Rapid liver and spleen stiffness improvement in compensated advanced chronic liver disease patients treated with oral antivirals
Pons Delgado, Mònica (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Santos, Begoña (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Simón-Talero, Macarena (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Ventura-Cots, Meritxell (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Riveiro Barciela, Mar (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Esteban, Rafael (Esteban Mur) (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Augustin Recio, Salvador (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Genescà Ferrer, Joan (Hospital Universitari Vall d'Hebron. Institut de Recerca)
Universitat Autònoma de Barcelona

Date:	2017
Abstract:	We aimed to investigate the early changes in liver and spleen stiffness measurement (LSM, SSM) in hepatitis C virus (HCV) patients with compensated advanced chronic liver disease (cACLD) treated with new antivirals (DAA) to elucidate factors determining the initial change in stiffness and its implications for the long-term follow up of HCV-cured patients. A total of 41 patients with cACLD who started DAA therapy underwent LSM and SSM at baseline, week 4, end of treatment (EOT), 24 and 48 weeks of follow up using transient elastography. LSM improved rapidly during the first 4 weeks of treatment (baseline: 20. 8kPa; week 4: 17. 5kPa, p = 0. 002), with no significant changes between week 4 and EOT (18. 3kPa, p = 0. 444) and between EOT and 48-week follow up (14. 3kPa, p = 0. 148). Likewise, SSM improved rapidly (baseline: 45. 7kPa; week 4: 33. 8kPa, p = 0. 047), with no significant changes between week 4 and EOT (30. 8kPa, p = 0. 153) and between EOT and 48-week follow up (31. 2kPa, p = 0. 317). A higher decrease in LSM was observed in patients with baseline ALT ⩾ twofold upper limit normal (2 × ULN) than in those with ALT < 2 × ULN (-5. 7kPa versus -1. 6kPa). Patients who presented a decrease in LSM ⩾ 10% during treatment compared with those with LSM < 10% decrease, showed lower SSM values, higher platelet counts and lower bilirubin levels at 24-week follow up. Those with decrease in SSM ⩾ 10%, presented a higher increase in platelets than those with SSM < 10% change (p = 0. 015). LSM and SSM decrease very rapidly during DAA treatment in cACLD patients suggesting that it most probably reflects a reduction in inflammation rather than in fibrosis. cACLD patients should be maintained under surveillance independently of stiffness changes, because advanced fibrosis can still be present.
Grants:	Instituto de Salud Carlos III PI13-01289 Instituto de Salud Carlos III PI14-00331 Instituto de Salud Carlos III PI15-00066
Note:	Altres ajuts: cofunded by European Union (ERDF/ESF, 'Investing in your future'). CIBERehd is supported by Instituto de Salud Carlos III, Spain. [ClinicalTrials.gov identifier: NCT02439567.]
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Compensated advanced chronic liver disease (cACLD) ; Direct-acting antiviral agents (DAA) ; Hepatitis C ; Inflammation ; Liver stiffness ; Spleen stiffness
Published in:	Therapeutic Advances in Gastroenterology, Vol. 10 (june 2017) , p. 619-629, ISSN 1756-2848

DOI: 10.1177/1756283X17715198
PMID: 28835776

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