High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma

M. Persico, A. Aglitti, A. Aghemo, M. Rendina, A. Lleo, A. Ciancio, V. Di Marco, P. Lampertico, M. R. Brunetto, M. Zuin, P. Andreone, E. Villa, G. Troshina, V. Calvaruso, E. Degasperi, B. Coco, A. Giorgini, F. Conti, A. Di Leo, L. MarziV. Boccaccio, S. Bollani, P. Maisonneuve, S. Bruno

Research output: Contribution to journalArticle

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Abstract

Background: The efficacy of direct-acting anti-viral (DAA) therapy in patients with a history of hepatocellular carcinoma (HCC) is unknown. Aim: We prospectively evaluated whether previously treated HCC affects DAA efficacy in a large real-life cohort of cirrhotic patients. Methods: From January to December 2015 all consecutive HCV mono-infected patients with cirrhosis and/or history of HCC attending 10 Italian tertiary liver centres were enrolled. Baseline characteristics and response to therapy were recorded. 1927 patients were enrolled (mean age: 62.1 ± 10.9 years; 1.205 males). Genotype 1 was the most frequent (67.9%) followed by genotypes 3 (12.4%), 2 (11.2%) and 4 (8.6%). 88.4% and 10.9% of cases were classified Child A and B, respectively, and 14 (<1%) cases were classified Child C. Ascites and hepatic encephalopathy occurred in 10.7% and 3.2% of patients, respectively. Varices were detected in 39.3% of patients. Suboptimal and optimal treatment was prescribed: 15.9% of patients received sofosbuvir/simeprevir, 33.4% sofosbuvir/ledipasvir, 20.2% a Viekirax + Exviera regimen, 15.7% sofosbuvir/ribavirin, 9.9% sofosbuvir/daclatasvir and 3.4% Viekirax; 1.3% of patients received an interferon-based regimen. Results: The sustained virologic response (SVR) rate at intention-to-treat analysis was 95.1%. It differed significantly across Child classes, that is, 96.3%, 86.1% and 71.4% Child A, B and C, respectively (P < 0.0001) and across genotypes (P = 0.002). The SVR rate did not differ between patients with (95.0%) and those without previous HCC (95.1%). At multivariable analysis, SVR was significantly associated with HCV genotype, Child class. Conclusion: This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.

Original languageEnglish
Pages (from-to)1705-1712
Number of pages8
JournalAlimentary Pharmacology and Therapeutics
Volume47
Issue number12
DOIs
Publication statusPublished - Jun 1 2018

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Hepacivirus
Hepatocellular Carcinoma
Genotype
Intention to Treat Analysis
Hepatic Encephalopathy
Ribavirin
Varicose Veins
Ascites
Interferons
Fibrosis
Therapeutics
Liver

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)

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High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma. / Persico, M.; Aglitti, A.; Aghemo, A.; Rendina, M.; Lleo, A.; Ciancio, A.; Di Marco, V.; Lampertico, P.; Brunetto, M. R.; Zuin, M.; Andreone, P.; Villa, E.; Troshina, G.; Calvaruso, V.; Degasperi, E.; Coco, B.; Giorgini, A.; Conti, F.; Di Leo, A.; Marzi, L.; Boccaccio, V.; Bollani, S.; Maisonneuve, P.; Bruno, S.

In: Alimentary Pharmacology and Therapeutics, Vol. 47, No. 12, 01.06.2018, p. 1705-1712.

Research output: Contribution to journalArticle

Persico, M, Aglitti, A, Aghemo, A, Rendina, M, Lleo, A, Ciancio, A, Di Marco, V, Lampertico, P, Brunetto, MR, Zuin, M, Andreone, P, Villa, E, Troshina, G, Calvaruso, V, Degasperi, E, Coco, B, Giorgini, A, Conti, F, Di Leo, A, Marzi, L, Boccaccio, V, Bollani, S, Maisonneuve, P & Bruno, S 2018, 'High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma', Alimentary Pharmacology and Therapeutics, vol. 47, no. 12, pp. 1705-1712. https://doi.org/10.1111/apt.14685
Persico, M. ; Aglitti, A. ; Aghemo, A. ; Rendina, M. ; Lleo, A. ; Ciancio, A. ; Di Marco, V. ; Lampertico, P. ; Brunetto, M. R. ; Zuin, M. ; Andreone, P. ; Villa, E. ; Troshina, G. ; Calvaruso, V. ; Degasperi, E. ; Coco, B. ; Giorgini, A. ; Conti, F. ; Di Leo, A. ; Marzi, L. ; Boccaccio, V. ; Bollani, S. ; Maisonneuve, P. ; Bruno, S. / High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma. In: Alimentary Pharmacology and Therapeutics. 2018 ; Vol. 47, No. 12. pp. 1705-1712.
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abstract = "Background: The efficacy of direct-acting anti-viral (DAA) therapy in patients with a history of hepatocellular carcinoma (HCC) is unknown. Aim: We prospectively evaluated whether previously treated HCC affects DAA efficacy in a large real-life cohort of cirrhotic patients. Methods: From January to December 2015 all consecutive HCV mono-infected patients with cirrhosis and/or history of HCC attending 10 Italian tertiary liver centres were enrolled. Baseline characteristics and response to therapy were recorded. 1927 patients were enrolled (mean age: 62.1 ± 10.9 years; 1.205 males). Genotype 1 was the most frequent (67.9{\%}) followed by genotypes 3 (12.4{\%}), 2 (11.2{\%}) and 4 (8.6{\%}). 88.4{\%} and 10.9{\%} of cases were classified Child A and B, respectively, and 14 (<1{\%}) cases were classified Child C. Ascites and hepatic encephalopathy occurred in 10.7{\%} and 3.2{\%} of patients, respectively. Varices were detected in 39.3{\%} of patients. Suboptimal and optimal treatment was prescribed: 15.9{\%} of patients received sofosbuvir/simeprevir, 33.4{\%} sofosbuvir/ledipasvir, 20.2{\%} a Viekirax + Exviera regimen, 15.7{\%} sofosbuvir/ribavirin, 9.9{\%} sofosbuvir/daclatasvir and 3.4{\%} Viekirax; 1.3{\%} of patients received an interferon-based regimen. Results: The sustained virologic response (SVR) rate at intention-to-treat analysis was 95.1{\%}. It differed significantly across Child classes, that is, 96.3{\%}, 86.1{\%} and 71.4{\%} Child A, B and C, respectively (P < 0.0001) and across genotypes (P = 0.002). The SVR rate did not differ between patients with (95.0{\%}) and those without previous HCC (95.1{\%}). At multivariable analysis, SVR was significantly associated with HCV genotype, Child class. Conclusion: This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.",
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T1 - High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma

