Portal pressure predicts outcome and safety of antiviral therapy in cirrhotic patients with hepatitis C virus infection
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Portal pressure predicts outcome and safety of antiviral therapy in cirrhotic patients with hepatitis C virus infection. / Reiberger, Thomas; Rutter, Karoline; Ferlitsch, Arnulf; Payer, Berit Anna; Hofer, Harald; Beinhardt, Sandra; Kundi, Michael; Ferenci, Peter; Gangl, Alfred; Trauner, Michael; Peck-Radosavljevic, Markus.
In: CLIN GASTROENTEROL H, Vol. 9, No. 7, 01.07.2011, p. 602-8.e1.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Portal pressure predicts outcome and safety of antiviral therapy in cirrhotic patients with hepatitis C virus infection
AU - Reiberger, Thomas
AU - Rutter, Karoline
AU - Ferlitsch, Arnulf
AU - Payer, Berit Anna
AU - Hofer, Harald
AU - Beinhardt, Sandra
AU - Kundi, Michael
AU - Ferenci, Peter
AU - Gangl, Alfred
AU - Trauner, Michael
AU - Peck-Radosavljevic, Markus
N1 - Copyright © 2011 AGA Institute. Published by Elsevier Inc. All rights reserved.
PY - 2011/7/1
Y1 - 2011/7/1
N2 - BACKGROUND & AIMS: There are limited data on the efficacy and safety of antiviral therapy in patients with hepatitis C virus (HCV)-related cirrhosis, particularly on the impact of portal hypertension.METHODS: We assessed hepatovenous pressure gradient (HVPG), liver stiffness (transient elastography), and interleukin (IL)-28B polymorphisms (rs12979860) in 90 cirrhotic patients with HCV infection (82% genotype 1 or 4) before antiviral therapy with pegylated interferon and ribavirin. Efficacy and safety were evaluated.RESULTS: Rates of sustained virologic response were significantly lower among patients with clinically significant portal hypertension (CSPH; HVPG ≥ 10 mm Hg; n = 50) than among patients without CSPH (HVPG <10 mm Hg; n = 40): 14% vs 51% (P = .0007). Seventy-nine percent and 83% of patients with CSPH and without CSPH, respectively, received more than 80% of planned dose (P = .647). The predictive value of HVPG (area under the curve [AUC], 0.743) was greater than that of liver stiffness (AUC, 0.647) or of baseline HCV RNA levels (AUC, 0.620). The IL-28B polymorphism was not associated significantly with a sustained virologic response. Multivariate analysis revealed that HVPG (odds ratio [OR], 14.3; P = .009), baseline HCV RNA levels (OR, 5.3; P = .019), and HCV genotype (OR, 6.5; P = .046) were independent risk factors for treatment failure. A trend toward higher incidence of anemia and neutropenia was observed for patients with CSPH. The incidence and grade of thrombocytopenia were significantly higher among patients with than without CSPH (94% vs 75%; P = .006).CONCLUSIONS: HVPG is an independent predictor of response to antiviral therapy, with better predictive value than liver stiffness, baseline HCV RNA levels, HCV genotype, or IL-28B polymorphism. The incidence and grade of thrombocytopenia during antiviral therapy are higher among patients with CSPH. In evaluating cirrhotic HCV patients for antiviral treatment, measurement of HVPG should be considered.
AB - BACKGROUND & AIMS: There are limited data on the efficacy and safety of antiviral therapy in patients with hepatitis C virus (HCV)-related cirrhosis, particularly on the impact of portal hypertension.METHODS: We assessed hepatovenous pressure gradient (HVPG), liver stiffness (transient elastography), and interleukin (IL)-28B polymorphisms (rs12979860) in 90 cirrhotic patients with HCV infection (82% genotype 1 or 4) before antiviral therapy with pegylated interferon and ribavirin. Efficacy and safety were evaluated.RESULTS: Rates of sustained virologic response were significantly lower among patients with clinically significant portal hypertension (CSPH; HVPG ≥ 10 mm Hg; n = 50) than among patients without CSPH (HVPG <10 mm Hg; n = 40): 14% vs 51% (P = .0007). Seventy-nine percent and 83% of patients with CSPH and without CSPH, respectively, received more than 80% of planned dose (P = .647). The predictive value of HVPG (area under the curve [AUC], 0.743) was greater than that of liver stiffness (AUC, 0.647) or of baseline HCV RNA levels (AUC, 0.620). The IL-28B polymorphism was not associated significantly with a sustained virologic response. Multivariate analysis revealed that HVPG (odds ratio [OR], 14.3; P = .009), baseline HCV RNA levels (OR, 5.3; P = .019), and HCV genotype (OR, 6.5; P = .046) were independent risk factors for treatment failure. A trend toward higher incidence of anemia and neutropenia was observed for patients with CSPH. The incidence and grade of thrombocytopenia were significantly higher among patients with than without CSPH (94% vs 75%; P = .006).CONCLUSIONS: HVPG is an independent predictor of response to antiviral therapy, with better predictive value than liver stiffness, baseline HCV RNA levels, HCV genotype, or IL-28B polymorphism. The incidence and grade of thrombocytopenia during antiviral therapy are higher among patients with CSPH. In evaluating cirrhotic HCV patients for antiviral treatment, measurement of HVPG should be considered.
KW - Adult
KW - Antiviral Agents
KW - Elasticity Imaging Techniques
KW - Female
KW - Hepatitis C, Chronic
KW - Humans
KW - Incidence
KW - Interferon-alpha
KW - Interleukins
KW - Liver
KW - Liver Cirrhosis
KW - Male
KW - Middle Aged
KW - Polyethylene Glycols
KW - Polymorphism, Genetic
KW - Portal Pressure
KW - Predictive Value of Tests
KW - Prognosis
KW - Recombinant Proteins
KW - Ribavirin
KW - Thrombocytopenia
KW - Treatment Outcome
U2 - 10.1016/j.cgh.2011.03.002
DO - 10.1016/j.cgh.2011.03.002
M3 - SCORING: Journal article
C2 - 21397726
VL - 9
SP - 602-8.e1
JO - CLIN GASTROENTEROL H
JF - CLIN GASTROENTEROL H
SN - 1542-3565
IS - 7
ER -
