Slow regression of liver fibrosis presumed by repeated biomarkers after virological cure in patients with chronic hepatitis C

Journal of Hepatology
Volume 59, Issue 4 , Pages 675-683, October 2013

Thierry Poynard, Joseph Moussalli, Mona Munteanu, Dominique Thabut, Pascal Lebray, Marika Rudler, Yen Ngo, Vincent Thibault, Helmi Mkada, Frederic Charlotte, Françoise Imbert Bismut, Olivier Deckmyn, Yves Benhamou, Marc Antoine Valantin, Vlad Ratziu, Christine Katlama, FibroFrance-GHPS group

Received 31 March 2013; received in revised form 29 April 2013; accepted 8 May 2013. published online 28 May 2013.

Abstract

Background & Aims

Chronic hepatitis C is both a virologic and fibrotic disease and complications can occur in patients with sustained virologic response (SVR) with residual fibrosis. Due to the limitations of repeated biopsies, no studies have assessed the dynamic of fibrosis before and after treatment. Using biopsy as reference, FibroTest™ has been validated as a biomarker of fibrosis progression and regression, with similar prognostic values. The aim was to estimate the impact of SVR on the dynamic of fibrosis presumed by FibroTest™.

Methods

In a prospective cohort, the main end point was the 10-year regression rate of fibrosis, defined as a minimum 0.20 decrease in FibroTest™, equivalent to one METAVIR stage.

Results

A total of 933 patients with both repeated FibroTest™ and transient elastography were included. At 10years, among the 415 patients with baseline advanced fibrosis, 49% (95% CI 33–64%) of the 108 SVR had a regression, which was greater than in the 219 non-responders [23% (14–33%; p<0.001 vs. SVR)] and not lower than in the 88 non-treated [45% (10–80%; p=0.39 vs. SVR)] patients. In all 171 SVR, cirrhosis regressed in 24/43 patients, but 15 new cirrhosis cases occurred out of 128 patients, that is only a net reduction of 5.3% [(24–15)=9/171); (2.4–9.8%)]. Four cases of primary liver cancer occurred in SVR [4.6% (0–9.8)], and 13 in non-responders [5.6% (1.5–9.8); p=0.07].

Conclusions

In patients with chronic hepatitis C, and as presumed by FibroTest™, virological cure was associated with slow regression of fibrosis 10years later, a disappointing 5% decrease in cirrhosis cases, and a remaining 5% risk of primary liver cancer.

Keywords: Cirrhosis, FibroTest™, FibroSure, Elastography

PII: S0168-8278(13)00345-0

doi:10.1016/j.jhep.2013.05.015

© 2013 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.

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