Session Title: Category 5g. VIRAL HEPATITIS: g. HEPATITIS C - CLINICAL (THERAPY)
Presentation Date: Apr 15, 2010
SUCCESSFUL THERAPY WITH PEGYLATED INTERFERON ALFA-2A AND RIBAVIRIN CAUSES A SUSTAINED DECREASE IN PORTAL PRESSURE IN PATIENTS WITH CHRONIC HEPATITIS C-RELATED CIRRHOSIS
M. Garcia-Retortillo1*, D. Rincón2, A. Albillos3, J. Colmenero1, R. Bataller1, J.L. Calleja4, R. Bañares2, J.G. Abraldes1, J. Bosch1, J.M. Sanchez-Tapias1, X. Forns1, J.C. Garcia-Pagán1, CIBERehd Spain
1Liver Unit, Hospital Clínic, Barcelona, 2Hospital Gregorio Marañón, 3Hospital Ramón y Cajal, 4Hospital Puerta de Hierro, Madrid, Spain. *firstname.lastname@example.org
Introduction: In patients with compensated hepatitis C-related cirrhosis (HC-Cirrhosis), an hepatic venous pressure gradient (HVPG) ≥10mmHg (Clinically Significant Portal Hypertension, CSPHT) is associated with higher risk of hepatic decompensation and worse prognosis. In this setting, reduction of HVPG >10% of baseline has been shown to prevent complications from portal hypertension. Antiviral therapy is indicated in these patients, and preliminary data suggest a beneficial effect of antiviral therapy on HVPG.
Aim: To assess, in patients with HC-Cirrhosis and CSPHT, the short and long-term effect of antiviral therapy with PegInterferon alfa-2a (180ug weekly) and ribavirin (800-1200mg/d) (Peg+Riba) on HVPG.
Methods: In 30 patients with HC-cirrhosis and CSPH receiving antiviral therapy with Peg+Riba, HVPG was determined at baseline and after 12 weeks of therapy. In 15/17 patients with early virological response (EVR: decrease >2 logs of viral load at week 12) HVPG was again measured 6 weeks after completing 48 weeks of treatment (9 of them with SVR, and 6 without). In 5/13 patients without EVR, Peg+Riba was stopped and HVPG was again measured after a similar observational follow up period.
Results: 80% of patients were male and the median age was 52±9 years. Genotype 1 represented 87% of all cases and median baseline viral load was log10 6.08±0.66. At week 12, HVPG significantly decreased from 15.5±3.8 to 13.9±3.3 mmHg (p< 0.001) with a median decrease of 9.1±13%. In 13 patients, this reduction was >10% or below the 10 mmHg threshold (HVPG responders). HVPG responders were those with higher baseline viral load (6.5±0.3 vs 5.7±0.7; p=0.001) and those that had had a greater reduction in viral load and ALT at week 12 (-4,2±2.2 vs -2,6±2: p=0.03 and -102±74 vs -49±71 IU/L; p=0.06 respectively in HVPG nonresponders). In the 9 patients with SVR, the reduction in HVPG achieved at week 12 was maintained six weeks after completing antiviral therapy (12,9±2,8mmHg (12weeks) to 12.2±3.5;p=0.2) while HVPG tended to increase in the 11 pts without SVR or EVR (from 13.4±3.3 to 15.0±4.4 mmHg; p=0.06).
Conclusion: Successful Peg+Riba treatment significantly reduces HVPG in HC-cirrhosis and by this mechanism may prevent the appearance of portal hypertension-related complications.