Albumin predicts cirrhosis improvement after SVR with DAAs
PARIS — Rapid improvement in albumin levels after 4 weeks of treatment with direct-acting antivirals for hepatitis C significantly predicted long-term clinical and biochemical improvements among patients with advanced liver disease, according to a presentation at the International Liver Congress 2018.
“The introduction of DAAs has completely changed the HCV setting in clinical practice,” Chiara Mazzarelli, MD, from King’s College Hospital, United Kingdom, said in her presentation. “As hepatologists, we know that HCV clearance ... is associated with improvement and normalization of liver function.”
The study comprised 187 patients with HCV and cirrhosis, including 45 patients with decompensated liver disease and 13 patients with active hepatocellular carcinoma, who received sofosbuvir with daclatasvir or ledipasvir plus ribavirin for 12 weeks.
The sustained virologic response rate was 93.6%. Of the six patients who did not achieve SVR, three had Child-Pugh class A and three had class B. Six other patients died or were lost to follow-up. The SVR rate was lower among patients with decompensated liver disease compared with those with Child-Pugh class A (86% vs. 95%).
The researchers observed improvement in MELD among 40% of patients at week 12 posttreatment, 45% of patients at week 24, and 47% at week 48. Among patients with a MELD score less than 14, improvement in MELD occurred in 68.1% at week 12, 77.7% at week 24, and 83.4% at week 48.
Factors that predicted improvement at week 24 or week 48 included male sex, bilirubin levels, and albumin-bilirubin score at baseline. Albumin levels less than 3.5 g/dL and an albumin-bilirubin score of 3 correlated with a higher risk for adverse events such as death, need for transplantation, hospital admission, sepsis, or development of HCC (P < .001).
“Viral eradication was associated with the clinical and biochemical improvement in these patients, which maintained during longer follow-up,” Mazzarelli said. “Rapid improvement in albumin after only 4 weeks of treatment was the strongest predictor of long-term improvement.” – by Talitha Bennett
For more information:
Mazzarelli C, et al. FRI-389. Presented at: International Liver Congress; Apr. 11-15, 2018; Paris, France.
Disclosure: Healio Gastroenterology and Liver Disease could not confirm financial relationships at time of publication.