Direct acting antivirals are associated with more liver stiffness regression than pegylated interferon therapy in chronic hepatitis C patients

ABSTRACT

Objectives

Extent of post-treatment fibrosis change in patients with different stages of fibrosis not fully known. We aimed to study changes in liver fibrosis in chronic hepatitis C patients who were treated with pegylated interferon/ribavirin (PEG/RBV) or direct acting antivirals (DAAs).

Methods

Retrospective evaluation of results of transient elastography (TE) was done before and 1 year after end of treatment for patients treated with PEG/RBV (n = 268) and DAAs (n = 245).

Results

The average age was 45.54 ± 10.64 years; mainly males. All patients in the DAAs group achieved sustained virological response (SVR), unlike 56.3% of the patients in the PEG/RBV group. F3-F4 fibrosis was predominant in the PEG/RBV nonresponder patients (51.3%) and DAAs responders (57.1%). TE decreased 1 year after end of treatment (p = 0.001) in the viral responders of the PEG/RBV group (7.44 ± 4.02 vs. 10.24 ± 7.29 kPa) and DAAs group (12.12 ± 9.21 vs. 16.81 ± 12.84 kPa) respectively. The delta TE change in the DAAs responders was higher than the PEG/RBV responders (p = 0.001) and PEG/RBV nonresponders (p = 0.001). The percentage of patients with liver fibrosis regression was higher in DAAs responders (52.5%) than in PEG/RBV responders (23.3%).

Conclusion

Treatment with DAAs is associated with fibrosis improvement more than treatment with PEG/RBV in chronic hepatitis C patients.

KEYWORDS:

• HCV
• transient elastography
• liver fibrosis
• regression
• direct-acting antivirals

Expert Opinion

Hepatitis C virus (HCV) is a leading cause of liver disease allover the world. Liver fibrosis is a common consequence of HCV infection, that may progress to cirrhosis, decompensation, and hepatocellular carcinoma.

Till now there is no approved treatment for liver fibrosis. The removal of the liver disease causative agent as HCV, is the only way to stop disease and trigger reversal of fibrosis.

Daily interferon injections were the first drug regimen to treat HCV infection, and were disappointing. A breakthrough was the pegylation of interferon which allowed weekly injection with higher efficacy especially when combined with ribavirin. Nearly half the patients had viral cure defined as sustained virological response. A lot of patients were ineligible for pegylated interferon therapy especially advanced cirrhosis and those with decompensation.

Another breakthrough was the advent of the direct acting antivirals (DAAs). Earlier DAAs generations were combined with pegylated interferon and fortunately nowadays there are used alone. DAAs are easy to take drugs with few side effects and high patient compliance in contrast to interferon therapy. DAAs are associated with very high incidence of sustained virological response. In our study we compared the magnitude of fibrosis reversal, assessed by using FibroScan, in the two different eras of treatment. Fortunately, DAAs were the best as regard fibrosis reversal.

Article highlights

• HCV is a common cause of liver fibrosis that may proceed to liver cirrhosis and decompensation.

• Chronic hepatitis C was treated in the past with pegylated interferon/ribavirin (PEG/RBV) therapy.

• Recently direct-acting antivirals (DAAs) are the standard of care drugs.

• Chronic hepatitis B and autoimmune hepatitis patients had declining fibrosis stages with successful treatment.

• This study aimed to study the regression of liver fibrosis in treated chronic hepatitis C patients and to compare the PEG/RBV and DAAs as regards the degree of regression.

Declaration of interest

I Waked discloses being an Investigator and/or speaker for AbbVie, Gilead Sciences, Janssen, Marcyrl, Onxio, Pharco. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors shared in data collection. Imam Waked and Mohsen Salama did conception of the design. Eman Abdelsameea, Ayman Alsebaey, Mohamed Abdel-Samiee, and Wael Abdel-Razek did the analysis and paper writing. Final revision was by Imam Waked, Eman Abdelsameea, and Ayman Alsebaey. All authors agreed to be accountable for all aspects of the work.

Additional information

Funding

This paper was not funded.