Long-Term Results of the Etiotropic Therapy of Subcompensed Liver Cirrhosis in the Outcome of Chronic Hepatitis C
P. O. Bogomolov,
A. O. Bueverov,
V. E. Bakirova,
E. O. Lyusina,
E. A. Fedosyina,
S. V. Koblov,
O. V. Sumtsova https://doi.org/10.22416/1382-4376-2019-29-6-30-35
Abstract
Aim. The evaluation of long-term results of antiviral therapy (AVT) with ombitasvir/paritaprevir/ritonavir and dasabuvir in patients with noncompensated liver cirrhosis (LC) in the outcome of chronic hepatitis C.
Material and methods. A retrospective analysis included the data from patients with subcompensated liver cirrhosis (LC) of HCV etiology (genotype 1b) (7–9 points of the Child-Pugh score) having received interferon-free antiviral therapy (AVT) with ombitasvir/paritaprevir/ritonavir and dasabuvir during 12 weeks from September to December 2015. In total, 66 patients (27 men and 39 women) received such a therapy, the median age was 56.4 years.
Results. 147 weeks (IQR 56–156) following AVT completion, the long-term results were evaluated. At that time, 27 patients were available for observation. The assessment of liver function compensation using the Child-Pugh score showed improvement in 25 (93 %) patients. The assessment of laboratory data revealed a decrease in the median of total bilirubin by 13.6 μmol/l, as well as an increase in the median of serum albumin by 9.7 g/L and the median of platelets by 41,700/μl. Two deaths were reported due to hepatocellular cancer (HCC) and bleeding from esophageal varices. HCC was detected in 8 patients. Two patients underwent liver transplantation.
Conclusion. AVT in patients with LC of HCV etiology is associated with a high frequency of virologic response. Longterm follow-up results indicate a significant improvement of liver function, but also a continuing high risk of developing complications of underlying disease, primarily HCC.
Material and methods. A retrospective analysis included the data from patients with subcompensated liver cirrhosis (LC) of HCV etiology (genotype 1b) (7–9 points of the Child-Pugh score) having received interferon-free antiviral therapy (AVT) with ombitasvir/paritaprevir/ritonavir and dasabuvir during 12 weeks from September to December 2015. In total, 66 patients (27 men and 39 women) received such a therapy, the median age was 56.4 years.
Results. 147 weeks (IQR 56–156) following AVT completion, the long-term results were evaluated. At that time, 27 patients were available for observation. The assessment of liver function compensation using the Child-Pugh score showed improvement in 25 (93 %) patients. The assessment of laboratory data revealed a decrease in the median of total bilirubin by 13.6 μmol/l, as well as an increase in the median of serum albumin by 9.7 g/L and the median of platelets by 41,700/μl. Two deaths were reported due to hepatocellular cancer (HCC) and bleeding from esophageal varices. HCC was detected in 8 patients. Two patients underwent liver transplantation.
Conclusion. AVT in patients with LC of HCV etiology is associated with a high frequency of virologic response. Longterm follow-up results indicate a significant improvement of liver function, but also a continuing high risk of developing complications of underlying disease, primarily HCC.
About the Authors
P. O. Bogomolov
M.F. Vladimirsky Moscow Regional Research and Clinical Institute (MONIKI)
Russian Federation
Cand. Sci. (Med.), Departmental Head, Hepatology Department
129119, Moscow, Shchepkina str., 61/2
Russian Federation
Cand. Sci. (Med.), Departmental Head, Hepatology Department
129119, Moscow, Shchepkina str., 61/2
A. O. Bueverov
I.M. Sechenov First Moscow State Medical University (Sechenov University),
M.F. Vladimirsky Moscow Regional Research and Clinical Institute (MONIKI).
Russian Federation
Dr. Sci. (Med.), Prof., Department of Medical and Social Expertise and Polyclinic Therapy, Leading Research fellow, hepatology department
129119, Moscow, Shchepkina str., 61/2
Russian Federation
Dr. Sci. (Med.), Prof., Department of Medical and Social Expertise and Polyclinic Therapy, Leading Research fellow, hepatology department
129119, Moscow, Shchepkina str., 61/2
V. E. Bakirova
M.F. Vladimirsky Moscow
Regional Research and Clinical Institute (MONIKI)
Russian Federation
Russian Federation
Cand. Sci. (Med.), Senior Research fellow, Hepatology Department
129119, Moscow, Shchepkina str., 61/2
E. O. Lyusina
M.F. Vladimirsky Moscow Regional Research and Clinical Institute (MONIKI)
Russian Federation
Russian Federation
Cand. Sci. (Med.), Senior Research fellow, Hepatology Department
129119, Moscow, Shchepkina str., 61/2
E. A. Fedosyina
M.F. Vladimirsky Moscow Regional Research and Clinical Institute (MONIKI)
Russian Federation
Russian Federation
Cand. Sci. (Med.), Departmental Head, Hepatology Department
129119, Moscow, Shchepkina str., 61/2
S. V. Koblov
M.F. Vladimirsky Moscow Regional Research and Clinical Institute (MONIKI)
Russian Federation
Doctor, Hepatology Department
129119, Moscow, Shchepkina str., 61/2
Russian Federation
Doctor, Hepatology Department
129119, Moscow, Shchepkina str., 61/2
O. V. Sumtsova
M.F. Vladimirsky Moscow Regional Research and Clinical Institute (MONIKI)
Russian Federation
Doctor, Hepatology Department
129119, Moscow, Shchepkina str., 61/2
Russian Federation
Doctor, Hepatology Department
129119, Moscow, Shchepkina str., 61/2
References
1. Yakovlev A.A., Komarova A.A., Musatov V.B. et al. Sovremennyye tendentsii izmeneniy etiologicheskoy struktury i kliniko-laboratornoy kharakteristiki gepatotsellyulyarnoy kartsinomy. Epidemiologiya i infektsionnyye bolezni / Current trends of the changes of the etiological structure and clinical and laboratory characteristics of hepatocellular carcinoma. Epidemiology and Infectious Diseases. 2013;6:21–26 (In Rus.)
