TY  - JOUR
N1  - copyright of this article belongs to Elsevier BV
ID  - open3379
UR  - https://www.sciencedirect.com/science/article/pii/S0016508524053599?via%3Dihub
IS  - 7
A1  - Premkumar, Madhumita
A1  - Dhiman, Radha K
A1  - Duseja, Ajay
A1  - Mehtani, Rohit
A1  - Taneja, Sunil
A1  - Gupta, Ekta
A1  - Gupta, Pankaj
A1  - Sandhu, Anchal
A1  - Sharma, Prerna
A1  - Rathi, Sahaj
A1  - Verma, Nipun
A1  - Kulkarni, Anand V
A1  - Bhujade, Harish
A1  - Chaluvashetty, Sreedhara B
A1  - Kalra, Naveen
A1  - Grover, Gagandeep S
A1  - Nain, Jasvinder
A1  - Reddy, K Rajender
Y1  - 2024/12/07/
N2  - BACKGROUND & AIMS: Chronic hepatitis C-related decompensated cirrhosis is associated with lower sustained virologic response (SVR)-12 rates and variable regression of disease severity after direct-acting antiviral agents. We assessed rates of SVR-12, recompensation (Baveno VII criteria), and survival in such patients. METHODS: Between July 2018 and July 2023, patients with decompensated chronic hepatitis C-related cirrhosis after direct-acting antiviral agents treatment were evaluated for SVR-12 and then had 6-monthly follow-up. RESULTS: Of 6516 patients with cirrhosis, 1152 with decompensated cirrhosis (age 53.2 ± 11.5 years; 63% men; Model for End-stage Liver Disease-Sodium MELD-Na: 16.5 $\pm$ 4.6; 87\% genotype 3) were enrolled. SVR-12 was 81.8\% after 1 course; ultimately SVR was 90.8\% after additional treatment. Decompensation events included ascites (1098; 95.3\%), hepatic encephalopathy (191; 16.6\%), and variceal bleeding (284; 24.7\%). Ascites resolved in 86\% (diuretic withdrawal achieved in 24\% patients). Recompensation occurred in 284 (24.7\%) at a median time of 16.5 (interquartile range, 14.5-20.5) months. On multivariable Cox proportional hazards analysis, low bilirubin (adjusted hazard ratio aHR, 0.6; 95\% confidence interval CI, 0.5-0.8; P < 0.001), international normalized ratio (aHR, 0.2; 95\% CI, 0.1-0.3; P < 0.001), absence of large esophageal varices (aHR, 0.4; 95\% CI, 0.2-0.9; P = 0.048), or gastric varices (aHR, 0.5; 95\% CI, 0.3-0.7; P = 0.022) predicted recompensation. Portal hypertension progressed in 158 (13.7\%) patients, with rebleed in 4\%. Prior decompensation with variceal bleeding (aHR, 1.6; 95\% CI, 1.2-2.8; P = 0.042), and presence of large varices (aHR, 2.9; 95\% CI, 1.3-6.5; P < 0.001) were associated with portal hypertension progression. Further decompensation was seen in 221 (19\%); 145 patients died and 6 underwent liver transplantation. A decrease in MELDNa of $\geq$3 was seen in 409 (35.5\%) and a final MELDNa score of <10 was seen in 335 (29\%), but 2.9\% developed hepatocellular carcinoma despite SVR-12. CONCLUSIONS: SVR-12 in hepatitis C virus-related decompensated cirrhosis in a predominant genotype 3 population led to recompensation in 24.7\% of patients over a follow-up of 4 years in a public health setting. Despite SVR-12, new hepatic decompensation evolved in 19\% and hepatocellular carcinoma developed in 2.9\% of patients. (ClinicalTrials.gov, Number: NCT03488485).
PB  - Elsevier BV
JF  - Gastroenterology
VL  - 167
KW  - Chronic Hepatitis C; DAAs; Decompensated Cirrhosis; Direct-Acting Antivirals; HCV Elimination; Hepatitis C Virus; Punjab Model; Recompensation
TI  - Recompensation of chronic hepatitis C-related decompensated cirrhosis following direct-acting antiviral therapy: Prospective cohort study from a hepatitis C virus elimination program
SP  - 1429
EP  - 1445
ER  -