Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
Centre for Evidence Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
J Viral Hepat. 2021 Jan;28(1):168-176. doi: 10.1111/jvh.13408. Epub 2020 Nov 2.
Whilst the benefit of direct-acting antiviral agents (DAAs) in achieving sustained virological response (SVR) is now well-accepted, their impact on liver function, particularly in relation to achievement of SVR, has not been well documented. We studied 2394 patients with chronic HCV infection, 1276 receiving DAAs and 1118 interferon-based therapy. Liver function was assessed by the albumin-bilirubin (ALBI) score or grade. Overall survival according to SVR status and baseline ALBI grade was examined. We also studied time to first decompensation according to ALBI grade, as well as longitudinal changes in ALBI score over time according to SVR. Among the patients receiving DAAs, 89% achieved SVR (Japan = 99%, UK = 78%). Amongst the decompensated patients in the UK cohort, three distinct risk groups according to ALBI grade at baseline were observed. The UK patients receiving DAAs, who had predominantly decompensated disease, showed clear evidence of improvement of liver function detectable within 2 years of the start of treatment, especially in those achieving SVR. These early changes in liver function were very similar to those observed in the first 2-3 years after interferon-based therapy. DAAs improve liver function especially in those with decompensated disease who achieve SVR. Experience with interferon-based therapy suggests that failure to achieve SVR is associated with long-term decline in liver function and, in contrast, patients who do achieve SVR can expect long-term disease improvement and subsequent stabilization of liver function. Our initial analysis suggests that those receiving DAAs are likely, in the long term, to follow a similar course.
虽然直接作用抗病毒药物 (DAA) 在实现持续病毒学应答 (SVR) 方面的益处已被广泛认可，但它们对肝功能的影响，特别是与 SVR 实现相关的影响，尚未得到充分记录。我们研究了 2394 例慢性 HCV 感染患者，其中 1276 例接受 DAA 治疗，1118 例接受干扰素治疗。通过白蛋白-胆红素 (ALBI) 评分或分级评估肝功能。根据 SVR 状态和基线 ALBI 分级检查总体生存率。我们还研究了根据 ALBI 分级的首次失代偿时间，以及根据 SVR 随时间变化的 ALBI 评分的纵向变化。在接受 DAA 治疗的患者中，89%达到 SVR（日本为 99%，英国为 78%）。在英国队列中失代偿的患者中，根据基线时的 ALBI 分级观察到三个不同的风险组。在英国，接受 DAA 治疗的患者主要患有失代偿性疾病，治疗开始后 2 年内肝功能明显改善，尤其是在达到 SVR 的患者中。这些肝功能的早期变化与干扰素治疗后前 2-3 年观察到的变化非常相似。DAA 可改善肝功能，尤其是在达到 SVR 的失代偿性疾病患者中。干扰素治疗的经验表明，未能达到 SVR 与肝功能长期下降相关，而达到 SVR 的患者可以预期长期疾病改善和随后肝功能稳定。我们的初步分析表明，长期来看，接受 DAA 治疗的患者可能会遵循类似的病程。
