Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 6, 2015; 6(4): 114-119
Published online Nov 6, 2015. doi: 10.4292/wjgpt.v6.i4.114
Direct antiviral agent treatment of decompensated hepatitis C virus-induced liver cirrhosis
Shogo Ohkoshi, Haruka Hirono, Satoshi Yamagiwa
Shogo Ohkoshi, Haruka Hirono, Department of Internal Medicine, School of Life Dentistry at Niigata, the Nippon Dental University, Niigata-city 951-8580, Japan
Satoshi Yamagiwa, Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences Niigata University, Niigata-city 951-8520, Japan
Author contributions: Ohkoshi S wrote the paper; Hirono H and Yamagiwa S made a discussion with Ohkoshi S.
Supported by Grant-in-Aid for Scientific Research (C) (25461012 for Shogo Ohkoshi) from the Japan Society for the Promotion of Science (JSPS).
Conflict-of-interest statement: The authors do not have any commercial affiliation or consultancy that could be construed as a conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shogo Ohkoshi, MD, PhD, Department of Internal Medicine, School of Life Dentistry at Niigata, the Nippon Dental University, 1-8 Hamaura-Cho, Chuo-ku, Niigata-city 951-8580, Japan. okoshi@ngt.ndu.ac.jp
Telephone: +81-25-2118243 Fax: +81-25-2671582
Received: May 20, 2015
Peer-review started: May 21, 2015
First decision: July 10, 2015
Revised: July 15, 2015
Accepted: September 10, 2015
Article in press: September 16, 2015
Published online: November 6, 2015
Processing time: 175 Days and 21.1 Hours
Abstract

Recently, direct antiviral agents (DAAs) have been increasingly used for the treatment of chronic hepatitis C virus (HCV) infections, replacing interferon-based regimens that have severe adverse effects and low tolerability. The constant supply of new DAAs makes shorter treatment periods with enhanced safety possible. The efficacy of DAAs for treatment of compensated liver cirrhosis (LC) is not less than that for treatment of non-cirrhotic conditions. These clinical advantages have been useful in pre- and post-liver transplantation (LT) settings. Moreover, DAAs can be used to treat decompensated HCV-induced LC in elderly patients or those with severe complications otherwise having poor prognosis. Although encouraging clinical data are beginning to appear, the actual efficacy of DAAs for suppressing disease progression, allowing delisting for LT and, most importantly, improving prognosis of patients with decompensated HCV-LC remains unknown. Case-control studies to examine the short- or long-term effects of DAAs for treatment of decompensated HCV-LC are urgently need.

Keywords: Decompensated liver cirrhosis, Prognosis, Direct antiviral agent, Hepatitis C virus, Comorbidity, Nucleic acid analogue

Core tip: Decompensated liver cirrhosis (LC) due to hepatitis C virus (HCV) infection is a severe disease with poor prognosis. Because interferon-included regimens are contraindicated at this stage, liver transplantation has been the only way to cure the disease. However, recent development of direct antiviral agents (DAAs) is offering a hope for this difficult situation. Promising antiviral effects of DAAs for LC have been observed, suggesting they might be useful for treatment of decompensated HCV-LC. To explore this possibility, large case-control studies are needed.