Elastography as a predictor of liver cirrhosis complications after hepatitis C virus eradication in the era of direct-acting antivirals

Table 1 Liver stiffness improvement after treatment with direct acting antivirals

Ref.	Study design	Number of Patients	Drugs	Patients with LS improvement (%)	Pre-treatment LS	Post-treatment LS	P value	Measurement
Elsharkawy et al[26], 2017	Retrospective	337	DAA	81.8% (cirrhotic) 71.7% (non-cirrhotic)	14.8 ± 10.7 kPa	11.8 ± 8.8 kPa	0.000	Fibroscan
Chekuri et al[27], 2016	Observational	100	IFN-based and DAA	NA	10.40 kPa	7.60 kPa	< 0.01	Fibroscan
Bachofner et al[30], 2017	Multicenter, observational	392	DAA	93%	12.65 kPa	8.55 kPa	< 0.001	Fibroscan
Afdhal et al[39], 2017	Prospective	52	DAA	59.6%	15.2 kPa	9.3 kPa (6.7–16.8 kPa)	< 0.0001	Fibroscan
Ravaioli et al[68], 2018	Retrospective	139	DAA	44.6% (LS reduction > 30%)	18.6 kPa (15-26.3 kPa)	13.8 kPa (10.4-20.4 kPa)	< 0.001	Fibroscan
Pan et al[70], 2018	Retrospective	84	DAA	62%	Fibrosis regression by at least two stages: Cirrhosis group (48%); F3 fibrosis group (39%)		-	Fibroscan

DAA: Direct acting antivirals; IFN: Interferon; LS: Liver stiffness; NA: Not applicable.

Table 2 Direct-acting antiviral agents and liver cirrhosis related events

Ref.	Study design	Number of patients	Drugs	HCC	Portal hypertension-related complications
Kozbial et al[32], 2018	Prospective	551	DAA	16 (4.1%)	Ascites: 3.1%; variceal hemorrhage: 1%; hepatic encephalopathy: 0%
Masuzaki et al[36], 2009	Prospective	984	DAA	77 (2.9% per 1 person-year); HCC risk: 45.5 times higher in LS > 25 kPa	NA
Afdhal et al[39], 2017	Prospective	50	DAA	LS improvement in patients who did not develop HCC during follow-up (42.6% reduction in patients without HCC vs 13.6% in HCC group)	24% patients had ≥ 20% decreases in HVPG during treatment (89% subjects with baseline HVPG ≥ 12 mmHg had a ≥ 20% reduction in HVPG after SVR)
Giannini et al[51], 2019	Prospective	52	DAA	4 (7.7%)	Clinical decompensation: 0%
Tachi et al[58], 2017	Prospective	263	DAA	19 (7.2%)	NA
Foster et al[60], 2016	Retrospective, observational	467	DAA	NA	MELD improvement (0.85, SD 2.54); composite adverse outcome in 52.0% (treated) vs 61.7% (untreated)
Rinaldi et al[63], 2019	Multicenter, prospective	258	DAA	35 (13.6%)	NA
Ravaioli et al[68], 2018	Retrospective	139	DAA	20 (14.4%)	NA
Pan et al[70], 2018	Retrospective	84	DAA	4 (4.8%)	NA
Toyoda et al[75], 2015	Retrospective/prospective	522	IFN-based	18 (1.2% after five yr; 4.3% after ten yr)	NA
D’Ambrosio et al[77], 2018	Prospective	38	DAA	5 (13%)	Clinical decompensation: 0%
Lleo et al[78], 2019	Prospective	1927	DAA	Previous HCC: 38/161 (recurrence rate: 24.8 per 100-yr); No previous HCC: 50/1766 (incidence rate: 2.4 per 100-yr)	NA
Hamada et al[79], 2018	Retrospective	196	DAA	8 (4.1%)	NA

DAA: Direct acting antivirals; HCC: Hepatocellular carcinoma; HVPG: Hepatic venous pressure gradient; IFN: Interferon; LS: Liver stiffness; MELD: Model for end-stage liver disease; NA: Not applicable; SD: Standard deviation; SVR: Sustained virological response.