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Barré T, Bourlière M, Parlati L, Ramier C, Marcellin F, Protopopescu C, Di Beo V, Cagnot C, Dorival C, Nicol J, Zoulim F, Carrat F, Carrieri P. Hepatitis C virus cure from direct-acting antivirals and mortality: Are people with and without a history of injection drug use in the same boat? (ANRS CO22 Hepather cohort). Drug Alcohol Rev 2024; 43:718-731. [PMID: 38133601 DOI: 10.1111/dar.13802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The risk of mortality in people with a history of injection drug use (PHID) is high, as is the prevalence of hepatitis C virus (HCV) infection. Although direct-acting antivirals (DAA) are effective in this population in terms of sustained virological response, it is not known whether PHID benefit as much as people with no history of injection drug use from DAA-related HCV cure in terms of reduced all-cause mortality. METHODS Using Cox proportional hazards models based on the ANRS CO22 Hepather cohort data (n = 9735), we identified factors associated with all-cause mortality among HCV-infected people. We tested for interaction effects between drug injection status, HCV cure and other explanatory variables. RESULTS DAA-related HCV cure was associated with a 66% (adjusted hazard ratio [95% confidence interval]: 0.34 [0.29-0.39]) lower risk of all-cause mortality, irrespective of drug injection status. Detrimental effects of unhealthy alcohol use on mortality were identified in PHID only. DISCUSSION AND CONCLUSIONS DAA-related HCV cure led to comparable benefits in terms of reduced mortality in PHID and people with no history of injection drug use. Policies and strategies to enhance DAA uptake among PHID are needed to lower mortality in this population. Clinical trial registration details: ClinicalTrials.gov: NCT01953458.
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Affiliation(s)
- Tangui Barré
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Marc Bourlière
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
- Département d'hépatologie et gastroentérologie, Hôpital Saint Joseph, Marseille, France
| | - Lucia Parlati
- Université de Paris Cité; Institut National de la Santé et de la Recherche Médicale; Assistance Publique-Hôpitaux de Paris, Département d'Hépatologie/Addictologie, Hôpital Cochin, Paris, France
| | - Clémence Ramier
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Fabienne Marcellin
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Camelia Protopopescu
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Vincent Di Beo
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
| | - Carole Cagnot
- ANRS | Emerging Infectious Diseases, Department of Clinical Research, Paris, France
| | - Celine Dorival
- Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Jérôme Nicol
- Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Fabien Zoulim
- Institut National de la Santé et de la Recherche Médicale U1052, Centre National de la Recherche Scientifique, Unités Mixtes de Recherche-5286, Cancer Research Center of Lyon, Lyon, France
- University of Lyon, Université Claude-Bernard, Lyon, France
- Hospices Civils de Lyon, Lyon, France
| | - Fabrice Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Hôpital Saint-Antoine, Unité de Santé Publique, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Patrizia Carrieri
- Aix Marseille Université, Institut National de la Santé et de la Recherche Médicale, Institut de Recherche pour le Developpement , Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Institut des Sciences de la Santé Publique d'Aix-Marseille, Marseille, France
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Lam L, Fontaine H, Lapidus N, Dorival C, Bellet J, Larrey D, Nahon P, Diallo A, Cagnot C, Lusivika-Nzinga C, Téoulé F, Hejblum G, Bourlière M, Pol S, Carrat F. Impact of direct-acting antiviral treatment for hepatitis C on cardiovascular diseases and extrahepatic cancers. Pharmacoepidemiol Drug Saf 2023; 32:486-495. [PMID: 36444965 DOI: 10.1002/pds.5576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The impact of direct-acting antivirals (DAAs) on extrahepatic complications in chronic hepatitis C (CHC) patients remains poorly described. We estimated the association of DAAs with cardiovascular events and extrahepatic cancers. METHODS The prospective ANRS CO22 HEPATHER cohort was enriched with individual data until December 2018 from the French Health Insurance Database (SNDS). CHC patients were enrolled between August 2012 and December 2015 in 32 French hepatology centers. A total of 8148 CHC adults were selected. Cardiovascular events (stroke, acute coronary syndrome, pulmonary embolism, heart failure, arrhythmias and conduction disorders [ACD], peripheral arterial disease [PAD]) and extrahepatic solid cancers were derived from the SNDS. Associations between DAAs and extrahepatic events were estimated using marginal structural models, with adjustments for clinical confounders. RESULTS Analyses of 12 905 person-years of no DAA exposure and 22 326 person-years following DAA exposure showed a decreased risk of PAD after DAA exposure (hazard ratio [HR], 0.54; 95% CI, 0.33-0.89), a beneficial effect of DAAs on overall cardiovascular outcomes in patients with advanced fibrosis (aHR, 0.58; 95% CI, 0.42-0.79), and an increased risk of ACD (hazard ratio [HR], 1.46; 95% CI, 1.04-2.04), predominant after the first year following DAA initiation. There was no association between DAAs and extrahepatic cancer risk (HR, 1.23; 95% CI, 0.50-3.03). CONCLUSIONS DAAs were not associated with extrahepatic cancer development or reduction. They were associated with a decreased risk of PAD and an increased risk of ACD, supporting long-term cardiac monitoring after DAA therapy.
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Affiliation(s)
- Laurent Lam
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Paris, France
| | - Hélène Fontaine
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Nathanael Lapidus
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Paris, France
- Department of Public Health, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Céline Dorival
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Paris, France
| | - Jonathan Bellet
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Paris, France
| | - Dominique Larrey
- Service des maladies de l'appareil digestif, Hôpital Saint Eloi and IBR, INSERM, Montpellier, France
| | - Pierre Nahon
- Service d'Hépatologie, AP-HP, Hôpital Avicenne, Bobigny, France
- Université Sorbonne Paris Nord, Bobigny, France
- Inserm, UMR-1162, "Génomique fonctionnelle des tumeurs solides", Paris, France
| | - Alpha Diallo
- ANRS, Emerging Infectious Diseases, Paris, France
| | | | - Clovis Lusivika-Nzinga
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Paris, France
| | - François Téoulé
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Paris, France
| | - Gilles Hejblum
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Paris, France
| | - Marc Bourlière
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France
- INSERM, UMR 1252 IRD SESSTIM, Aix Marseille Université, Marseille, France
| | - Stanislas Pol
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
- Université Paris Cité, Paris, France
| | - Fabrice Carrat
- INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Sorbonne Université, Paris, France
- Department of Public Health, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
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Lam L, Fontaine H, Lapidus N, Bellet J, Lusivika-Nzinga C, Nicol J, Dorival C, Cagnot C, Hejblum G, Pol S, Bourlière M, Carrat F. Performance of algorithms for identifying patients with chronic hepatitis B or C infection in the french health insurance claims databases using the ANRS CO22 HEPATHER cohort. J Viral Hepat 2023; 30:232-241. [PMID: 36529681 DOI: 10.1111/jvh.13788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 02/16/2023]
Abstract
The validity of algorithms for identifying patients with chronic hepatitis B or C virus (HBV or HCV) infection in claims databases has been little explored. The performance of 15 algorithms was evaluated. Data from HBV- or HCV-infected patients enrolled between August 2012 and December 2015 in French hepatology centres (ANRS CO22 HEPATHER cohort) were individually linked to the French national health insurance system (SNDS). The SNDS covers 99% of the French population and contains healthcare reimbursement data. Performance metrics were calculated by comparing the viral status established by clinicians with those obtained with the algorithms identifying chronic HBV- and HCV-infected patients. A total of 14 751 patients (29% with chronic HBV and 63% with chronic HCV infection) followed-up until December 2018 were selected. Despite good specificity, the algorithms relying on ICD-10 codes performed poorly. By contrast, the multi-criteria algorithms combining ICD-10 codes, antiviral dispensing, laboratory diagnostic tests (HBV DNA or HCV RNA detection and quantification, HCV genotyping), examinations for the assessment of liver fibrosis and long-term disease registrations were the most effective (sensitivity 0.92, 95% CI, 0.91-0.93 and specificity 0.96, 95% CI, 0.95-0.96 for identifying chronic HBV-infected patients; sensitivity 0.94, 95% CI, 0.94-0.94 and specificity 0.85, 95% CI, 0.84-0.86 for identifying chronic HCV-infected patients). In conclusion, the multi-criteria algorithms perform well in identifying patients with chronic hepatitis B or C infection and can be used to estimate the magnitude of the public health burden associated with hepatitis B and C in France.
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Affiliation(s)
- Laurent Lam
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Hélène Fontaine
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France
| | - Nathanael Lapidus
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France.,Department of Public Health, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
| | - Jonathan Bellet
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Clovis Lusivika-Nzinga
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Jérôme Nicol
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Céline Dorival
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | | | - Gilles Hejblum
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France
| | - Stanislas Pol
- Department of Hepatology, Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Paris, France.,Université de Paris Cité, Paris, France
| | - Marc Bourlière
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France.,INSERM, UMR 1252 IRD SESSTIM, Aix Marseille Université, Marseille, France
| | - Fabrice Carrat
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Paris, France.,Department of Public Health, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Sorbonne Université, Paris, France
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Nahon P, Bamba-Funck J, Layese R, Trépo E, Zucman-Rossi J, Cagnot C, Ganne-Carrié N, Chaffaut C, Guyot E, Ziol M, Sutton A, Audureau E. Integrating genetic variants into clinical models for hepatocellular carcinoma risk stratification in cirrhosis. J Hepatol 2023; 78:584-595. [PMID: 36427656 DOI: 10.1016/j.jhep.2022.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/06/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND & AIMS Identifying individuals at higher risk of developing hepatocellular carcinoma (HCC) is pivotal to improve the performance of surveillance strategies. Herein, we aimed to evaluate the ability of single nucleotide polymorphisms (SNPs) to refine HCC risk stratification. METHODS Six SNPs in PNPLA3, TM6SF2, HSD17B13, APOE, and MBOAT7 affecting lipid turnover and one variant involved in the Wnt-β-catenin pathway (WNT3A-WNT9A rs708113) were assessed in patients with alcohol-related and/or HCV-cured cirrhosis included in HCC surveillance programmes (prospective CirVir and CIRRAL cohorts). Their prognostic value for HCC occurrence was assessed using Fine-Gray models combined into a 7-SNP genetic risk score (GRS). The predictive ability of two clinical scores (a routine non-genetic model determined by multivariate analysis and the external aMAP score) with/without the GRS was evaluated by C-indices. The standardised net benefit was derived from decision curves. RESULTS Among 1,145 patients, 86 (7.5%) developed HCC after 43.7 months. PNPLA3 and WNT3A-WNT9A variants were independently associated with HCC occurrence. The GRS stratified the population into three groups with progressively increased 5-year HCC incidence (Group 1 [n = 627, 5.4%], Group 2 [n = 276, 10.7%], and Group 3 [n = 242, 15.3%]; p <0.001). The multivariate model identified age, male sex, diabetes, platelet count, gamma-glutamyltransferase levels, albuminemia and the GRS as independent risk factors. The clinical model performance for 5-year HCC prediction was similar to that of the aMAP score (C-Index 0.769). The addition of the GRS to both scores modestly improved their performance (C-Indices of 0.786 and 0.783, respectively). This finding was confirmed by decision curve analyses showing only fair clinical net benefit. CONCLUSIONS Patients with cirrhosis can be stratified into HCC risk classes by variants affecting lipid turnover and the Wnt-β-catenin pathway. The incorporation of this genetic information modestly improves the performance of clinical scores. IMPACT AND IMPLICATIONS The identification of patients at higher risk of developing liver cancer is pivotal to improve the performance of surveillance. Risk assessment can be achieved by combining several clinical and biological parameters used in routine practice. The addition of patients' genetic characteristics can modestly improve this prediction and will ultimately pave the way for precision medicine in patients eligible for HCC surveillance, allowing physicians to trigger personalised screening strategies.
