Interferon-free regimens for chronic hepatitis C overcome the effects of portal hypertension on virological responses

被引：39

作者：

Mandorfer, M. ^{[1
,2
]}

Kozbial, K. ^{[1
]}

Freissmuth, C. ^{[1
]}

Schwabl, P. ^{[1
,2
]}

Staettermayer, A. F. ^{[1
]}

Reiberger, T. ^{[1
,2
]}

Beinhardt, S. ^{[1
]}

Schwarzer, R. ^{[1
,2
]}

Trauner, M. ^{[1
]}

Ferlitsch, A. ^{[1
,2
]}

Hofer, H. ^{[1
]}

Peck-Radosavljevic, M. ^{[1
,2
]}

Ferenci, P. ^{[1
]}

机构：

[1] Med Univ Vienna, Dept Internal Med 3, Div Gastroenterol & Hepatol, A-1090 Vienna, Austria

[2] Med Univ Vienna, Vienna Hepat Hemodynam Lab, A-1090 Vienna, Austria

来源：

ALIMENTARY PHARMACOLOGY & THERAPEUTICS | 2015年 / 42卷 / 06期

关键词：

VENOUS-PRESSURE GRADIENT; TREATMENT-NAIVE PATIENTS; ANTIVIRAL THERAPY; LIVER-DISEASE; TRANSIENT ELASTOGRAPHY; DECOMPENSATED CIRRHOSIS; PEGYLATED INTERFERON; COINFECTED PATIENTS; PLUS SOFOSBUVIR; CHRONIC HCV;

D O I：

10.1111/apt.13315

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

BackgroundPortal hypertension is the strongest predictor of virological response to pegylated interferon (IFN)/ribavirin in patients with chronic hepatitis C (CHC)-related cirrhosis. AimTo investigate the effects of portal pressure assessed by hepatic venous pressure gradient (HVPG) measurement on virological responses in patients treated with IFN-free regimens outside of clinical trials. MethodsFifty-six patients with CHC and cirrhosis who underwent HVPG measurement before starting an IFN-free therapy were retrospectively studied. Patients were treated with sofosbuvir in combination with daclatasvir (n=32), ribavirin (n=12) or simeprevir (n=11), or the combination of simeprevir/daclatasvir (n=1), for 12-24weeks. ResultsHepatic venous pressure gradient values 10mmHg and 16mmHg were observed in 41 (73%) and 31 (55%) patients respectively. The distributions of treatment regimens and durations were comparable between patients with or without portal hypertension. Patients with portal hypertension had lower platelet counts and albumin levels, while bilirubin levels, INR, MELD and Child-Pugh scores were higher than in patients without portal hypertension. Importantly, rates of on-treatment virological response and viral kinetics, as well as the rates of sustained virological response 12weeks after the end of therapy [96% (54/56)] were not affected by portal hypertension. Anti-viral therapy improved liver stiffness, platelet count, serum albumin and bilirubin levels, as well as prothrombin time. ConclusionsThis is the first study to demonstrate that IFN-free regimens overcome the negative effect of portal hypertension on virological responses and viral kinetics. Improvements in liver stiffness and platelet count might reflect an anti-portal hypertensive effect of IFN-free treatments.

引用

页码：707 / 718

页数：12

共 47 条

[1]

EFFECT OF LONG TERM VIRAL SUPPRESSION WITH SOFOSBUVIR plus RIBAVIRIN ON HEPATIC VENOUS PRESSURE GRADIENT IN HCV-INFECTED PATIENTS WITH CIRRHOSIS AND PORTAL HYPERTENSION [J].