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Sofosbuvir based therapy in hepatitis C patients with and without cirrhosis: Is there difference?
Shahid Sarwar1, Anwaar A Khan2
1Dr. Shahid Sarwar, MBBS, FCPS (Med), FCPS (Gastroenterology), MCPS-HPE, Associate Professor of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan. Department of Gastroenterology, Doctors Hospital and Medical Center (DH&MC), Lahore, Pakistan.
Pakistan Journal of Medical Sciences
|April 4, 2017
Summary
Hepatitis C treatment with sofosbuvir/ribavirin ± interferon shows lower sustained viral response (SVR12) in patients with liver cirrhosis. Outcomes are significantly poorer in those with decompensated cirrhosis, indicating suboptimal treatment efficacy.
Area of Science:
- Hepatology
- Virology
- Clinical Medicine
Background:
- Hepatitis C virus (HCV) infection is a global health concern.
- Liver cirrhosis is a significant complication of chronic HCV, impacting treatment outcomes.
- Direct-acting antiviral therapies have revolutionized HCV treatment, but efficacy in advanced liver disease requires further study.
Purpose of the Study:
- To compare the sustained viral response (SVR12) rates of sofosbuvir/ribavirin ± interferon therapy in hepatitis C patients with and without liver cirrhosis.
- To evaluate the impact of liver cirrhosis, including decompensation, on treatment efficacy.
- To assess treatment outcomes in both treatment-naïve and treatment-experienced patients.
Main Methods:
- Observational study conducted at Doctors Hospital and Medical Center (DH&MC).
- Patients received either sofosbuvir/ribavirin for 24 weeks or sofosbuvir/ribavirin/pegylated interferon for 12 weeks.
- Primary outcome was negative HCV RNA by PCR 12 weeks post-treatment (SVR12); data analyzed using Chi-square and student's t-tests.
Main Results:
- Of 216 patients, 112 (51.9%) had cirrhosis, and 37 (17.1%) had decompensated liver disease.
- Overall SVR12 was 83.1% (173/206); 89.2% with triple therapy and 82.2% with sofosbuvir/ribavirin.
- SVR12 was significantly lower in cirrhosis patients (75.4%) compared to non-cirrhosis patients (93%) (p<0.000), and even lower in decompensated cirrhosis (68.8%) (p<0.000).
Conclusions:
- Sofosbuvir/ribavirin ± interferon therapy yields suboptimal treatment outcomes in hepatitis C patients with liver cirrhosis.
- Efficacy is particularly diminished in patients with decompensated cirrhosis compared to those without cirrhosis.
- Treatment strategies may need to be adapted for hepatitis C patients with advanced liver disease.