Decompensated cirrhosis and liver transplantation negatively impact in DAA treatment response: Real-world experience from HCV-LALREAN cohort.
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Ridruejo Ezequiel, Piñero Federico, Mendizabal Manuel, Cheinquer Hugo, Wolff Fernando Herz, Anders Margarita, Reggiardo Virginia, Ameigeiras Beatriz, Palazzo Ana, Alonso Cristina, Schinoni María Isabel, Zuain María Grazia Videla, Tanno Federico, Figueroa Sebastián, Santos Luisa, Peralta Mirta, Soza Alejandro, Vistarini Cecilia, Adrover Raúl, Fernández Nora, Perez Daniela, Hernández Nelia, Estepo Claudio, Bruno Andres, Descalzi Valeria, Sixto Marcela, Borzi Silvia, Cocozzella Daniel, Zerega Alina, de Araujo Alexandre, Varón Adriana, Silva Marcelo, Latin American Liver Research Educational and Awareness Network (LALREAN)
Аннотация
METHODS: This was a prospective multicenter cohort study from the Latin American Liver Research Educational and Awareness Network (LALREAN) including patients who received DAA treatment from May 2016 to April 2019. A multivariate logistic regression model was conducted to identify variables associated with unachieved sustained virological response (SVR), defined as treatment failure (odds ratios [OR] and 95% confidence intervals [CIs]).
RESULTS: From 2167 patients (55.2% with cirrhosis) who initiated DAA therapy, 89.4% completed a full-course treatment (n = 1938). Median treatment duration was 12 weeks, and 50% received ribavirin. Definitive suspension due to intolerance or other causes was observed in only 1.0% cases (n = 20). Overall non-SVR12 was 4.5% (95% CI, 3.5-5.7). There were no significant differences in treatment failure according to HCV genotypes and the degree of fibrosis. Independently associated variables with DAA failure were liver function impairment according to the Child-Pugh score B OR, 2.09 (P = .06), Child-Pugh C OR, 11.7 (P < .0001); and liver transplant (LT) recipient OR, 3.75 (P = .01).
CONCLUSION: In this real-life setting, higher DAA treatment failure rates were observed in patients with decompensated cirrhosis and in LT recipients. These predictive baseline factors should be addressed to individualize the appropriate time-point of DAA treatment (NCT03775798; www.
CLINICALTRIALS: gov).