2. Alazawi W., Cunningham M., Dearden J., Foster G.R. Systematic review: outcome of compensated cirrhosis due to chronic hepatitis C infection. Aliment. Pharmacol. Ther. 2010;32:344–55. DOI: 10.1111/j.1365-2036.2010.04370.x
3. Wong V.W., Wong G.L., Chim A.M. et al. Surrogate end points and long-term outcome in patients with chronic hepatitis B. Clin. Gastroenterol. Hepatol. 2009;7:1113–20. DOI: 10.1016/j.cgh.2009.05.025
4. Heller T., Rotman Y., Koh C. et al. Long-term therapy of chronic delta hepatitis with peginterferon alfa. Aliment. Pharmacol. Ther. 2014;40:93–104. DOI: 10.1111/apt.12788
5. Lingala S., Ghany M.G. Natural history of hepatitis C. Gastroenterol. Clin. North Amer. 2015;44(4):717–34. DOI: 10.1016/j.gtc.2015.07.003
6. Toshikuni N. Therapy with direct-acting antiviral agents for hepatitis C-related liver cirrhosis. Gut and Liver. 2017;11(3):335–48. DOI: 10.5009/gnl15458
7. Lopatkina T.N. Lecheniye virusnogo tsirroza pecheni v iskhode khronicheskogo gepatita С. Lechaschij vrach / Treatment of viral cirrhosis in the outcome of chronic hepatitis C. Lechaschij vrach. 2005;6:41–44 (In Rus.)
8. Planas R., Balleste B., Alvarez M.A. et al. Natural history of decompensated hepatitis C virus-related cirrhosis. A study of 200 patients. J Hepatol. 2004;40(5):823–30. DOI: 10.1016/j.jhep.2004.01.005
9. Vezali E., Aghemo A., Colombo M. A review of the treatment of chronic hepatitis C virus infection in cirrhosis. Clinical Therapeutics. 2010;32:2117–38. DOI: 10.1016/S0149-2918(11)00022-1
10. Bogomolov P.O., Voronkova N.V., Buyeverov A.O., Dubinina N.V., Nikitin I.G. Obratimost’ virusnogo tsirroza pecheni (klinicheskoye nablyudeniye). Klinicheskiye perspektivy gastroenterologii, gepatologii. / Reversibility of viral liver cirrhosis (Clinical case). Clinical prospects of gastroenterology, hepatology. 2013;4:15–18 (In Rus.)
11. Spengler U. Direct antiviral agents (DAAs) — a new age in the treatment of hepatitis C virus infection. Pharmacol. Ther. 2018;183:118–26. DOI: 10.1016/j.pharmthera.2017.10.009
12. Poordad F., Hezode C., Trinh R. et al. ABT-450/r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis. NEJM. 2014;370:1973–82. DOI: 10.1056/NEJMoa1402869
13. Feld J.J., Moreno C., Trinh R., Tam E., Bourgeois S., Horsmans Y. et al. Sustained virologic response of 100 % in HCV genotype 1 patients with cirrhosis receiving ombitasvir/paritaprevir/r and dasabuvir for 12 weeks. J. Hepatol. 2016;64:301–7. DOI: 10.1016/j.jhep.2015.10.005
14. FDA Drug Safety Communication: FDA warns of serious liver injury risk with hepatitis C treatments Viekira Pak and Technivie. URL: https://www.fda.gov/drugs/drugsafety-and-availability/fda-drug-safety-communicationfda-warns-serious-liver-injury-risk-hepatitis-c-treatmentsviekira-pak
15. Viekira Pak. Instructions for use. URL: https://www.rlsnet.ru/tn_index_id_80482.htm
Review
For citations:
Bogomolov P.O., Bueverov A.O., Bakirova V.E., Lyusina E.O., Fedosyina E.A., Koblov S.V., Sumtsova O.V. Long-Term Results of the Etiotropic Therapy of Subcompensed Liver Cirrhosis in the Outcome of Chronic Hepatitis C. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2019;29(6):30-35. (In Russ.) https://doi.org/10.22416/1382-4376-2019-29-6-30-35
Views:
1348
Email this article 
