Background: The efficacy of direct-acting anti-viral (DAA) therapy in patients with a history of hepatocellular carcinoma (HCC) is unknown. Aim: We prospectively evaluated whether previously treated HCC affects DAA efficacy in a large real-life cohort of cirrhotic patients. Methods: From January to December 2015 all consecutive HCV mono-infected patients with cirrhosis and/or history of HCC attending 10 Italian tertiary liver centres were enrolled. Baseline characteristics and response to therapy were recorded. 1927 patients were enrolled (mean age: 62.1 ± 10.9 years; 1.205 males). Genotype 1 was the most frequent (67.9%) followed by genotypes 3 (12.4%), 2 (11.2%) and 4 (8.6%). 88.4% and 10.9% of cases were classified Child A and B, respectively, and 14 (<1%) cases were classified Child C. Ascites and hepatic encephalopathy occurred in 10.7% and 3.2% of patients, respectively. Varices were detected in 39.3% of patients. Suboptimal and optimal treatment was prescribed: 15.9% of patients received sofosbuvir/simeprevir, 33.4% sofosbuvir/ledipasvir, 20.2% a Viekirax + Exviera regimen, 15.7% sofosbuvir/ribavirin, 9.9% sofosbuvir/daclatasvir and 3.4% Viekirax; 1.3% of patients received an interferon-based regimen. Results: The sustained virologic response (SVR) rate at intention-to-treat analysis was 95.1%. It differed significantly across Child classes, that is, 96.3%, 86.1% and 71.4% Child A, B and C, respectively (P < 0.0001) and across genotypes (P = 0.002). The SVR rate did not differ between patients with (95.0%) and those without previous HCC (95.1%). At multivariable analysis, SVR was significantly associated with HCV genotype, Child class. Conclusion: This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.

High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma / Persico, M.; Aglitti, A.; Aghemo, A.; Rendina, M.; Lleo, A.; Ciancio, A.; Di Marco, V.; Lampertico, P.; Brunetto, M. R.; Zuin, M.; Andreone, P.; Villa, E.; Troshina, G.; Calvaruso, V.; Degasperi, E.; Coco, B.; Giorgini, A.; Conti, F.; Di Leo, A.; Marzi, L.; Boccaccio, V.; Bollani, S.; Maisonneuve, P.; Bruno, S.. - In: ALIMENTARY PHARMACOLOGY & THERAPEUTICS. - ISSN 0269-2813. - 47:12(2018), pp. 1705-1712. [10.1111/apt.14685]

High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma

Rendina M.;Di Marco V.;Andreone P.;Villa E.;Giorgini A.;Di Leo A.;Bruno S.
2018

Abstract

Background: The efficacy of direct-acting anti-viral (DAA) therapy in patients with a history of hepatocellular carcinoma (HCC) is unknown. Aim: We prospectively evaluated whether previously treated HCC affects DAA efficacy in a large real-life cohort of cirrhotic patients. Methods: From January to December 2015 all consecutive HCV mono-infected patients with cirrhosis and/or history of HCC attending 10 Italian tertiary liver centres were enrolled. Baseline characteristics and response to therapy were recorded. 1927 patients were enrolled (mean age: 62.1 ± 10.9 years; 1.205 males). Genotype 1 was the most frequent (67.9%) followed by genotypes 3 (12.4%), 2 (11.2%) and 4 (8.6%). 88.4% and 10.9% of cases were classified Child A and B, respectively, and 14 (<1%) cases were classified Child C. Ascites and hepatic encephalopathy occurred in 10.7% and 3.2% of patients, respectively. Varices were detected in 39.3% of patients. Suboptimal and optimal treatment was prescribed: 15.9% of patients received sofosbuvir/simeprevir, 33.4% sofosbuvir/ledipasvir, 20.2% a Viekirax + Exviera regimen, 15.7% sofosbuvir/ribavirin, 9.9% sofosbuvir/daclatasvir and 3.4% Viekirax; 1.3% of patients received an interferon-based regimen. Results: The sustained virologic response (SVR) rate at intention-to-treat analysis was 95.1%. It differed significantly across Child classes, that is, 96.3%, 86.1% and 71.4% Child A, B and C, respectively (P < 0.0001) and across genotypes (P = 0.002). The SVR rate did not differ between patients with (95.0%) and those without previous HCC (95.1%). At multivariable analysis, SVR was significantly associated with HCV genotype, Child class. Conclusion: This large real-life study proves that the efficacy of DAA in cirrhotic patients is not impaired by successfully treated HCC.
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High efficacy of direct-acting anti-viral agents in hepatitis C virus-infected cirrhotic patients with successfully treated hepatocellular carcinoma / Persico, M.; Aglitti, A.; Aghemo, A.; Rendina, M.; Lleo, A.; Ciancio, A.; Di Marco, V.; Lampertico, P.; Brunetto, M. R.; Zuin, M.; Andreone, P.; Villa, E.; Troshina, G.; Calvaruso, V.; Degasperi, E.; Coco, B.; Giorgini, A.; Conti, F.; Di Leo, A.; Marzi, L.; Boccaccio, V.; Bollani, S.; Maisonneuve, P.; Bruno, S.. - In: ALIMENTARY PHARMACOLOGY & THERAPEUTICS. - ISSN 0269-2813. - 47:12(2018), pp. 1705-1712. [10.1111/apt.14685]
Persico, M.; Aglitti, A.; Aghemo, A.; Rendina, M.; Lleo, A.; Ciancio, A.; Di Marco, V.; Lampertico, P.; Brunetto, M. R.; Zuin, M.; Andreone, P.; Villa, E.; Troshina, G.; Calvaruso, V.; Degasperi, E.; Coco, B.; Giorgini, A.; Conti, F.; Di Leo, A.; Marzi, L.; Boccaccio, V.; Bollani, S.; Maisonneuve, P.; Bruno, S.
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