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Affiliation(s)
- Pierre Nahon
- APHP, Liver Unit, Bobigny, Université Sorbonne Paris Nord, F-93000 Bobigny, France; Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de Recherche des Cordeliers, Université de Paris, Paris, France.
| | - Jessica Bamba-Funck
- APHP, Biochemistry Unit, Bobigny, Université Sorbonne Paris Nord, and Inserm, UMR-1148 "Laboratory for Vascular Translational Science" Université Sorbonne Paris Nord, F-93000 Bobigny, France
| | - Richard Layese
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Service de Santé Publique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94000, Créteil, France
| | - Eric Trépo
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, CUB Hopital Erasme, and Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium
| | - Jessica Zucman-Rossi
- Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de Recherche des Cordeliers, Université de Paris, Paris, France
| | - Carole Cagnot
- Clinical Research Department, ANRS|Emerging Infectious Diseases, Paris, France
| | | | - Cendrine Chaffaut
- SBIM, APHP, Hôpital Saint-Louis, Paris, Inserm, UMR-1153, ECSTRA Team, Paris, France
| | - Erwan Guyot
- APHP, Biochemistry Unit, Bobigny, Université Sorbonne Paris Nord, and Inserm, UMR-1148 "Laboratory for Vascular Translational Science" Université Sorbonne Paris Nord, F-93000 Bobigny, France
| | - Marianne Ziol
- APHP, Pathology Unit, Bobigny, Université Sorbonne Paris Nord, F-93000 Bobigny, France; Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de Recherche des Cordeliers, Université de Paris, Paris, France
| | - Angela Sutton
- APHP, Biochemistry Unit, Bobigny, Université Sorbonne Paris Nord, and Inserm, UMR-1148 "Laboratory for Vascular Translational Science" Université Sorbonne Paris Nord, F-93000 Bobigny, France
| | - Etienne Audureau
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Service de Santé Publique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94000, Créteil, France
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Barré T, Carrat F, Ramier C, Fontaine H, Di Beo V, Bureau M, Dorival C, Larrey D, Delarocque-Astagneau E, Mathurin P, Marcellin F, Petrov-Sanchez V, Cagnot C, Carrieri P, Pol S, Protopopescu C, Alric L, Pomes C, Zoulim F, Maynard M, Bai R, Hucault L, Bailly F, Raffi F, Billaud E, Boutoille D, Lefebvre M, André-Garnier E, Cales P, Hubert I, Lannes A, Lunel F, Boursier J, Asselah T, Boyer N, Giuily N, Castelnau C, Scoazec G, Pol S, Fontaine H, Rousseaud E, Vallet-Pichard A, Sogni P, de Ledinghen V, Foucher J, Hiriart JB, M’Bouyou J, Irlès-Depé M, Bourlière M, Ahmed SNS, Oules V, Tran A, Anty R, Gelsi E, Truchi R, Thabut D, Hammeche S, Moussali J, Causse X, De Dieuleveult B, Ouarani B, Labarrière D, Ganne N, Grando-Lemaire V, Nahon P, Brulé S, Ulker B, Guyader D, Jezequel C, Brener A, Laligant A, Rabot A, Renard I, Habersetzer F, Baumert TF, Doffoel M, Mutter C, Simo-Noumbissie P, Razi E, Bronowicki JP, Barraud H, Bensenane M, Nani A, Hassani-Nani S, Bernard MA, Pageaux GP, Larrey D, Meszaros M, Metivier S, Bureau C, Morales T, Peron JM, Robic MA, Decaens T, Faure M, Froissart B, Hilleret MN, Zarski JP, Riachi G, Goria O, Paris F, Montialoux H, Leroy V, Amaddeo G, Varaut A, Simoes M, Amzal R, Chazouillières O, Andreani T, Angoulevant B, Chevance A, Serfaty L, Samuel D, Antonini T, Coilly A, Duclos-Vallée JC, Tateo M, Abergel A, Reymond M, Brigitte C, Benjamin B, Muti L, Geist C, Conroy G, Riffault R, Rosa I, Barrault C, Costes L, Hagège H, Loustaud-Ratti V, Carrier P, Debette-Gratien M, Mathurin P, Lassailly G, Lemaitre E, Canva V, Dharancy S, Louvet A, Minello A, Latournerie M, Bardou M, Mouillot T, D’Alteroche L, Barbereau D, Nicolas C, Elkrief L, Jaillais A, Gournay J, Chevalier C, Archambeaud I, Habes S, Portal I, Gelu-Simeon M, Saillard E, Lafrance MJ, Catherine L, Carrat F, Chau F, Dorival C, Goderel I, Lusivika-Nzinga C, Bellance MA, Bellet J, Monfalet P, Chane-Teng J, Bijaoui S, Pannetier G, Téoulé F, Nicol J, Sebal F, Bekhti R, Cagnot C, Boston A, Nailler L, Le Meut G, Diallo A, Petrov-Sanchez V, Bourlière M, Boursier J, Carrat F, Carrieri P, Delarocque-Astagneau E, De Ledinghen V, Dorival C, Fontaine H, Fourati S, Housset C, Larrey D, Nahon P, Pageaux GP, Petrov-Sanchez V, Pol S, Bruyand M, Wittkop L, Zoulim F, Zucman-Rossi J, L’hennaff M, Sizorn M, Cagnot C. Cannabis use as a factor of lower corpulence in hepatitis C-infected patients: results from the ANRS CO22 Hepather cohort. J Cannabis Res 2022; 4:31. [PMID: 35690798 PMCID: PMC9188079 DOI: 10.1186/s42238-022-00138-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background Patients with chronic hepatitis C virus (HCV) infection are at greater risk of developing metabolic disorders. Obesity is a major risk factor for these disorders, and therefore, managing body weight is crucial. Cannabis use, which is common in these patients, has been associated with lower corpulence in various populations. However, this relationship has not yet been studied in persons with chronic HCV infection. Methods Using baseline data from the French ANRS CO22 Hepather cohort, we used binary logistic and multinomial logistic regression models to test for an inverse relationship between cannabis use (former/current) and (i) central obesity (i.e., large waist circumference) and (ii) overweight and obesity (i.e., elevated body mass index (BMI)) in patients from the cohort who had chronic HCV infection. We also tested for relationships between cannabis use and both waist circumference and BMI as continuous variables, using linear regression models. Results Among the 6348 participants in the study population, 55% had central obesity, 13.7% had obesity according to their BMI, and 12.4% were current cannabis users. After multivariable adjustment, current cannabis use was associated with lower risk of central obesity (adjusted odds ratio, aOR [95% confidence interval, CI]: 0.45 [0.37–0.55]), BMI-based obesity (adjusted relative risk ratio (aRRR) [95% CI]: 0.27 [0.19–0.39]), and overweight (aRRR [95% CI]: 0.47 [0.38–0.59]). This was also true for former use, but to a lesser extent. Former and current cannabis use were inversely associated with waist circumference and BMI. Conclusions We found that former and, to a greater extent, current cannabis use were consistently associated with smaller waist circumference, lower BMI, and lower risks of overweight, obesity, and central obesity in patients with chronic HCV infection. Longitudinal studies are needed to confirm these relationships and to assess the effect of cannabis use on corpulence and liver outcomes after HCV cure. Trial registration ClinicalTrials.gov identifier: NCT01953458.
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Coilly A, Sebagh M, Fougerou-Leurent C, Pageaux GP, Leroy V, Radenne S, Silvain C, Lebray P, Houssel-Debry P, Cagnot C, Rossignol E, Danjou H, Veislinger A, Samuel D, Duclos-Vallée JC, Dumortier J. HCV eradication does not protect from fibrosis progression in patients with fibrosing cholestatic hepatitis after liver transplantation. Clin Res Hepatol Gastroenterol 2022; 46:102024. [PMID: 36122871 DOI: 10.1016/j.clinre.2022.102024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 09/05/2022] [Accepted: 09/11/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Hepatitis C virus (HCV) may recur after liver transplantation (LT) in the severe form of fibrosing cholestatic hepatitis (FCH). The prognosis dramatically improved by the use of direct acting antivirals (DAAs). The aim of the present study was to describe the change in histological features of FCH after virological eradication. METHODS From the ANRS CUPILT cohort we included 17 patients who presented FCH and at least two graft biopsies, one before DAA-treatment and one after. A single expert pathologist, blinded for clinical outcome, retrospectively confirmed the diagnosis of FCH and progression of fibrosis. RESULTS Diagnosis of FCH was made after a median [IQR] 6.0 [3.1-11.8] months after LT, and the median interval between diagnosis and onset of treatment was 1.2 [0.7-6.1] months. The rate of viral eradication was 94.1%. The median delay between the pre-treatment and the treatment biopsies was 12.5 [11.1-20.0] months. Between the end of treatment and the second biopsy, the delay was 5.3 [0.6-7.4] months. Fibrosis stage worsened in 10 patients (58.8%); 6 patients had cirrhosis (35.3%). Chronic rejection appeared in 4 (23.5%) patients. CONCLUSION Our results suggest that, despite viral eradication in patients presenting FCH after LT, fibrosis progression was observed in half of patients. This should encourage monitoring fibrosis progression despite HCV cure.
