Sustained virological response to interferon-α is associated with improved outcome in HCV-related cirrhosis: A retrospective study
✍ Scribed by Savino Bruno; Tommaso Stroffolini; Massimo Colombo; Simona Bollani; Luisa Benvegnù; Giuseppe Mazzella; Antonio Ascione; Teresa Santantonio; Felice Piccinino; Pietro Andreone; Alessandra Mangia; Giovanni B. Gaeta; Marcello Persico; Stefano Fagiuoli; Piero L. Almasio
- Book ID
- 102240598
- Publisher
- John Wiley and Sons
- Year
- 2007
- Tongue
- English
- Weight
- 227 KB
- Volume
- 45
- Category
- Article
- ISSN
- 0270-9139
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✦ Synopsis
The effect of achieving a sustained virological response (SVR) following interferon-␣ (IFN␣) treatment on the clinical outcomes of patients with HCV-related cirrhosis is unknown. In an attempt to assess the risk of liver-related complications, HCC and liver-related mortality in patients with cirrhosis according to the response to IFN␣ treatment, a retrospective database was developed including all consecutive patients with HCV-related, histologically proven cirrhosis treated with IFN␣ monotherapy between January 1992 and December 1997. SVR was an undetectable serum HCV-RNA by PCR 24 weeks after IFN␣ discontinuation. HCC was assessed by ultrasound every 6 months. Independent predictors of all outcomes were assessed by Cox regression analysis. Of 920 patients, 124 (13.5%) were classified as achieving a SVR. During a mean follow-up of 96.1 months (range: 6-167) the incidence rates per 100 person-years of liver-related complications, HCC and liver-related death were 0, 0.66, and 0.19 among SVR and 1.88, 2.10, and 1.44 among non-SVR (P < 0.001 by log-rank test). Multivariate analyses found that non-SVR was associated with a higher risk of liver-related complications (hazard ratio, HR, not applicable), HCC (HR 2.59; 95% CI 1.13-5.97) and liver-related mortality (HR 6.97; 95% CI 1.71-28.42) as compared to SVR. Conclusion: Thus, in patients with HCV-related, histologically proven cirrhosis, achievement of a SVR after IFN␣ therapy was associated with a reduction of liver-related mortality lowering both the risk of complications and HCC development. Irrespective of SVR achievement, all patients should continue surveillance because the risk of occurrence of HCC was not entirely avoided. (HEPATOLOGY 2007