Z Gastroenterol 2016; 54 - P93
DOI: 10.1055/s-0036-1584071

Long-term impact of achieving sustained virologic response(SVR)by IFN-free DAA treatment in patients with advanced liver disease.

K Kozbial 1, S Moser 2, R Al-Zoairy 3, R Schwarzer 4, H Laferl 5, C Freissmuth 1, R Stern 1, S Beinhardt 1, A Stättermayer 1, A Maieron 4, M Gschwantler 2, P Ferenci 1, H Hofer 1
  • 1Medizinische Universität Wien, Vienna, Austria
  • 2Wilhelminenspital Wien, Vienna, Austria
  • 3Universitätsklinik Innsbruck, Innsbruck, Austria
  • 4Krankenhaus der Elisabethinen, Linz, Austria
  • 5Kaiser Franz-Josef Spital, Vienna, Austria

Background and aims: IFN-free antiviral treatment with DAAs improves liver function in many patients with cirrhosis already at the end of therapy, however, results of long-term follow-up are not yet known. The aim of this study was to evaluate patients' virological and clinical outcomes at follow-up week 48 after interferon-free DAA therapy.

Methods: 159patients with cirrhosis (n = 135) or advanced fibrosis (F3, n = 24) with SVR after IFN-free DAA therapy and at least48 weeks of treatment-free follow up were evaluated (m/f = 99/60; mean age 56.8 ± 10.5yrs; genotype [GT-1: 128, GT-2: 2, GT-3: 18; GT-4: 11], cirrhosis CPS-A: 101, CPS-B: 26, CPS-C: 8, median baseline liver stiffness in patients with cirrhosis: 21.3kPa, in patients with F3: 10.3kPa).

Results:SVR was durable in all patients during long term follow up. The overall condition as well as albumin (mean 38.7 vs. 42.0 g/L, p < 0.001), platelets (mean 126 vs. 141G/l, p < 0.001), and AFP (median 8.2 vs. 4.0 IU/ml, p < 0.001) improved in most patients from baseline to FUP48. Changes in Child Pugh Score (CPS) are shown in the table below. Six patients died after SVR 4 (3 related to liver disease). One patient was transplanted after SVR4, and four were delisted due to clinical improvement. During follow-up HCC was diagnosed in 14 patients (8.6%) (F4: 12, F3: 2, m/f = 11/3; mean age 63.5 ± 8.2yrs; GT-1: 11; GT-3: 2, GT-4: 1; CPS at baseline: A: 6, B: 5, C: 1). Priorto treatmentnone of themhad evidence of HCC by imaging methods; AFP had been in the normal range in six patients.

Changes in CPS:

SVR 48 weeks

Pretreatment

CPS A

CPS B

CPS C

CPS A

75

3

1

CPS B

16

8

2

CPS C

2*

3

3

*one patient improved after liver transplantation

Conclusion: Liver function improved in patients with cirrhosis and advanced liver fibrosis after SVR; however, the risk of HCC remains high. Thus, a vigorous surveillanceof patients with cirrhosisis mandatoryafter achieving SVR.