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Affiliation(s)
- Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire; Université Paris-Saclay, UMR-S 1193; Inserm Unité 1193; FHU Hepatinov, Villejuif 94800, France.
| | - Mylène Sebagh
- AP-HP Hôpital Bicêtre, Service d'Anatomie Pathologique, Kremlin-Bicêtre, France
| | - Claire Fougerou-Leurent
- Rennes University Hospital, Unit of Clinical Pharmacology; INSERM Clinical Investigation Centre 1414, Rennes, France
| | - Georges-Philippe Pageaux
- CHU Saint-Eloi, Département D'hépato-Gastroentérologie et de Transplantation Hépatique, Université Montpellier 1, Montpellier, France
| | - Vincent Leroy
- CHU de Grenoble, Pôle Digidune, Clinique Universitaire d'Hépato-Gastroentérologie; Unité INSERM /Université Grenoble Alpes U823, IAPC Institut Albert Bonniot, Grenoble, France
| | - Sylvie Radenne
- Hospices Civils de Lyon, Hôpital de la Croix Rousse, Service d'Hépato-gastroentérologie, Lyon, France
| | - Christine Silvain
- Département d'Hépato-gastroentérologie, CHU de Poitiers, Pôle Biologie Santé, Poitiers EA 4331, France
| | - Pascal Lebray
- AP-HP, Departement d'hépatologie et de Gastroenterologie, Groupe Hospitalier Pitié-Salpétrière, Université Pierre et Marie Curie Paris 6, Paris, France
| | | | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, ANRS (France Recherche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Emilie Rossignol
- Rennes University Hospital, Unit of Clinical Pharmacology; INSERM Clinical Investigation Centre 1414, Rennes, France
| | - Hélène Danjou
- Rennes University Hospital, Unit of Clinical Pharmacology; INSERM Clinical Investigation Centre 1414, Rennes, France
| | - Aurélie Veislinger
- Rennes University Hospital, Unit of Clinical Pharmacology; INSERM Clinical Investigation Centre 1414, Rennes, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire; Université Paris-Saclay, UMR-S 1193; Inserm Unité 1193; FHU Hepatinov, Villejuif 94800, France
| | - Jean-Charles Duclos-Vallée
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire; Université Paris-Saclay, UMR-S 1193; Inserm Unité 1193; FHU Hepatinov, Villejuif 94800, France
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Service d'Hépato-gastroentérologie, Université Claude Bernard Lyon 1, Pavillons D et L, 69437, Lyon Cedex 03, France.
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Azzi J, Dorival C, Cagnot C, Fontaine H, Lusivika-Nzinga C, Leroy V, De Ledinghen V, Tran A, Zoulim F, Alric L, Gournay J, Bronowicki JP, Decaens T, Riachi G, Mikhail N, Soliman R, Shiha G, Pol S, Carrat F, Ganne-Carrié N. Prediction of hepatocellular carcinoma in Hepatitis C patients with advanced fibrosis after sustained virologic response. Clin Res Hepatol Gastroenterol 2022; 46:101923. [PMID: 35405354 DOI: 10.1016/j.clinre.2022.101923] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/07/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS Prediction of hepatocellular carcinoma (HCC) occurrence in patients with chronic hepatitis C (HCV) who achieved a sustained virological response (SVR) after direct acting antivirals (DAAs) remains challenging. METHODS Among HCC-free HCV patients with advanced fibrosis enrolled in the ANRS CO22 HEPATHER cohort who achieved SVR 12 weeks after treatment with DAAs, HCC predictive models were developed using Cox multivariable regression. The derived score was externally validated in a large Egyptian cohort. Our main outcome was the HCC-free survival. RESULTS During follow-up (median 3.05 years), 153 out of 3531 patients developed a HCC. Main variables associated with HCC occurrence were: male gender, HCV genotype 3, esophageal varices, albumin < 40 g/L, total bilirubin >11 µmol/L and hypercholesterolemia before DAA initiation, together with age > 58 years, FIB-4 index ≥3.25 evaluated at SVR. A score was established allowing the stratification of patients by high (score ≥ 12/22), intermediate (7 ≤ score <12) and low risk of HCC (score < 7/22) with 3-yrs HCC incidence of 18.96%, 5.50% and 1.65%, respectively. The integrated time-dependent area under the ROC curve (i-AUC) was 0.76 in our patients and 0.61 in the validation cohort. CONCLUSION The externally validated HEPATHER HCC score has good short-term predictive performance in HCV- patients who achieved SVR12 after DAAs allowing to identify high-risk patients in whom HCC screening may be cost-effective and low-risk patients in whom HCC screening may be superfluous in the first 3 years after SVR.
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Affiliation(s)
- Jessica Azzi
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Céline Dorival
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Carole Cagnot
- ANRS (France Recherche Nord & Sud Sida-HIV Hépatites), Unit for Basic and Clinical Research on Viral Hepatitis, Paris, France
| | | | - Clovis Lusivika-Nzinga
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Vincent Leroy
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, AP-HP, Université Paris-Est, INSERM U955, Créteil, France
| | - Victor De Ledinghen
- Hepatology Unit Hôpital Haut-Lévêque, Pessac, INSERM U1053, Université Bordeaux Segalen, Bordeaux, France
| | - Albert Tran
- Université Côte d'Azur, Nice, France; CHU de Nice, Digestive Center, Nice, France; INSERM, U1065, C3M, Team 8 « Chronic liver diseases associated with obesity and alcohol », Nice, France
| | - Fabien Zoulim
- Department of Hepatology, Hospices Civils de Lyon, INSERM U1052, Université de Lyon, Lyon, France
| | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, CHU Purpan, UMR 152 Pharma Dev, IRD Toulouse 3 University, France
| | - Jérôme Gournay
- Gastroenterology and Hepatology Department, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes, France
| | - Jean-Pierre Bronowicki
- Inserm U1254 and Department of Hepato-Gastroenterology, University Hospital of Nancy Brabois, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Thomas Decaens
- Department of Hepatology and Gastroenterology, CHU Grenoble-Alpes, Université Grenoble-Alpes, Institute for Advanced Biosciences INSERM U1209, Grenoble, France
| | - Ghassan Riachi
- Department of Hepatology and Gastroenterology, CHU Charles Nicolle, Rouen, France
| | - Nabiel Mikhail
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt; Biostatistics and Cancer Epidemiology Department, South Egypt Cancer Institute, Assiut University, Assuit, Egypt
| | - Reham Soliman
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt; Tropical Medicine Department, Faculty of Medicine, Port Said University, Port Said, Egypt
| | - Gamal Shiha
- Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt; Hepatology and Gastroenterology Unit, Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Stanislas Pol
- AP-HP, Hôpital Cochin, Unité d'Hépatologie, Paris, France; Université de Paris, INSERM U1223 and USM-20, Institut Pasteur, Paris, France
| | - Fabrice Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; AP-HP, Sorbonne Université, Hôpital Saint-Antoine, Santé Publique, Paris, France
| | - Nathalie Ganne-Carrié
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, APHP, Liver Unit, Bobigny, France; Université Sorbonne Paris Nord, Bobigny, France; Inserm, UMR-1138 « Functional Genomics of solid tumors », Centre de Recherche des Cordeliers, Université de Paris, France.
