Published online Feb 21, 2018. doi: 10.3748/wjg.v24.i7.852
Peer-review started: October 25, 2017
First decision: November 22, 2017
Revised: December 31, 2017
Accepted: January 15, 2018
Article in press: January 15, 2018
Published online: February 21, 2018
Processing time: 109 Days and 10 Hours
To improve patient care by assisting health care professionals in the decision-making process for treatment of patients infected with hepatitis C virus (HCV).
Direct-acting antivirals (DAAs) have recently opened up promising new therapeutic options for patients with chronic HCV infection. Nevertheless, in order to study the efficacy of these regimens, especially in difficult-to-treat patient populations, such as patients with liver cirrhosis, real-life data is needed.
We investigated patients in our real-life cohort from two tertiary referral centres in Germany. We analysed data from patients with HCV infection and liver cirrhosis to evaluate predictors of functional benefit for identifying patients profiting most of antiviral therapy beyond HCV eradication.
Predictors of functional benefit were determined in a univariable as well as multivariable model assessed by binary logistic regression analysis. For reasons of validity of the logistic regression analysis (relative to the number of outcome events), a maximum of 7 clinically relevant variables was selected.
Our results indicate that the Child-Pugh score, the MELD score, the number of platelets and the levels of albumin and bilirubin may be predictors of functional benefit from DAA-based therapy, so that these variables may serve as another tool to guide antiviral therapy in affected patients.
With the introduction of DAAs, the indication for therapy for patients with HCV infection and with liver cirrhosis has dramatically expanded with vast improvements of SVR. However, it remains unclear, which patients profit most from antiviral therapy. Therefore, a simple and feasible clinical index may be beneficial to evaluate the presumed effect of antiviral therapy before treatment initiation. Based on the parameters studied, we suggest the MELD score as part of such an evaluation system.
The ultimate goal of antiviral therapy in patients with HCV infection is to avoid hepatic complications such as the development of hepatocellular carcinoma or hepatic decompensation. Further research with large patient groups and longer observation periods is warranted to define and confirm predictive markers to identify patients, which profit clinically most from antiviral therapy beyond viral eradication