Korean J Gastroenterol.  2018 Oct;72(4):197-204. 10.4166/kjg.2018.72.4.197.

The Efficacy and Safety of Direct-acting Antiviral Treatment for Chronic Hepatitis C Patients: A Single Center Study

• Park SJ
• Kim AR
• Choe WH
• Kim JH
• Yoo BC
• Kwon SY

• KMID: 2424111
• DOI: http://doi.org/10.4166/kjg.2018.72.4.197

Abstract

BACKGROUND/AIMS
Direct-acting antiviral (DAA) therapy has been shown to achieve a high rate of sustained virologic response (SVR) and favorable outcomes in chronic hepatitis C (CHC) patients. We investigated the virologic response and its clinical impact in CHC patients.
METHODS
CHC patients with compensated liver function treated with DAAs between 2016 and 2017 were included for retrospective analysis. We analyzed baseline characteristics and virologic and biochemical responses at on-treatment 4 weeks, end of treatment, and post-treatment 12 weeks. Fibrosis was measured as liver stiffness measurement by transient elastography (FibroScan). Adverse events were monitored during the treatment period.
RESULTS
A total of 135 patients (61.5% with genotype [GT] 1b and 38.5% with GT 2a) were enrolled 47.4% were male, 79.3% were treatment naive, and 30.4% had cirrhosis. SVR 12 was observed in 97.6% (81/83) in the GT 1b and 98.1% (51/52) in the GT 2a; treatment with daclatasvir+asunaprevir was the most commonly used in GT 1b (55/83), and sofosbuvir+ribavirin was the most commonly used in GT 2a (49/52). The median change of liver stiffness measurement at two time points using the signed rank test was -3.2 kPa in patients who underwent transient elastography before treatment and at SVR 12 (n=25). The most common adverse events were anemia, dyspepsia, and insomnia. One GT 2a patient treated with sofosbuvir+ribavirin stopped the treatment at 8 weeks due to symptomatic bradyarrhythmia; however, he recovered spontaneously and achieved SVR 12.
CONCLUSIONS
DAA treatment of chronic hepatitis C genotype 1b and 2a resulted in a high rate of sustained virologic response and improvement of liver fibrosis score.

Keyword

Hepatitis C, chronic; Antiviral agents; Sustained virologic response

MeSH Terms

Anemia
Antiviral Agents
Bradycardia
Dyspepsia
Elasticity Imaging Techniques
Fibrosis
Genotype
Hepatitis C, Chronic*
Hepatitis, Chronic*
Humans
Liver
Liver Cirrhosis
Male
Retrospective Studies
Sleep Initiation and Maintenance Disorders
Antiviral Agents

Figure

• 

  Fig. 1. Virological response. (A) SVR 12 according to DAAs in each genotype. The result of DAA treatment for 1b and 2a showed high SVR 12 results without any significant difference in the treatment regimens. (B) SVR 12 according to the presence of cirrhosis in each genotype. SVR 12 rate showed similar results in both genotypes regardless of LC and non-LC. SVR, sustained virologic response; DCV, daclatasvir; ASV, asunaprevir; EBR, elbasvir; GZR, grazoprevir; OBV, ombitasvir; PTV, paritaprevir; r, ritonavir; DSV, dasabuvir; SOF, sofosbuvir; LDV, ledipasvir; RBV, ribavirin; GT, genotype; LC, liver cirrhosis; DAAs, direct-acting antivirals.

• 

  Fig. 2. FIB-4 scores pre- and posttreatment with DAA in all patients (n=135). The median FIB-4 scores decreased from 4.15±3.72 at baseline to 2.84±2.78 at SVR 12 (p<0.001). FIB-4, fibrosis-4; Pre-Tx, pretreatment; SVR, sustained virologic response; DAA, direct-acting antiviral.

• 

  Fig. 3. LSM score (n=25). Significant improvement in the LSM score was observed after successful DAA treatment. LSM, liver stiffness measurement; kPa, kilopascal; Pre-Tx, pretreatment; SVR, sustained virologic response; DAA, direct-acting antiviral.

Reference

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