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Journal of Viral Hepatitis
Article . 2018 . Peer-reviewed
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Durability of virologic response, risk of de novo hepatocellular carcinoma, liver function and stiffness 2 years after treatment with ombitasvir/paritaprevir/ritonavir±dasabuvir±ribavirin in the AMBER, real‐world experience study

Authors: R. Flisiak; E. Janczewska; M. Łucejko; E. Karpińska; D. Zarębska‐Michaluk; K. Nazzal; B. Bolewska; +10 Authors

Durability of virologic response, risk of de novo hepatocellular carcinoma, liver function and stiffness 2 years after treatment with ombitasvir/paritaprevir/ritonavir±dasabuvir±ribavirin in the AMBER, real‐world experience study

Abstract

SummaryWe followed for 2 years patients treated with direct‐acting agents (DAA) to assess long‐term durability of virologic response, improvement of liver function, reduction in liver stiffness (LS) and risk of hepatocellular carcinoma (HCC). The study included patients from 16 hepatologic centres involved in the AMBER, investigator‐initiated study on treatment of chronic hepatitis C patients within a programme preceding EU registration of ombitasvir/paritaprevir/ritonavir±dasabuvir±ribavirin. A total of 204 patients among 209 from the primary study were enrolled, 200 with available testing at 2‐year follow‐up (2yFU) with undetectable HCV RNA (198 responders and 2 nonresponders retreated). During 2yFU, 4 patients died, 17 had hepatic decompensation and 3 needed liver transplantation. De novo hepatocellular carcinoma was diagnosed in 4 and its recurrence in 3 patients. Significant decreases in bilirubin, MELD, Child‐Pugh scores and liver stiffness, and increases in albumin level were observed during 2yFU. Strengths of the study were a fixed period of post‐treatment follow‐up, prospective character of the study and high proportion of available patients from the primary study. The major weaknesses were lack of a comparative arm and relatively insufficient number of patients for subsets analysis. In conclusion, 2‐year follow‐up confirmed durability of virologic response after treatment of HCV infection with ombitasvir/paritaprevir/ritonavir±dasabuvir±ribavirin. It was accompanied by significant improvement of major measures of hepatic function and reduction of hepatic stiffness. Successful therapy did not prevent hepatic decompensation, HCC or death in cirrhotics that support the need for longer than 2‐year monitoring for possible disease progression.

Keywords

Male, Cyclopropanes, Liver Cirrhosis, chronic - drug therapy, Hepacivirus, Uracil - analogs & derivatives, Liver cirrhosis - drug therapy, 2-Naphthylamine, Ritonavir - therapeutic use, Anilides, Treatment outcome, Liver neoplasms - epidemiology, Middle aged, chronic - virology, Uracil - pharmacology, Viral load - drug effects, Liver Neoplasms, Liver - pathology, Hepatitis C, hepatocellular - epidemiology, Liver, Drug Therapy, Combination, Female, Drug therapy, Anilides - pharmacology, Uracil - therapeutic use, chronic - pathology, Liver cirrhosis - pathology, Adult, Carcinoma, Hepatocellular, Macrocyclic Compounds, Genotype, Liver cirrhosis - virology, Antiviral agents - therapeutic use, Liver cirrhosis - epidemiology, Lactams, Macrocyclic, Follow-up studies, Liver - physiopathology, Ribavirin - pharmacology, Antiviral Agents, Macrocyclic compounds - therapeutic use, Sulfonamides - therapeutic use, chronic - epidemiology, Sulfonamides - pharmacology, Humans, hepatocellular carcinoma; liver cirrhosis; long-term follow-up; sustained virologic response; therapy; viral hepatitis C, Aged, combination, Carbamates - pharmacology, Carcinoma, Macrocyclic compounds - pharmacology, Poland - epidemiology, Hepatitis C, Chronic, Hepacivirus - genetics, Liver - drug effects, Ribavirin - therapeutic use, Ritonavir - pharmacology, Carbamates - therapeutic use, Anilides - therapeutic use, Hepacivirus - drug effects, Carbamates, Antiviral agents - pharmacology, Follow-Up Studies

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
19
Top 10%
Top 10%
Top 10%
Green