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DAA treatment of chronic hepatitis C results in rapid regression of transient elastography and fibrosis markers FIB-4 and APRI


Bachofner, Jacqueline A; Valli, Piero V; Kröger, Arne; Bergamin, Irina; Künzler, Patrizia; Baserga, Adriana; Braun, Dominique; Seifert, Burkhardt; Moncsek, Anja; Fehr, Jan; Semela, David; Magenta, Lorenzo; Müllhaupt, Beat; Terziroli Beretta-Piccoli, Benedetta; Mertens, Joachim C (2017). DAA treatment of chronic hepatitis C results in rapid regression of transient elastography and fibrosis markers FIB-4 and APRI. Liver International, 37(3):369-376.

Abstract

BACKGROUND Novel direct antiviral agents (DAA) targeting hepatitis C virus (HCV) have revolutionized the treatment of chronic hepatitis C infection (CHC). Rates of sustained virological response (SVR) to treatment have drastically improved since introduction of DAA. Transient Elastography (TE) is an ultrasound based, non-invasive technique to assess liver stiffness (LS). We examined the changes in TE values and fibrosis scores FIB-4 and APRI after DAA treatment of CHC. METHODS 549 patients who received a DAA based treatment for CHC were screened and 392 were included. TE values recorded prior to therapy and within 18 months after therapy were evaluated. In addition, FIB-4 and APRI scores were calculated and histological results were recorded if available. RESULTS Median TE prior to DAA treatment was 12.65 kPa (IQR 9.45 - 19.2 kPa) and decreased to 8.55 kPa (IQR 5.93 - 15.25) post-treatment. This finding is statistically significant (p < 0.001) and equals a TE regression of 32.41% after DAA treatment. Median FIB-4 and APRI values significantly decreased from 2.54 (IQR 1.65-4.43) and 1.10 (IQR 0.65-2.43) to 1.80 (IQR 1.23-2.84, p < 0.001) and 0.43 (IQR 0.3-0.79, p < 0.001), respectively. CONCLUSION Patients with SVR after DAA therapy showed significant regression of TE values. Rapid decrease of TE was in concordance with regression of validated fibrosis scores FIB-4 and APRI. It remains to be examined whether this indicates a regression of fibrosis or merely resolution of chronic liver inflammation with subsequent improvement of TE values and laboratory parameters. This article is protected by copyright. All rights reserved.

Abstract

BACKGROUND Novel direct antiviral agents (DAA) targeting hepatitis C virus (HCV) have revolutionized the treatment of chronic hepatitis C infection (CHC). Rates of sustained virological response (SVR) to treatment have drastically improved since introduction of DAA. Transient Elastography (TE) is an ultrasound based, non-invasive technique to assess liver stiffness (LS). We examined the changes in TE values and fibrosis scores FIB-4 and APRI after DAA treatment of CHC. METHODS 549 patients who received a DAA based treatment for CHC were screened and 392 were included. TE values recorded prior to therapy and within 18 months after therapy were evaluated. In addition, FIB-4 and APRI scores were calculated and histological results were recorded if available. RESULTS Median TE prior to DAA treatment was 12.65 kPa (IQR 9.45 - 19.2 kPa) and decreased to 8.55 kPa (IQR 5.93 - 15.25) post-treatment. This finding is statistically significant (p < 0.001) and equals a TE regression of 32.41% after DAA treatment. Median FIB-4 and APRI values significantly decreased from 2.54 (IQR 1.65-4.43) and 1.10 (IQR 0.65-2.43) to 1.80 (IQR 1.23-2.84, p < 0.001) and 0.43 (IQR 0.3-0.79, p < 0.001), respectively. CONCLUSION Patients with SVR after DAA therapy showed significant regression of TE values. Rapid decrease of TE was in concordance with regression of validated fibrosis scores FIB-4 and APRI. It remains to be examined whether this indicates a regression of fibrosis or merely resolution of chronic liver inflammation with subsequent improvement of TE values and laboratory parameters. This article is protected by copyright. All rights reserved.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > University Hospital Zurich > Clinic for Gastroenterology and Hepatology
04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2017
Deposited On:14 Oct 2016 14:06
Last Modified:28 Feb 2017 02:01
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:1478-3223
Publisher DOI:https://doi.org/10.1111/liv.13256
PubMed ID:27678216

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