41:12Z
dc.date.issued2020
dc.description.abstractBackground: Direct-acting antivirals (DAA) have revolutionized hepatitis C treatment, with high sustained virological response (SVR) rates reported, even in historically difficult-to-treat groups. SVR is associated with a decreased risk of hepatocellular carcinoma (HCC), need for transplantation, and overall and liver-related mortality. Data from real-life cohorts on the medium- to long-term outcomes of patients with advanced liver disease and DAA-induced SVR are still missing. Objectives: To report and analyze the long-term outcomes of DAA-induced SVR in a real-life cohort of patients with advanced liver disease. Method: In this retrospective, longitudinal, single-center study, we collected data from patients with chronic hepatitis C infection and advanced liver disease (cirrhosis or advanced fibrosis) that had initiated DAA treatment between February 2015 and January 2017. Results: A total of 237 patients were included. A treatment completion rate of 98.7% and an SVR rate of 97.8% (intention to treat: 96.6%) were found. Of the 229 patients with SVR, 67.2% were cirrhotic (64.2% Child-Pugh class A; 3.1% Child-Pugh class B) and 32.8% had stage F3 fibrosis, with an average follow-up of 28 months. The overall mortality rate was 19/1,000 person-years and the liver-related mortality rate was 9.5/1,000 person-years. The hepatic decompensation incidence rate was 25/1,000 person-years and the HCC incidence rate was 11.6/1,000 person-years. There was a sustained increase in serum platelet values during up to 2 years of follow-up. A history of pretreatment decompensation and baseline platelet and albumin values were significantly associated with the occurrence of adverse liver events after the end of treatment. Conclusions: A DAA-induced SVR remains durable and is associated with an excellent clinical prognosis in patients with compensated advanced liver disease and with improvement or disease stabilization in decompensated patients. SVR is associated with a low risk of - yet does not prevent - HCC occurrence or disease progression, especially in the presence of other causes of liver injury. It is recommended that these patients be kept under surveillance.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationPereira Guedes T, Fragoso P, Lemos C, et al. Long-Term Follow-Up of Advanced Liver Disease after Sustained Virological Response to Treatment of Hepatitis C with Direct-Acting Antivirals: Outcomes from a Real-World Portuguese Cohort. GE Port J Gastroenterol. 2020;27(3):149-159. doi:10.1159/000503074pt_PT
dc.identifier.doi10.1159/000503074pt_PT
dc.identifier.issn2387-1954
dc.identifier.issn2341-4545
dc.identifier.urihttp://hdl.handle.net/10400.16/2639
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherKarger AGpt_PT
dc.relation.publisherversionhttps://www.karger.com/Article/FullText/503074pt_PT
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/pt_PT
dc.subjectAntiviral agentspt_PT
dc.subjectHepatitis Cpt_PT
dc.subjectHepatocellular carcinomapt_PT
dc.subjectLiver cirrhosispt_PT
dc.subjectSustained virological responsept_PT
dc.titleLong-Term Follow-Up of Advanced Liver Disease after Sustained Virological Response to Treatment of Hepatitis C with Direct-Acting Antivirals: Outcomes from a Real-World Portuguese Cohortpt_PT
dc.title.alternativeSeguimento a longo prazo da doença hepática avançada após cura do vírus C com antivíricos de ação direta: dados de uma coorte Portuguesapt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceSwitzerlandpt_PT
oaire.citation.endPage159pt_PT
oaire.citation.issue3pt_PT
oaire.citation.startPage149pt_PT
oaire.citation.titleGE - Portuguese Journal of Gastroenterologypt_PT
oaire.citation.volume27pt_PT
person.familyNameGarrido
person.familyNameMaia
person.familyNamePedroto
person.givenNameMónica
person.givenNameLuís
person.givenNameIsabel
person.identifier.orcid0000-0003-4538-045X
person.identifier.orcid0000-0002-9814-6184
person.identifier.orcid0000-0001-6573-699X
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication6988c25a-eea2-4002-b740-48ed87ceb226
relation.isAuthorOfPublicationb4528bff-008b-49e3-bfbe-76b45c947abb
relation.isAuthorOfPublicatione523f164-bf0d-4248-8069-53df9d926349
relation.isAuthorOfPublication.latestForDiscovery6988c25a-eea2-4002-b740-48ed87ceb226

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