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8
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Carrieri P, Carrat F, Di Beo V, Bourlière M, Barré T, De Ledinghen V, Pageaux GP, Bureau M, Cagnot C, Dorival C, Delarocque-Astagneau E, Marcellin F, Pol S, Fontaine H, Protopopescu C, Laurent Alric, Bonnet D, Payssan-Sicart V, Pomes C, Zoulim F, Maynard M, Bai R, Hucault L, Bailly F, Raffi F, Billaud E, Boutoille D, Lefebvre M, André-Garnier E, Cales P, Hubert I, Lannes A, Lunel F, Boursier J, Asselah T, Boyer N, Giuily N, Castelnau C, Scoazec G, Pol S, Fontaine H, Rousseaud E, Vallet-Pichard A, Sogni P, de Ledinghen V, Foucher J, Hiriart JB, M’Bouyou J, Irlès-Depé M, Bourlière M, Si Ahmed SN, Oules V, Tran A, Anty R, Gelsi E, Truchi R, Thabut D, Hammeche S, Moussali J, Causse X, De Dieuleveult B, Ouarani B, Labarrière D, Ganne N, Grando-Lemaire V, Nahon P, Brulé S, Ulker B, Guyader D, Jezequel C, Brener A, Laligant A, Rabot A, Renard I, Habersetzer F, Baumert TF, Doffoel M, Mutter C, Simo-Noumbissie P, Razi E, Bronowicki JP, Barraud H, Bensenane M, Nani A, Hassani-Nani S, Bernard MA, Pageaux GP, Larrey D, Meszaros M, Metivier S, Bureau C, Morales T, Peron JM, Robic MA, Decaens T, Froissart B, Hilleret MN, Costentin C, Gerster T, Riachi G, Goria O, Paris F, Montialoux H, Leroy V, Amaddeo G, Varaut A, Simoes M, Amzal R, Chazouillières O, Andreani T, Angoulevant B, Chevance A, Serfaty L, Duclos Vallée JC, Samuel D, Antonini T, Coilly A, Tateo M, Abergel A, Reymond M, Brigitte C, Benjamin B, Muti L, Geist C, Conroy G, Riffault R, Rosa I, Barrault C, Costes L, Hagège H, Loustaud-Ratti V, Carrier P, Debette-Gratien M, Mathurin P, Lassailly G, Lemaitre E, Canva V, Dharancy S, Louvet A, Minello A, Latournerie M, Bardou M, Mouillot T, D’Alteroche L, Barbereau D, Nicolas C, Elkrief L, Jaillais A, Gournay J, Chevalier C, Archambeaud I, Habes S, Portal I, Gelu-Simeon M, Saillard E, Lafrance MJ, Catherine L, Carrat F, Chau F, Dorival C, Goderel I, Lusivika-Nzinga C, Bellance MA, Bellet J, Monfalet P, Chane-Teng J, Bijaoui S, Pannetier G, Téoulé F, Nicol J, Bekhti R, Cagnot C, Boston A, Nailler L, Le Meut G, Diallo A, Petrov-Sanchez V, Marc Bourlière, Boursier J, Carrat F, Carrieri P, Delarocque-Astagneau E, De Ledinghen V, Dorival C, Fontaine H, Fourati S, Housset C, Larrey D, Nahon P, Pageaux GP, Petrov-Sanchez V, Pol S, Bruyand M, Wittkop L, Zoulim F, Zucman-Rossi J, L’hennaff M, Sizorn M, Boston A, Diallo A, Cagnot C, Bousselet A, Caralp M. Severe liver fibrosis in the HCV cure era: major effects of social vulnerability, diabetes, and unhealthy behaviors. JHEP Rep 2022; 4:100481. [PMID: 35514789 PMCID: PMC9065909 DOI: 10.1016/j.jhepr.2022.100481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/08/2022] [Accepted: 02/24/2022] [Indexed: 11/06/2022] Open
Abstract
Background & Aims After HCV cure, not all patients achieve significant liver fibrosis regression. We explored the effects of clinical and socio-behavioral factors on liver fibrosis, before and after HCV cure with direct-acting antivirals. Methods We analyzed data from the ongoing ANRS CO22 HEPATHER cohort, which prospectively collects clinical and socio-behavioral data on HCV-infected patients. Mixed-effects logistic regression models helped identify predictors of longitudinal measures of severe liver fibrosis, defined as a fibrosis-4 index >3.25. We also estimated the adjusted population attributable fractions (PAFs) for modifiable risk factors. Results Among the 9,692 study patients (accounting for 24,687 visits over 4 years of follow-up, 48.5% of which were post-HCV cure), 26% had severe fibrosis at enrolment. After multivariable adjustment, HCV-cured patients had an 87% lower risk of severe fibrosis. An inverse dose-response relationship was found for coffee consumption, with the risk of severe fibrosis diminishing by 58% per additional cup/day (adjusted odds ratio (aOR 0.42; 95% CI 0.38-0.46). Unemployment, low educational level, and diabetes were associated with a higher severe fibrosis risk (aOR 1.69; 95% CI 1.32-2.16, aOR 1.50; 95% CI 1.20-1.86, and aOR 4.27; 95% CI 3.15-5.77, respectively). Severe fibrosis risk was 3.6/4.6-fold higher in individuals with previous/current unhealthy alcohol use than in abstinent patients. All these associations remained valid after HCV cure. The risk factors accounting for the greatest severe fibrosis burden were unemployment, low education level, and diabetes (PAFs: 29%, 21%, and 17%, respectively). Conclusions Monitoring liver fibrosis after HCV cure is crucial for patients with low socioeconomic status, previous/current unhealthy alcohol use, and diabetes. Innovative HCV care models for the most socially vulnerable individuals and interventions for healthier lifestyles are needed to reinforce the positive effects of HCV cure on liver health. Lay summary After hepatitis C virus (HCV) cure, not all patients achieve significant liver fibrosis regression. Herein, we studied the effects of clinical and socio-behavioral factors on the risk of severe liver fibrosis. Coffee consumption was strongly inversely associated with severe fibrosis, while diabetes, previous and current unhealthy alcohol use were associated with a 4.3-, 3.6- and 4.6-fold higher risk of severe fibrosis, respectively. Unemployment and low educational level were also associated with a higher risk of severe fibrosis. All these associations remained valid after HCV cure. These results demonstrate the need to continue liver fibrosis monitoring in at-risk groups, and to facilitate healthier lifestyles after HCV cure as a clinical and public health priority. Liver fibrosis assessment is a key prognostic tool in the hepatitis C cure era. Significant liver fibrosis regression does not always occur after hepatitis C cure. Coffee intake displays protective effects on severe fibrosis even after HCV cure. Social vulnerability, diabetes, and unhealthy alcohol use predict severe fibrosis. Socio-behavioral factors are associated with severe fibrosis even after HCV cure.
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9
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Pageaux GP, Nzinga CL, Ganne N, Samuel D, Dorival C, Zoulim F, Cagnot C, Decaens T, Thabut D, Asselah T, Mathurin P, Habersetzer F, Bronowicki JP, Guyader D, Rosa I, Leroy V, Chazouilleres O, de Ledinghen V, Bourliere M, Causse X, Cales P, Metivier S, Loustaud-Ratti V, Riachi G, Alric L, Gelu-Simeon M, Minello A, Gournay J, Geist C, Tran A, Abergel A, Portal I, d'Alteroche L, Raffi F, Fontaine H, Carrat F, Pol S. Clinical outcomes after treatment with direct antiviral agents: beyond the virological response in patients with previous HCV-related decompensated cirrhosis. BMC Infect Dis 2022; 22:94. [PMID: 35086481 PMCID: PMC8796427 DOI: 10.1186/s12879-022-07076-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background In HCV-infected patients with advanced liver disease, the direct antiviral agents-associated clinical benefits remain debated. We compared the clinical outcome of patients with a previous history of decompensated cirrhosis following treatment or not with direct antiviral agents from the French ANRS CO22 HEPATHER cohort. Methods We identified HCV patients who had experienced an episode of decompensated cirrhosis. Study outcomes were all-cause mortality, liver-related or non-liver-related deaths, hepatocellular carcinoma, liver transplantation. Secondary study outcomes were sustained virological response and its clinical benefits. Results 559 patients met the identification criteria, of which 483 received direct antiviral agents and 76 remained untreated after inclusion in the cohort. The median follow-up time was 39.7 (IQR: 22.7–51) months. After adjustment for multivariate analysis, exposure to direct antiviral agents was associated with a decrease in all-cause mortality (HR 0.45, 95% CI 0.24–0.84, p = 0.01) and non-liver-related death (HR 0.26, 95% CI 0.08–0.82, p = 0.02), and was not associated with liver-related death, decrease in hepatocellular carcinoma and need for liver transplantation. The sustained virological response was 88%. According to adjusted multivariable analysis, sustained virological response achievement was associated with a decrease in all-cause mortality (HR 0.29, 95% CI 0.15–0.54, p < 0.0001), liver-related mortality (HR 0.40, 95% CI 0.17–0.96, p = 0.04), non-liver-related mortality (HR 0.17, 95% CI 0.06–0.49, p = 0.001), liver transplantation (HR 0.17, 95% CI 0.05–0.54, p = 0.003), and hepatocellular carcinoma (HR 0.52, 95% CI 0.29–0.93, p = 0.03). Conclusion Treatment with direct antiviral agents is associated with reduced risk for mortality. The sustained virological response was 88%. Thus, direct antiviral agents treatment should be considered for any patient with HCV-related decompensated cirrhosis. Trial registration: ClinicalTrials.gov registry number: NCT01953458. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07076-0.
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Affiliation(s)
- Georges-Philippe Pageaux
- Department of Hepatology and Gastroenterology, Centre Hospitalo-Universitaire Saint Eloi, Université de Montpellier, 34295, Montpellier, France.
| | - Clovis Lusivika Nzinga
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Nathalie Ganne
- Department of Hepatology, Hôpitaux Universitaires Paris Seine-Saint-Denis, Site Avicenne, AP-HP, Bobigny, France.,Université Paris 13, Sorbonne Paris Cité et INSERM UMR 1162, Paris, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, 94800, Villejuif, France.,Université Paris-Saclay, Inserm, Physiopathogénèse et Traitement des Maladies du Foie, 94800, Villejuif, France.,Inserm, Unité 1193, Université Paris-Saclay, Hepatinov, 94800, Villejuif, France
| | - Céline Dorival
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | - Fabien Zoulim
- Department of Hepatology, Hospices Civils de Lyon, INSERM U1052, Université de Lyon, Lyon, France
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, ANRS (France REcherche Nord&Sud Sida-Vih Hépatites), Paris, France
| | - Thomas Decaens
- Université Grenoble Alpes, 38000, Grenoble, France.,Institute for Advanced Biosciences, Research Center Inserm U1209, CNRS UMR5309, 38700, La Tronche, France.,Service d'hépatogastroentérologie, Pôle Digidune, CHU Grenoble Alpes, 38700, La Tronche, France
| | - Dominique Thabut
- Department of Hepatology and Gastroenterology, Groupe Hospitalier Pitié-Salpétrière, AP-HP, INSERM UMR-S938, Sorbonne Université, Paris, France
| | - Tarik Asselah
- INSERM UMR 1149, Hepatology, Hospital Beaujon, Centre de Recherche sur l'Inflammation, (CRI), University Paris Diderot, Clichy, France
| | - Philippe Mathurin
- Service des Maladies de l'appareil Digestif, Université Lille 2 and Inserm U795, Lille, France
| | - François Habersetzer
- CIC, Inserm 1110 et Pôle Hépato-digestif des Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Jean-Pierre Bronowicki
- Inserm U1254 and Department of Hepato-Gastroenterology, University Hospital of Nancy Brabois, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Dominique Guyader
- CHU de Rennes, Service d'hépatologie, 35033, Rennes, France.,Univ Rennes1, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR_A 1341, UMR_S 1241, 35033, Rennes, France
