Korean J Gastroenterol.  2016 Mar;67(3):137-141. 10.4166/kjg.2016.67.3.137.

Renewed 2015 Clinical Practice Guidelines for Management of Hepatitis C by Korean Association for the Study of the Liver; What Has Been Changed? - Treatment of Patients with Decompensated Cirrhosis

• Gwak GY

• KMID: 2373413
• DOI: http://doi.org/10.4166/kjg.2016.67.3.137

Abstract

HCV-related decompensated liver cirrhosis is a life-threatening illness with an average 5-year survival rate of 50%. Because these patients have higher risk of morbidity and mortality including development of hepatocellular carcinoma, the benefits of eradicating the virus may be greater than in those with less-advanced disease. Recently, direct-acting antiviral agents (DAAs) are replacing interferon-based regimens that have serious adverse events and low tolerability in the treatment of HCV infection. Many clinical trials using combination of several DAAs with or without ribavirin are now actively on-going in HCV-related decompensated cirrhosis, and encouraging data are beginning to appear. In this review, recent advances in the treatment of HCV-related decompensated cirrhosis are introduced with special focus on new DAAs.

Keyword

Hepatitis C virus; Decompensated liver cirrhosis; Direct-acting antiviral agents

MeSH Terms

Antiviral Agents/*therapeutic use
Drug Therapy, Combination
Hepatitis C/complications/*drug therapy/pathology
Humans
Interferon-alpha/therapeutic use
Liver Cirrhosis/*complications/pathology
Practice Guidelines as Topic
Republic of Korea
Ribavirin/therapeutic use
Antiviral Agents
Interferon-alpha
Ribavirin

Reference

References

1. Fattovich G, Giustina G, Degos F, et al. Morbidity and mortality in compensated cirrhosis type C: a retrospective follow-up study of 384 patients. Gastroenterology. 1997; 112:463–472.

2. Planas R, Ballesté B, Alvarez MA, et al. Natural history of decompensated hepatitis C virus-related cirrhosis. A study of 200 patients. J Hepatol. 2004; 40:823–830.

3. Poordad F, Hezode C, Trinh R, et al. ABT-450/r-ombitasvir and dasabuvir with ribavirin for hepatitis C with cirrhosis. N Engl J Med. 2014; 370:1973–1982.

4. Reddy KR, Bourlière M, Sulkowski M, et al. Ledipasvir and sofosbuvir in patients with genotype 1 hepatitis C virus infection and compensated cirrhosis: An integrated safety and efficacy analysis. Hepatology. 2015; 62:79–86.

5. Iacobellis A, Siciliano M, Perri F, et al. Peginterferon alfa-2b and ribavirin in patients with hepatitis C virus and decompensated cirrhosis: a controlled study. J Hepatol. 2007; 46:206–212.

6. Cheong HR, Woo HY, Heo J, et al. Clinical efficacy and safety of the combination therapy of peginterferon alpha and ribavirin in cirrhotic patients with HCV infection. Korean J Hepatol. 2010; 16:38–48.

7. Everson GT, Trotter J, Forman L, et al. Treatment of advanced hepatitis C with a low accelerating dosage regimen of antiviral therapy. Hepatology. 2005; 42:255–262.

8. Charlton M, Everson GT, Flamm SL, et al. SOLAR-1 Investigators. Ledipasvir and sofosbuvir plus ribavirin for treatment of HCV infection in patients with advanced liver disease. Gastroenterology. 2015; 149:649–659.

9. Poordad F, Schiff ER, Vierling JM, et al. Daclatasvir, sofosbuvir, and ribavirin combination for HCV patients with advanced cirrhosis or posttransplant recurrence: phase 3 ALLY-1 study. J Hepatol. 2015; 62:S261–S262.

10. Saxena V, Nyberg L, Pauly M, et al. Safety and efficacy of simepre-vir/sofosbuvir in hepatitis C-infected patients with compensated and decompensated cirrhosis. Hepatology. 2015; 62:715–725.

11. Garcia-Retortillo M, Forns X, Feliu A, et al. Hepatitis C virus kinetics during and immediately after liver transplantation. Hepatology. 2002; 35:680–687.

12. Forman LM, Lewis JD, Berlin JA, Feldman HI, Lucey MR. The association between hepatitis C infection and survival after orthotopic liver transplantation. Gastroenterology. 2002; 122:889–896.

13. Prieto M, Berenguer M, Rayón JM, et al. High incidence of allograft cirrhosis in hepatitis C virus genotype 1b infection following transplantation: relationship with rejection episodes. Hepatology. 1999; 29:250–256.

14. Gane E, Pilmore H. Management of chronic viral hepatitis before and after renal transplantation. Transplantation. 2002; 74:427–437.

15. Curry MP, Forns X, Chung RT, et al. Sofosbuvir and ribavirin prevent recurrence of HCV infection after liver transplantation: an open-label study. Gastroenterology. 2015; 148:100–107.e1.

16. Fontana RJ, Hann HW, Perrillo RP, et al. Determinants of early mortality in patients with decompensated chronic hepatitis B treated with antiviral therapy. Gastroenterology. 2002; 123:719–727.