AU - Persico, M.

AU - Aglitti, A.

AU - Aghemo, A.

AU - Rendina, M.

AU - Lleo, A.

AU - Ciancio, A.

AU - Di Marco, V.

AU - Lampertico, P.

AU - Brunetto, M. R.

AU - Zuin, M.

AU - Andreone, P.

AU - Villa, E.

AU - Troshina, G.

AU - Calvaruso, V.

AU - Degasperi, E.

AU - Coco, B.

AU - Giorgini, A.

AU - Conti, F.

AU - Di Leo, A.

AU - Marzi, L.

AU - Boccaccio, V.

AU - Bollani, S.

AU - Maisonneuve, P.

AU - Bruno, S.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Background: The efficacy of direct-acting anti-viral (DAA) therapy in patients with a history of hepatocellular carcinoma (HCC) is unknown. Aim: We prospectively evaluated whether previously treated HCC affects DAA efficacy in a large real-life cohort of cirrhotic patients. Methods: From January to December 2015 all consecutive HCV mono-infected patients with cirrhosis and/or history of HCC attending 10 Italian tertiary liver centres were enrolled. Baseline characteristics and response to therapy were recorded. 1927 patients were enrolled (mean age: 62.1 ± 10.9 years; 1.205 males). Genotype 1 was the most frequent (67.9%) followed by genotypes 3 (12.4%), 2 (11.2%) and 4 (8.6%). 88.4% and 10.9% of cases were classified Child A and B, respectively, and 14 (<1%) cases were classified Child C. Ascites and hepatic encephalopathy occurred in 10.7% and 3.2% of patients, respectively. Varices were detected in 39.3% of patients. Suboptimal and optimal treatment was prescribed: 15.9% of patients received sofosbuvir/simeprevir, 33.4% sofosbuvir/ledipasvir, 20.2% a Viekirax + Exviera regimen, 15.7% sofosbuvir/ribavirin, 9.9% sofosbuvir/daclatasvir and 3.4% Viekirax; 1.3% of patients received an interferon-based regimen. Results: The sustained virologic response (SVR) rate at intention-to-treat analysis was 95.1%. It differed significantly across Child classes, that is, 96.3%, 86.1% and 71.4% Child A, B and C, respectively (P < 0.0001) and across genotypes (P = 0.002). The SVR rate did not differ between patients with (95.0%) and those without previous HCC (95.1%). At multivariable analysis, SVR was significantly associated with HCV genotype, Child class. Conclusion: This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.

AB - Background: The efficacy of direct-acting anti-viral (DAA) therapy in patients with a history of hepatocellular carcinoma (HCC) is unknown. Aim: We prospectively evaluated whether previously treated HCC affects DAA efficacy in a large real-life cohort of cirrhotic patients. Methods: From January to December 2015 all consecutive HCV mono-infected patients with cirrhosis and/or history of HCC attending 10 Italian tertiary liver centres were enrolled. Baseline characteristics and response to therapy were recorded. 1927 patients were enrolled (mean age: 62.1 ± 10.9 years; 1.205 males). Genotype 1 was the most frequent (67.9%) followed by genotypes 3 (12.4%), 2 (11.2%) and 4 (8.6%). 88.4% and 10.9% of cases were classified Child A and B, respectively, and 14 (<1%) cases were classified Child C. Ascites and hepatic encephalopathy occurred in 10.7% and 3.2% of patients, respectively. Varices were detected in 39.3% of patients. Suboptimal and optimal treatment was prescribed: 15.9% of patients received sofosbuvir/simeprevir, 33.4% sofosbuvir/ledipasvir, 20.2% a Viekirax + Exviera regimen, 15.7% sofosbuvir/ribavirin, 9.9% sofosbuvir/daclatasvir and 3.4% Viekirax; 1.3% of patients received an interferon-based regimen. Results: The sustained virologic response (SVR) rate at intention-to-treat analysis was 95.1%. It differed significantly across Child classes, that is, 96.3%, 86.1% and 71.4% Child A, B and C, respectively (P < 0.0001) and across genotypes (P = 0.002). The SVR rate did not differ between patients with (95.0%) and those without previous HCC (95.1%). At multivariable analysis, SVR was significantly associated with HCV genotype, Child class. Conclusion: This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.

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