| | - Isabelle Rosa
- Department of Hepatology and Gastroenterology, Centre Hospitalier Intercommunal, Créteil, France
| | - Vincent Leroy
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, AP-HP, Université Paris-Est, INSERM U955, Créteil, France
| | - Olivier Chazouilleres
- Department of Hepatology, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Victor de Ledinghen
- Hepatology Unit Hôpital Haut-Lévêque, Pessac, INSERM U1053, Université Bordeaux Segalen, Bordeaux, France
| | - Marc Bourliere
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France
| | - Xavier Causse
- Department of Hepatology and Gastroenterology, CHR Orléans, Orléans, France
| | - Paul Cales
- Hepatology Department, University Hospital, Angers, France.,HIFIH Laboratory, Angers University, Angers, France
| | | | - Véronique Loustaud-Ratti
- Department of Hepatology and Gastroenterology, CHU Limoges, U1248 INSERM, Univ. Limoges, 87000, Limoges, France
| | - Ghassan Riachi
- Department of Hepatology and Gastroenterology, CHU Charles Nicolle, Rouen, France
| | - Laurent Alric
- Department of Internal Medicine and Digestive Diseases, CHU Purpan, UMR 152 Pharma Dev, IRD Toulouse 3 University, Toulouse, France
| | - Moana Gelu-Simeon
- Service d'Hépato-Gastroentérologie, CHU de la Guadeloupe-Faculté de Médecine, Université des Antilles, 97110, Pointe-à-Pitre Cedex, France.,INSERM, UMR-S1085/IRSET, 35043, Rennes, France
| | - Anne Minello
- Department of Hepatology and Gastroenterology, University Hospital Dijon, INSERM UMR 1231, Dijon, France
| | - Jérôme Gournay
- Gastroenterology and Hepatology Department, Institut des Maladies de l'Appareil Digestif, University Hospital of Nantes, Nantes, France
| | - Claire Geist
- Department of Hepatology and Gastroenterology, Centre Hospitalier Régional, Metz, France
| | - Albert Tran
- Digestive Center, Centre Hospitalier Universitaire de Nice, INSERM U1065-8, Nice, France
| | - Armand Abergel
- Department of Digestive and Hepatobiliary Diseases, Estaing University Hospital, Clermont-Ferrand, France.,UMR 6602 CNRS-Sigma-Université Clermont Auvergne, Clermont-Ferrand, France
| | - Isabelle Portal
- Service d'Hépato-Gastroentérologie, Hôpital de la Timone, Aix-Marseille Université, AP-HM, Marseille, France
| | - Louis d'Alteroche
- Unit of Hepatology, Hépatogastroentérologie, CHU Trousseau, 37044, Tours, France
| | - François Raffi
- Department of Infectious Diseases, Hotel-Dieu Hospital-INSERM CIC 1413, Nantes University Hospital, Nantes, France
| | - Hélène Fontaine
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Unité d'Hépatologie, Paris, France
| | - Fabrice Carrat
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Stanislas Pol
- Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France.,Université Paris Descartes, Paris, France.,INSERM U-1223 et USM20, Institut Pasteur, Paris, France
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10
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Nahon P, Najean M, Layese R, Zarca K, Segar LB, Cagnot C, Ganne-Carrié N, N'Kontchou G, Pol S, Chaffaut C, Carrat F, Ronot M, Audureau E, Durand-Zaleski I. Early hepatocellular carcinoma detection using magnetic resonance imaging is cost-effective in high-risk patients with cirrhosis. JHEP Rep 2022; 4:100390. [PMID: 34977518 PMCID: PMC8683591 DOI: 10.1016/j.jhepr.2021.100390] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/02/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022]
Abstract
Background & Aims Reinforced hepatocellular carcinoma (HCC) surveillance using magnetic resonance imaging (MRI) could increase early tumour detection but faces cost-effectiveness issues. In this study, we aimed to evaluate the cost-effectiveness of MRI for the detection of very early HCC (Barcelona Clinic Liver Cancer [BCLC] 0) in patients with an annual HCC risk >3%. Methods French patients with compensated cirrhosis included in 4 multicentre prospective cohorts were considered. A scoring system was constructed to identify patients with an annual risk >3%. Using a Markov model, the economic evaluation estimated the costs and life years (LYs) gained with MRI vs. ultrasound (US) monitoring over a 20-year period. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the incremental costs by the incremental LYs. Results Among 2,513 patients with non-viral causes of cirrhosis (n = 840) and/or cured HCV (n = 1,489)/controlled HBV infection (n = 184), 206 cases of HCC were detected after a 37-month follow-up. When applied to training (n = 1,658) and validation (n = 855) sets, the construction of a scoring system identified 33.4% and 37.5% of patients with an annual HCC risk >3% (3-year C-Indexes 75 and 76, respectively). In patients with a 3% annual risk, the incremental LY gained with MRI was 0.4 for an additional cost of €6,134, resulting in an ICER of €15,447 per LY. Compared to US monitoring, MRI detected 5x more BCLC 0 HCC. The deterministic sensitivity analysis confirmed the impact of HCC incidence. At a willingness to pay of €50,000/LY, MRI screening had a 100% probability of being cost-effective. Conclusions In the era of HCV eradication/HBV control, patients with annual HCC risk >3% represent one-third of French patients with cirrhosis. MRI is cost-effective in this population and could favour early HCC detection. Lay summary The early identification of hepatocellular carcinoma in patients with cirrhosis is important to improve patient outcomes. Magnetic resonance imaging could increase early tumour detection but is more expensive and less accessible than ultrasound (the standard modality for surveillance). Herein, using a simple score, we identified a subgroup of patients with cirrhosis (accounting for >one-third), who were at increased risk of hepatocellular carcinoma and for whom the increased expense of magnetic resonance imaging would be justified by the potential improvement in outcomes.
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Key Words
- AFP, alpha-fetoprotein
- AMRI, abbreviated magnetic resonance imaging
- BCLC, Barcelona Clinic Liver Cancer
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- ICER, incremental cost-effectiveness ratio
- LY, life years
- LYG, life years gained
- MRI
- MRI, magnetic resonance imaging
- NAFLD, non-alcoholic fatty liver disease
- QALY, quality-adjusted life year
- RFA, radiofrequency ablation
- SHR, subdistribution hazard ratio
- TACE, transarterial chemoembolization
- US, ultrasound
- cirrhosis
- cost-effectiveness
- liver cancer risk
- surveillance
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Affiliation(s)
- Pierre Nahon
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Unit, Bobigny, France.,Université Sorbonne Paris Nord, F-93000 Bobigny, France.,Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Marie Najean
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, F-75004, Paris, France
| | - Richard Layese
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Service de Santé Publique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94000, Créteil, France
| | - Kevin Zarca
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, F-75004, Paris, France
| | - Laeticia Blampain Segar
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, F-75004, Paris, France
| | - Carole Cagnot
- Clinical Research Department, ANRS
- Emerging Infectious Diseases, Paris, France
| | - Nathalie Ganne-Carrié
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Unit, Bobigny, France.,Université Sorbonne Paris Nord, F-93000 Bobigny, France.,Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Gisèle N'Kontchou
- AP-HP, Hôpitaux Universitaires Paris Seine Saint-Denis, Liver Unit, Bobigny, France.,Université Sorbonne Paris Nord, F-93000 Bobigny, France.,Inserm, UMR-1138 "Functional Genomics of Solid Tumors", Centre de recherche des Cordeliers, Université de Paris, Paris, France
| | - Stanislas Pol
- Université de Paris, département d'hépatologie/Addictologie, Hôpital Cochin, APHP, Paris, France
| | - Cendrine Chaffaut
- SBIM, APHP, Hôpital Saint-Louis, Paris, France.,Inserm, UMR-1153, ECSTRA Team, Paris, France
| | - Fabrice Carrat
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Maxime Ronot
- AP-HP, Hôpital Beaujon, Service de Radiologie, Clichy, France
| | - Etienne Audureau
- Univ Paris Est Créteil, INSERM, IMRB, Equipe CEpiA (Clinical Epidemiology and Ageing), Unité de Recherche Clinique (URC Mondor), Service de Santé Publique, Assistance Publique Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94000, Créteil, France
| | - Isabelle Durand-Zaleski
- Université de Paris, CRESS, INSERM, INRA, URCEco, AP-HP, Hôpital de l'Hôtel Dieu, F-75004, Paris, France
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11
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Barré T, Fontaine H, Ramier C, Di Beo V, Pol S, Carrieri P, Marcellin F, Cagnot C, Dorival C, Zucman-Rossi J, Zoulim F, Carrat F, Protopopescu C. Elevated coffee consumption is associated with a lower risk of elevated liver fibrosis biomarkers in patients treated for chronic hepatitis B (ANRS CO22 Hepather cohort). Clin Nutr 2022; 41:610-619. [DOI: 10.1016/j.clnu.2022.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/04/2022] [Accepted: 01/15/2022] [Indexed: 11/03/2022]
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12
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Pol S, Luzivika Nzinga C, Dorival C, Zoulim F, Cagnot C, Decaens T, Thabut D, Asselah T, Mathurin P, Ganne N, Samuel D, Habersetzer F, Bronowicki JP, Guyader D, Rosa I, Leroy V, Chazouilleres O, De Ledinghen V, Bourliere M, Causse X, Cales P, Metivier S, Loustaud-Ratti V, Abergel A, Fontaine H, Carrat F. Corrigendum. Aliment Pharmacol Ther 2021; 54:1364-1365. [PMID: 34699103 DOI: 10.1111/apt.16661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Stanislas Pol
- Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Unité d'Hépatologie, Paris, France.,INSERM U-1223, Institut Pasteur, Université de Paris, Paris, France
| | - Clovis Luzivika Nzinga
- Institut National de la santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Céline Dorival
- Institut National de la santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Fabien Zoulim
- Department of Hepatology, Hospices Civils de Lyon, INSERM U1052, Université de Lyon, Lyon, France
| | - Carole Cagnot
- ANRS (France REcherche Nord&sud Sida-vih Hépatites), Unit for Basic and Clinical Research on Viral Hepatitis, Paris, France
| | - Thomas Decaens
- Department of Hepatology and Gastroenterology, Centre Hospitalo-Universitaire, INSERM U1209, Université Grenoble Alpes, Grenoble, France
| | - Dominique Thabut
- Department of Hepatology and Gastroenterology, Groupe Hospitalier Pitié-Salpétrière, AP-HP, INSERM UMR-S938, Sorbonne Université, Paris, France
| | - Tarik Asselah
- INSERM UMR 1149, Hepatology, Hospital Beaujon, Centre de Recherche sur l'Inflammation (CRI), University Paris Diderot, Clichy, France
| | - Philippe Mathurin
- Service des maladies de l'appareil digestif, Université Lille 2 and Inserm U795, Lille, France
| | - Nathalie Ganne
