Prasanta Debnath, II, MD, Sanjay Chandnani, MD, DM, Pravin Rathi, MD, DM, Sujit Nair, MD, Suhas Udgirkar, MD, DM
Topiwala National Medical College and BYL Nair Charitable Hospital, Mumbai, Maharashtra, India
Introduction: The introduction of direct-acting antiviral (DAA)-based therapies for chronic hepatitis C virus (HCV) infection has revolutionized the approach to HCV treatment, resulting in highly efficacious and well-tolerated therapy for nearly all patients. Patients with a history of decompensated cirrhosis represent a unique subset of patients with a worse response to HCV therapy compared with those who have compensated cirrhosis or chronic HCV infection. Decompensated cirrhosis due to HCV is a difficult to treat population. At present, there is no gold standard predictors of response to Direct Acting Anti-virals (DAA). We conducted this study to look for factors responsible for improvement in state of decompensation post DAA therapy, i.e. attainment of Child-Turcotte-Pugh (CTP) class A from CTP class B or C.
Methods: Retrospective analysis was conducted for patients of decompensated HCV cirrhosis (48 patients of CTP class B and 14 patients of CTP class C). We collected demographic, clinical, treatment response, and laboratory data from patients, which included age, BMI, LFT, INR, GFR, MELD score, response to therapy (SVR12), presence of ascites, encephalopathy were noted for recruited decompensated HCV cirrhosis and tested their associations with patient outcomes at 24 weeks post-treatment. Patients were given Sofosbuvir combination treatment with Daclatasvir / Ledipasvir / Velpatasvir and/or Ribavirin according to genotype, for 12 weeks, where Ribavirin was used and rest 24 weeks.
Results: Total 62 patients of decompensated HCV cirrhosis patients recruited, with males 54%, Median age 48 years. 48 patients were CPT class B whereas 14 patients of CPT class C. Patients with MELD score < 10, 10-15 and > 15 were 21 (33.8%), 28 (45.1%) and 13 (21.1%) in pre-treatment and 23 (37%), 30 (48.3%) and 9 (14.7%) in post-treatment period respectively. Post-treatment 34 patients (54.8%) turned into CTP class A, 25 (40.3%) and 3 (4.9%) remained in CTP class B & C. Factors associated with favorable prognosis were male sex, baseline albumin, bilirubin, MELD score, presence of ascites.
Discussion: This study showed that oral DAAs were able to reverse liver dysfunction in patients with decompensated HCV cirrhosis in more than half of our patient cohort and favoured use of treatment in such patients. The longer term benefits of therapy need to be ascertained though.
Citation: Prasanta Debnath, II, MD, Sanjay Chandnani, MD, DM, Pravin Rathi, MD, DM, Sujit Nair, MD, Suhas Udgirkar, MD, DM. P0632 - PREDICTORS OF RESPONSE TO DIRECT ACTING ANTI-VIRAL THERAPY IN PATIENTS WITH DECOMPENSATED HEPATITIS C CIRRHOSIS. Program No. P0632. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.