Follow‐up of sustained virological responders with hepatitis C and advanced liver disease after interferon/ribavirin‐free treatment

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>The introduction of direct‐acting antivirals (<jats:styled-content style="fixed-case">DAA</jats:styled-content>) has increased sustained virological response (<jats:styled-content style="fixed-case">SVR</jats:styled-content>) rates in patients with advanced liver disease and chronic hepatitis C(<jats:styled-content style="fixed-case">CHC</jats:styled-content>)infection. At present, data on clinical outcome and long‐term durability of viral eradication after successful <jats:styled-content style="fixed-case">DAA</jats:styled-content> therapy are scarce.</jats:p></jats:sec><jats:sec><jats:title>Aim</jats:title><jats:p>To evaluate the long‐term success of viral eradication in patients with advanced fibrosis or cirrhosis treated with <jats:styled-content style="fixed-case">DAA</jats:styled-content>s.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Five hundred and fifty‐one patients with advanced fibrosis (n = 158) or cirrhosis (<jats:styled-content style="fixed-case">CPS</jats:styled-content>‐A:317,<jats:styled-content style="fixed-case">CPS</jats:styled-content>‐B/C:76) and <jats:styled-content style="fixed-case">SVR</jats:styled-content> after interferon and ribavirin‐free <jats:styled-content style="fixed-case">DAA</jats:styled-content> therapy treated between October 2013 and April 2016 were studied with a median follow‐up of 65.6 (13.0‐155.3) weeks. Only patients without hepatocellular carcinoma (<jats:styled-content style="fixed-case">HCC</jats:styled-content>) at baseline and without liver transplantation were included.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Twelve patients (2.2%) died during follow‐up: the mortality rate was 0.6% in F3, 2.2% in <jats:styled-content style="fixed-case">CPS</jats:styled-content>‐A and 5.3% in <jats:styled-content style="fixed-case">CPS</jats:styled-content>‐B/C patients (<jats:italic>P</jats:italic> = .08). During follow‐up 36 patients with cirrhosis (9.1%) developed a liver related event, including 16 with de‐novo <jats:styled-content style="fixed-case">HCC</jats:styled-content> (4.1%). Seven patients were transplanted at a median of 9.7 (range 3.8‐21.7) months after <jats:styled-content style="fixed-case">EOT</jats:styled-content>. History of decompensation was significantly associated with liver related events during follow‐up (<jats:styled-content style="fixed-case">HR</jats:styled-content> 7.9; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 2.7‐22.6; <jats:italic>P</jats:italic> < .001), and with mortality (<jats:styled-content style="fixed-case">HR</jats:styled-content> 5.5; 95% <jats:styled-content style="fixed-case">CI</jats:styled-content> 1.5‐20.2, <jats:italic>P</jats:italic> = .01).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Eradication of <jats:styled-content style="fixed-case">HCV</jats:styled-content> by <jats:styled-content style="fixed-case">DAA</jats:styled-content> therapy was durable irrespective of the <jats:styled-content style="fixed-case">DAA</jats:styled-content> combination used. Most of the cured patients had an excellent long‐term clinical prognosis. Nevertheless, the risk of new occurrence of <jats:styled-content style="fixed-case">HCC</jats:styled-content> remains worrisome and thus regular surveillance is obligatory even after clinical stabilization and improvement of the patient.</jats:p></jats:sec>