- Department of Hepatology, Hôpitaux Universitaires Paris Seine-Saint-Denis, AP-HP, Bondy, France.,Université Paris 13, Sorbonne Paris Cité et INSERM UMR 1162, Paris, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France.,Inserm, Physiopathogénèse et traitement des maladies du Foie, Université Paris-Saclay, Villejuif, France.,Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France
| | - François Habersetzer
- CIC, Inserm 1110 et Pôle Hépato-digestif des Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Jean-Pierre Bronowicki
- Inserm U1254 and Department of Hepato-Gastroenterology, University Hospital of Nancy Brabois, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - Dominique Guyader
- CHU de Rennes, Service d'hépatologie, Univ Rennes1, Inra, Inserm, Institut NUMECAN (Nutrition, Métabolismes et Cancer), UMR_A 1341, UMR_S 1241, Rennes, France
| | - Isabelle Rosa
- Department of Hepatology and Gastroenterology, Centre Hospitalier Intercommunal, Créteil, France
| | - Vincent Leroy
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, AP-HP, Université Paris-Est, INSERM U955, Créteil, France
| | - Olivier Chazouilleres
- Department of Hepatology, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, France
| | - Victor De Ledinghen
- Hepatology Unit Hôpital Haut-Lévêque, Pessac, INSERM U1053, Université Bordeaux Segalen, Bordeaux, France
| | - Marc Bourliere
- Department of Hepatology and Gastroenterology, Hôpital Saint Joseph, Marseille, France
| | - Xavier Causse
- Department of Hepatology and Gastroenterology, CHR, Orléans, France
| | - Paul Cales
- Hepatology Department, University Hospital, Angers, France.,HIFIH Laboratory, Angers University, Angers, France
| | - Sophie Metivier
- Hepatology Unit, CHU Rangueil, Toulouse, France.,Department of Hepatology and Gastroenterology, CHU Limoges, U1248 INSERM, Univ Limoges, Limoges, France
| | | | - Armand Abergel
- Department of Hepatology and Gastroenterology, Centre Hospitalier Universitaire Estaing, Clermont-Ferrand, France
| | - Hélène Fontaine
- Assistance Publique - Hôpitaux de Paris, Hôpital Cochin, Unité d'Hépatologie, Paris, France
| | - Fabrice Carrat
- Institut National de la santé et de la Recherche Médicale, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.,Assistance Publique - Hôpitaux de Paris, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
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13
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Nahon P, Layese R, Cagnot C, Asselah T, Guyader D, Pol S, Pageaux GP, De Lédinghen V, Ouzan D, Zoulim F, Audureau E. HCV Eradication in Primary or Secondary Prevention Optimizes Hepatocellular Carcinoma Curative Management. Cancer Prev Res (Phila) 2021; 14:581-592. [PMID: 33608313 DOI: 10.1158/1940-6207.capr-20-0465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/12/2021] [Accepted: 02/16/2021] [Indexed: 01/13/2023]
Abstract
To assess the impact of HCV eradication on the outcomes of cirrhotic patients treated curatively for incidental hepatocellular carcinoma (HCC) detected during surveillance program. Data were collected on 1,323 French patients with compensated biopsy-proven HCV cirrhosis recruited in 35 centers (ANRS CO12 CirVir cohort). Sustained virologic responses (SVR) and the occurrence of HCC were recorded prospectively. During a median follow-up of 68.3 months, 218 patients developed HCC, 126 of whom underwent a curative procedure as first-line therapy (ablation = 95, resection = 31). The HCC BCLC stage was 0/A in 97.5% of patients; 74 (58.7%) never achieved SVR. During a median follow-up of 26.0 months after HCC treatment, 59 (46.8%) experienced HCC recurrence. SVR was not associated with a recurrence, whether considering final SVR status [HR = 0.77; 95% confidence interval (95% CI), 0.43-1.39; P = 0.39] or its time to achievement (prior to/after HCC occurrence; global P = 0.28). During the same timeframe, 46 patients with HCC (36.5%) died (liver failure: 41.9%, HCC progression: 37.2%, extrahepatic causes: 20.9%). Under multivariate analysis, SVR was associated with improved survival [HR = 0.21; 95% CI, 0.08-0.52; P = 0.001]. Survival benefit was explained by a lower incidence of liver decompensation and higher rates of sequential HCC re-treatment. Direct antiviral intake was not associated with a higher risk of HCC recurrence, but with improved survival (HR = 0.23; 95% CI, 0.06-0.83; P = 0.024). HCV eradication in primary or secondary prevention optimizes HCC management through preservation of liver function and improves survival, whatever the regimen. PREVENTION RELEVANCE: Liver failure is a competing risk of death in patients with HCC eligible for curative procedures. HCV eradication does not decrease risk of HCC recurrence in the first two years, but enables sequential curative HCC treatments through preservation of liver function. Direct-acting antiviral agent intake is not associated with HCC recurrence and improves survival.
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Affiliation(s)
- Pierre Nahon
- Service d'Hépatologie, Hôpital Avicenne, AP-HP, Bobigny, France. .,Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", Saint-Denis, France.,Inserm, UMR-1162, "Génomique fonctionnelle des tumeurs solides", Paris, France
| | - Richard Layese
- Département de Santé Publique, Hôpital Henri Mondor, AP-HP and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, Créteil, France
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, ANRS (France REcherche Nord et sud Sida-HIV Hépatites-FRENSH), Paris, France
| | - Tarik Asselah
- Service d'Hépatologie, Hôpital Beaujon, AP-HP and University Paris Diderot, Sorbonne Paris Cité, CRI, UMR 1149, Paris, France
| | | | - Stanislas Pol
- Département d'Hépatologie, Hôpital Cochin, AP-HP, Paris, France.,Inserm UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | - Denis Ouzan
- Service d'Hépatologie, Institut Arnaud Tzanck, St Laurent du Var, Nice, France
| | - Fabien Zoulim
- Service d'Hépatologie et Université de Lyon, Hospices Civils de Lyon, Lyon, France
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14
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Audureau E, Carrat F, Layese R, Cagnot C, Asselah T, Guyader D, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Chazouillères O, Mallat A, Grangé JD, Attali P, d'Alteroche L, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Pol S, Nahon P. Personalized surveillance for hepatocellular carcinoma in cirrhosis - using machine learning adapted to HCV status. J Hepatol 2020; 73:1434-1445. [PMID: 32615276 DOI: 10.1016/j.jhep.2020.05.052] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Refining hepatocellular carcinoma (HCC) surveillance programs requires improved individual risk prediction. Thus, we aimed to develop algorithms based on machine learning approaches to predict the risk of HCC more accurately in patients with HCV-related cirrhosis, according to their virological status. METHODS Patients with compensated biopsy-proven HCV-related cirrhosis from the French ANRS CO12 CirVir cohort were included in a semi-annual HCC surveillance program. Three prognostic models for HCC occurrence were built, using (i) Fine-Gray regression as a benchmark, (ii) single decision tree (DT), and (iii) random survival forest for competing risks survival (RSF). Model performance was evaluated from C-indexes validated externally in the ANRS CO22 Hepather cohort (n = 668 enrolled between 08/2012-01/2014). RESULTS Out of 836 patients analyzed, 156 (19%) developed HCC and 434 (52%) achieved sustained virological response (SVR) (median follow-up 63 months). Fine-Gray regression models identified 6 independent predictors of HCC occurrence in patients before SVR (past excessive alcohol intake, genotype 1, elevated AFP and GGT, low platelet count and albuminemia) and 3 in patients after SVR (elevated AST, low platelet count and shorter prothrombin time). DT analysis confirmed these associations but revealed more complex interactions, yielding 8 patient groups with varying cancer risks and predictors depending on SVR achievement. On RSF analysis, the most important predictors of HCC varied by SVR status (non-SVR: platelet count, GGT, AFP and albuminemia; SVR: prothrombin time, ALT, age and platelet count). Externally validated C-indexes before/after SVR were 0.64/0.64 [Fine-Gray], 0.60/62 [DT] and 0.71/0.70 [RSF]. CONCLUSIONS Risk factors for hepatocarcinogenesis differ according to SVR status. Machine learning algorithms can refine HCC risk assessment by revealing complex interactions between cancer predictors. Such approaches could be used to develop more cost-effective tailored surveillance programs. LAY SUMMARY Patients with HCV-related cirrhosis must be included in liver cancer surveillance programs, which rely on ultrasound examination every 6 months. Hepatocellular carcinoma (HCC) screening is hampered by sensitivity issues, leading to late cancer diagnoses in a substantial number of patients. Refining surveillance periodicity and modality using more sophisticated imaging techniques such as MRI may only be cost-effective in patients with the highest HCC incidence. Herein, we demonstrate how machine learning algorithms (i.e. data-driven mathematical models to make predictions or decisions), can refine individualized risk prediction.
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Affiliation(s)
- Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil, France
| | - Fabrice Carrat
- Sorbonne Université, Inserm, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil, France
| | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH)
| | - Tarik Asselah
- AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy
| | | | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var
| | - Fabien Zoulim
- Hospices Civils de Lyon, Service d'Hépatologie; INSERM U1052 - CRCL; Université de Lyon, Lyon
| | | | - Albert Tran
- CHU de Nice, Service d'Hépatologie, F-06202, Cedex 3, Nice; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity", F-06204, Cedex 3, Nice
| | | | | | | | - Paul Calès
- CHU d'Angers, Service d'Hépato-Gastroentérologie, Angers
| | | | - Laurent Alric
- CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse
| | | | | | - Jean-Frédéric Blanc
- Hôpital St André, Service d'Hépatologie, Bordeaux et Hôpital Haut-Lévêque, CHU Bordeaux, 33604 Pessac
| | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand
| | - Olivier Chazouillères
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, and Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine, Paris
| | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif
| | | | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen
| | - Dominique Thabut
- AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris
| | | | | | | | | | | | - David Zucman
- Hôpital Foch, Service de Médecine Interne, Suresnes
| | | | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy; Inserm U1148, Université Paris 13, Bobigny
| | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie; Inserm UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", F-93206 Saint-Denis; Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", F-75000, Paris, France.
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15
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Zarski JP, David-Tchouda S, Trocme C, Margier J, Vilotitch A, Hilleret MN, Cagnot C, Boursier V, Ziol M, Sutton A, Layese R, Audureau E, Roudot-Thoraval F, Nahon P. Non-invasive fibrosis tests to predict complications in compensated post-hepatitis C cirrhosis. Clin Res Hepatol Gastroenterol 2020; 44:524-531. [PMID: 31839535 DOI: 10.1016/j.clinre.2019.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Markers predicting complications of post-hepatitis C cirrhosis are needed. We asked whether changes in noninvasive markers of fibrosis can predict liver-related complications. METHODS This was a case-controlled study using a prospective national cohort (ANRS-CO12-CIRVIR) of 1323 HCV-infected patients with compensated cirrhosis: 97 patients who developed liver-related complications such as hepatocellular carcinoma or hepatic decompensation (cases) matched in age, sex and follow-up duration were compared with 257 patients without complications (controls). Actitest/Fibrotest™, Inflameter/Fibrometer™, ELF™ and Fibroscan™ were performed at baseline and yearly. Samples based on Propensity score matching were built and mixed linear models performed. Outcomes in a sustained virological response (SVR) negative population and a SVR-positive population were also described. RESULTS At baseline, all characteristics of patients were similar between the groups. All fibrosis tests were statistically higher for cases compared to controls, Fibroscan™ excepted: Fibrotest™: 0.83±0.13 vs. 0.77±0.16; Fibrometer™: 0.93±0.07 vs. 0.90±0.11; ELF™: 11.4±1.0 vs. 11.0±1.2 (P<0.02). The mean follow-up was 5.7±1.9 years. Over a 3-year period, the significant difference in fibrosis marker values between cases and controls remained constant; with a trend toward a decrease in inflammation markers in controls, independent of SVR status. CONCLUSIONS Baseline noninvasive serum fibrosis and inflammation markers were significantly higher in patients developing a complication than in controls. During the follow-up only inflammatory markers decreased in controls, but not in cases, and thus could potentially be used to predict the occurrence of complications in cirrhotic patients.
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Affiliation(s)
- Jean-Pierre Zarski
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France.
| | - Sandra David-Tchouda
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Candice Trocme
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Jennifer Margier
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Antoine Vilotitch
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | | | - Carole Cagnot
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Valerie Boursier
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Marianne Ziol
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Angela Sutton
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Richard Layese
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | - Etienne Audureau
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
| | | | - Pierre Nahon
- CHU de grenoble, gastroenterologie et hepatologie, CS 10217, 38043 Grenoble, France
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16
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Barrail-Tran A, Goldwirt L, Gelé T, Laforest C, Lavenu A, Danjou H, Radenne S, Leroy V, Houssel-Debry P, Duvoux C, Kamar N, De Ledinghen V, Canva V, Conti F, Durand F, D'Alteroche L, Botta-Fridlund D, Moreno C, Cagnot C, Samuel D, Fougerou-Leurent C, Pageaux GP, Duclos-Vallée JC, Taburet AM, Coilly A. Comparison of the effect of direct-acting antiviral with and without ribavirin on cyclosporine and tacrolimus clearance values: results from the ANRS CO23 CUPILT cohort. Eur J Clin Pharmacol 2019; 75:1555-1563. [PMID: 31384986 DOI: 10.1007/s00228-019-02725-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/17/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Direct-acting antiviral agents have demonstrated their efficacy in treating HCV recurrence after liver transplantation and particularly the sofosbuvir/daclatasvir combination. Pharmacokinetic data on both calcineurin inhibitors and direct-acting antiviral exposure in liver transplant recipients remain sparse. METHODS Patients were enrolled from the ANRS CO23 CUPILT cohort. All patients treated with sofosbuvir/daclatasvir with or without ribavirin were included in this study when blood samples were available to estimate the clearance of immunosuppressive therapy before direct-acting antiviral initiation and during follow-up. Apparent tacrolimus and cyclosporine clearances were estimated from trough concentrations measured using validated quality control assays. RESULTS Sixty-seven mainly male patients (79%) were included, with a mean age of 57 years and mean MELD score of 8.2; 50 were on tacrolimus, 17 on cyclosporine. Ribavirin was combined with sofosbuvir/daclatasvir in 52% of patients. Cyclosporine clearance remained unchanged as well as tacrolimus clearance under the ribavirin-free regimen. Tacrolimus clearance increased 4 weeks after direct-acting antivirals and ribavirin initiation versus baseline (geometric mean ratio 1.81; 90% CI 1.30-2.52). Patients under ribavirin had a significantly higher fibrosis stage (> 2) (p = 0.02) and lower haemoglobin during direct-acting antiviral treatment (p = 0.02) which impacted tacrolimus measurements. Direct-acting antiviral exposure was within the expected range. CONCLUSION Our study demonstrated that liver transplant patients with a recurrence of hepatitis C who are initiating ribavirin combined with a sofosbuvir-daclatasvir direct-acting antiviral regimen may be at risk of lower tacrolimus concentrations because of probable ribavirin-induced anaemia and higher fibrosis score, although there are no effects on cyclosporine levels. TRIAL REGISTRATION NCT01944527.
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Affiliation(s)
- Aurélie Barrail-Tran
- AP-HP, Hôpital Bicêtre, Department of Clinical Pharmacy, Hôpitaux Universitaires Paris Sud, Kremlinl-Bicêtre, France.
- Department of Clinical Pharmacy, Université Paris Sud, Châtenay Malabry, France.
- INSERM UMR1184, CEA, Université Paris Sud, Immunologie des Maladies Virales et Autoimmunes (IMVA), Kremlin-Bicêtre, France.
| | - Lauriane Goldwirt
- Department of Pharmacology, Assistance Publique Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France
| | - Thibaut Gelé
- AP-HP, Hôpital Bicêtre, Department of Clinical Pharmacy, Hôpitaux Universitaires Paris Sud, Kremlinl-Bicêtre, France
| | - Claire Laforest
- CHU Rennes, Service de Pharmacologie, Rennes, France
- INSERM, CIC 1414, Rennes, France
| | - Audrey Lavenu
- INSERM, CIC 1414, Rennes, France
- University of Rennes 1, Laboratory of Experimental and Clinical Pharmacology, Rennes, France
| | - Hélène Danjou
- CHU Rennes, Service de Pharmacologie, Rennes, France
- INSERM, CIC 1414, Rennes, France
| | - Sylvie Radenne
- Service d'Hépato-Gastroentérologie, HCL Hôpital de la Croix-Rousse, Lyon, France
| | - Vincent Leroy
- Service d'Hépato-Gastroentérologie, CHU Michallon, Grenoble, France
| | | | - Christophe Duvoux
- Service d'Hépato-Gastroentérologie, AP-HP Hôpital Henri-Mondor, Créteil, France
| | - Nassim Kamar
- Service de Néphrologie, HTA, Dialyse, Transplantation, CHU Rangueil, Toulouse, France
| | | | - Valérie Canva
- Service des Maladies de l'Appareil Digestif, CHRU Huriez, Lille, France
| | - Filomena Conti
- Service de Chirurgie Hépatobiliaire et Transplantation Hépatique, AP-HP Hôpital Pitié-Salpêtrière, Paris, France
| | - François Durand
- Service d'Hépatologie, AP-HP Hôpital Beaujon, Clichy, France
| | | | | | - Christophe Moreno
- CUB, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis ANRS (France REcheche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Didier Samuel
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
- Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France
- Hepatinov, Villejuif, France
| | | | - Georges-Philippe Pageaux
- Department of Hepatogastroenterology, CHU Saint Eloi, Université de Montpellier, Montpellier, France
| | - Jean-Charles Duclos-Vallée
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
- Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France
- Hepatinov, Villejuif, France
| | - Anne-Marie Taburet
- AP-HP, Hôpital Bicêtre, Department of Clinical Pharmacy, Hôpitaux Universitaires Paris Sud, Kremlinl-Bicêtre, France
- INSERM UMR1184, CEA, Université Paris Sud, Immunologie des Maladies Virales et Autoimmunes (IMVA), Kremlin-Bicêtre, France
- Hepatinov, Villejuif, France
| | - Audrey Coilly
- AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, Villejuif, France
- Univ Paris-Sud, UMR-S 1193, Université Paris-Saclay, Villejuif, France
- Inserm, Unité 1193, Université Paris-Saclay, Villejuif, France
- Hepatinov, Villejuif, France
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Brichler S, Nahon P, Zoulim F, Layese R, Bourcier V, Audureau E, Sutton A, Letouze E, Cagnot C, Marcellin P, Guyader D, Roulot D, Pol S, de Ledinghen V, Zarski JP, Calès P, Tran A, Peron JM, Mallat A, Riachi G, Grange JD, Blanc JF, Bacq Y, Ouzan D, Bronowicki JP, Mathurin P, Larrey D, Alric L, Attali P, Serfaty L, Pilette C, Bourlière M, Thabut D, Silvain C, Wartelle C, Zucman D, Christidis C, Roudot-Thoraval F, Ganne-Carrie N. Non-virological factors are drivers of hepatocellular carcinoma in virosuppressed hepatitis B cirrhosis: Results of ANRS CO12 CirVir cohort. J Viral Hepat 2019; 26:384-396. [PMID: 30380181 DOI: 10.1111/jvh.13029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 10/05/2018] [Accepted: 10/08/2018] [Indexed: 12/17/2022]
Abstract
Worldwide, hepatocellular carcinoma (HCC) occurs mainly in Asian patients with hepatitis B virus (HBV) infection. This study aimed to decipher the environmental and virological factors associated with HCC occurrence and validate risk scoring systems in a French multicentre prospective cohort of HBV cirrhotic patients. Patients with biopsy-proven Child-Pugh A viral cirrhosis included in the ANRS CO12 CirVir cohort who were HBsAg(+) without hepatitis C coinfection were selected for: (a) interview through a standardized questionnaire reporting coffee consumption and HCC familial history; (b) HBsAg quantification using baseline and sequential 2-year frozen sera; (c) baseline HBV genotype determination; and (d) assessment of risk factors and applicability of HCC risk scores (Kaplan-Meier analysis, Cox models). Among 317 patients studied (261 men, median age 53 years, past or ongoing antiviral treatment 93.3% and baseline detectable HBV DNA in 88 patients), the baseline and 2-year median HBsAg levels were 810 and 463 IU/mL, respectively. After a median follow-up of 65.2 months, 27 HCC cases were diagnosed (annual incidence: 1.6%). Three factors were independently associated with HCC occurrence: age > 50 years, platelets ≤ 150 × 103 /mm3 and body mass index ≥ 30 kg/m2 . Two out of five risk scores were validated, and the most accurate was PAGE-B at 1 year. Moreover, HCC in patients without maintained virological suppression seems more aggressive and less accessible to curative treatment. In conclusion, in French patients with HBV cirrhosis mostly virally suppressed, independent HCC risk factors were host-related (age, obesity) or linked to the severity of cirrhosis (thrombopenia), and the European PAGE-B score was the most accurate risk score.
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Affiliation(s)
- Segolene Brichler
- AP-HP, Hôpital Avicenne, Microbiologie Clinique, Bobigny, France.,Université Paris 13, Bobigny, France.,INSERM U955, Université Paris-Est, Créteil, France
| | - Pierre Nahon
- Université Paris 13, Bobigny, France.,AP-HP, Hôpital Jean-Verdier, Hépatologie, Bondy, France.,INSERM U1162, Université Paris 5, Paris, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Hépatologie, Lyon, France.,INSERM U1052, Université de Lyon, Lyon, France
| | - Richard Layese
- AP-HP, Hôpital Henri-Mondor, Unité de Recherche Clinique, Université Paris-Est, DHU A-TVB, IMRB- EA 7376, CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France
| | - Valerie Bourcier
- Université Paris 13, Bobigny, France.,AP-HP, Hôpital Jean-Verdier, Hépatologie, Bondy, France.,INSERM U1162, Université Paris 5, Paris, France
| | - Etienne Audureau
- AP-HP, Hôpital Henri-Mondor, Unité de Recherche Clinique, Université Paris-Est, DHU A-TVB, IMRB- EA 7376, CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France
| | - Angela Sutton
- APHP, Hôpital Jean-Verdier, Biochimie, Bondy, France
| | | | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France
| | | | | | | | - Stanislas Pol
- AP-HP, Hôpital Cochin, Hépatologie, INSERM UMS20 and U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | | | - Albert Tran
- CHU, Hépatologie, INSERM U1065, Université de Nice-Sophia-Antipolis, Nice, France
| | | | - Ariane Mallat
- AP-HP, Hôpital Henri-Mondor, Hépatologie, Créteil, France
| | | | | | | | | | - Denis Ouzan
- Institut Arnaud-Tzanck, Hépatologie, St-Laurent-du-Var, France
| | | | | | | | - Laurent Alric
- CHU, Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
| | - Pierre Attali
- AP-HP, Hôpital Paul-Brousse, Hépatologie, Villejuif, France
| | | | | | | | | | | | | | | | | | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri-Mondor, Unité de Recherche Clinique, Université Paris-Est, DHU A-TVB, IMRB- EA 7376, CEpiA (Clinical Epidemiology and Ageing Unit), Créteil, France.,AP-HP, Hôpital Henri-Mondor, Hépatologie, Créteil, France
| | - Nathalie Ganne-Carrie
- Université Paris 13, Bobigny, France.,AP-HP, Hôpital Jean-Verdier, Hépatologie, Bondy, France.,INSERM U1162, Université Paris 5, Paris, France
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18
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Thabut D, Bureau C, Layese R, Bourcier V, Hammouche M, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Goria O, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle-Bladou C, Dao T, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Hillaire S, Di Martino V, Sutton A, Audureau E, Roudot-Thoraval F, Nahon P. Validation of Baveno VI Criteria for Screening and Surveillance of Esophageal Varices in Patients With Compensated Cirrhosis and a Sustained Response to Antiviral Therapy. Gastroenterology 2019; 156:997-1009.e5. [PMID: 30768988 DOI: 10.1053/j.gastro.2018.11.053] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 11/13/2018] [Accepted: 11/25/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND & AIMS Management of patients with cirrhosis includes endoscopic screening and surveillance to detect esophageal varices (EV) and prevent bleeding. However, the Baveno VI guidelines recommend avoiding endoscopies for patients with liver stiffness measurements below 20 kPa and platelet counts above 150,000 (favorable Baveno VI status) and endoscopic assessment of patients with higher levels of liver stiffness and platelet counts (unfavorable Baveno VI status). We aimed to validate the Baveno VI guidelines, evaluating outcomes of patients in the ANRS-CO12 CirVir cohort with compensated cirrhosis associated with hepatitis B virus (HBV) or hepatitis C virus (HCV) infection, with or without a sustained response to antiviral therapy. METHODS We performed an ancillary study using data from 891 patients in the ANRS CO12 CirVir cohort, treated at 35 centers in France, with HCV or HBV infection and biopsy-proven cirrhosis, Child-Pugh A scores, no previous complications, and no hepatocellular carcinoma who underwent an endoscopic procedure and had interpretable liver stiffness measurements and platelet counts. Progression of portal hypertension (PHT) was defined as the onset of varices needing treatment (VNT) or PHT-related bleeding. An sustained response to antiviral therapy was defined as undetectable level of HCV RNA by polymerase chain reaction assay (<50 IU/mL) 12 weeks after the end of treatment (SVR) or an undetectable level of HBV DNA. The primary aims were to validate the Baveno VI guidelines for screening and surveillance of EV in patients with compensated cirrhosis and to study the effects of an SVR on the progression of PHT. RESULTS A total of 200 patients achieved an SVR (22.4%) (94 patients with HCV infection, 98 patients with HBV infection, and 8 patients with both); 80 of these patients had favorable Baveno VI status and none had VNT. Progression of PHT was studied in 548 patients; during a follow-up period of 61.2 months (interquartile range, 39.5-80.6 months), 105 of these patients (19.1%) had progression of PHT. Lack of an SVR and grade 1 EV were independently associated with progression of PHT. At the time of PHT progression, all patients had unfavorable Baveno VI status. Achieving favorable Baveno VI status after an SVR was associated with the absence of PHT progression. Favorable Baveno VI status and SVR were independently associated with survival. CONCLUSIONS In an analysis of data from a large cohort of patients with HBV- or HCV-associated cirrhosis in France, we validated the Baveno VI guidelines on screening and surveillance of PHT, even for patients who achieved a sustained response to antiviral therapy.
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Affiliation(s)
- Dominique Thabut
- Paris Sorbonne Université, Paris, France; AP-HP, Hôpital Pitié-Salpêtrière, Service d'hépato-gastroentérologie, Paris, France.
| | - Christophe Bureau
- Service d'hépato-gastroentérologie, Hôpital Purpan CHU Toulouse, 31059 Toulouse Cedex; Université Paul Sabatier Toulouse III, Toulouse
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil
| | - Valérie Bourcier
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris
| | - Maryam Hammouche
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris
| | - Carole Cagnot
- ANRS (France Recherche Nord & sud Sida-HIV Hépatites), Paris
| | | | | | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie et INSERM UMS20, Institut Pasteur, Université Paris Descartes, Paris
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var
| | | | | | - Albert Tran
- CHU de Nice, Service d'Hépatologie, et INSERM U1065, Université de Nice-Sophia-Antipolis, Nice
| | | | | | - Odile Goria
- Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen
| | - Paul Calès
- CHU d'Angers, Service d'Hépatologie, Angers
| | | | - Laurent Alric
- CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse
| | | | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand
| | | | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours
| | | | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen
| | | | | | | | | | | | | | | | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy; Inserm U1148, Université Paris 13, Bobigny, France
| | - Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil
| | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri Mondor, Service de Santé Publique, Unité de Recherche Clinique (URC Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Ageing) Unit EA7376, UPEC, F-94000, Créteil
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, Université Paris 13, Bobigny et INSERM U1162, Université Paris 5, Paris
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19
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Buscail C, Bourcier V, Fezeu L, Roulot D, Brûlé S, Ben Abdesselam Z, Cagnot C, Hercberg S, Nahon P, Ganne N, Julia C. Comportements alimentaires des patients atteints de cirrhose compensée et non compliquée : étude cas-témoins en Île-de-France. NUTR CLIN METAB 2018. [DOI: 10.1016/j.nupar.2018.09.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Nahon P, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Roudot-Thoraval F, Audureau E. Incidence of Hepatocellular Carcinoma After Direct Antiviral Therapy for HCV in Patients With Cirrhosis Included in Surveillance Programs. Gastroenterology 2018; 155:1436-1450.e6. [PMID: 30031138 DOI: 10.1053/j.gastro.2018.07.015] [Citation(s) in RCA: 167] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/30/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Retrospective studies have found an unexpectedly high incidence of hepatocellular carcinoma (HCC) among patients with hepatitis C virus (HCV)-associated cirrhosis who received direct-acting antiviral (DAA) agents. We analyzed data from the ANRS CO12 CirVir cohort to compare the incidence of HCC in patients with cirrhosis who received DAA therapy vs patients treated with interferon (IFN). METHODS Data were collected from 1270 patients with compensated biopsy-proven HCV-associated cirrhosis recruited from 2006 through 2012 at 35 centers in France. For descriptive purpose, patients were classified as follows: patients who received DAA treatment (DAA group, n = 336), patients who achieved a sustained virologic response (SVR) following an IFN-based regimen (SVR-IFN group, n = 495), or patients who never received DAA treatment and never had an SVR following IFN therapy (non-SVR group, n = 439). The patients were included in HCC surveillance programs based on ultrasound examination every 6 months, and clinical and biological data were recorded. To account for confounding by indication due to differences in patient characteristics at treatment initiation, we constructed a time-dependent Cox regression model weighted by the inverse probability of treatment and censoring (IPTCW) to assess the treatment effects of DAA on time until HCC. RESULTS Compared with patients in the SVR-IFN group, patients in the DAA group were older, higher proportions had diabetes or portal hypertension, and liver function was more severely impaired. The crude 3-year cumulative incidences of HCC were 5.9% in the DAA group, 3.1% in the SVR-IFN group, and 12.7% in the non-SVR group (overall P < .001; unadjusted hazard ratio [HR] for HCC 2.03; 95% confidence interval [CI] 1.07-3.84; P = .030 for the DAA group vs the SVR-IFN group). HCC characteristics were similar among groups. Among patients with HCC, the DAA group received less-frequent HCC screening than the other 2 groups (P = .002). After Cox analyses weighted by the IPTCW, we found no statistically significant increase in risk of HCC associated with DAA use (HR 0.89; 95% CI 0.46-1.73; P = .73). CONCLUSIONS Analysis of data from the ANRS CO12 CirVir cohort reveals that the apparent increase in HCC incidence observed in patients with cirrhosis treated with DAAs compared with patients who achieved SVR following an IFN therapy can be explained by patient characteristics (age, diabetes, reduced liver function) and lower screening intensity.
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Affiliation(s)
- Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer," F-93206 Saint-Denis, France; Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides," F-75000, Paris, France.
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, F-94000, Créteil, France
| | - Valérie Bourcier
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France
| | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord and sud Sida-HIV Hépatites-FRENSH), France
| | | | | | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie, France; Inserm UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Service d'Hépatologie et Université de Lyon, Lyon, France
| | | | - Albert Tran
- CHU de Nice, Service d'Hépatologie, F-06202, Cedex 3, Nice, France; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity", F-06204, Cedex 3, Nice, France
| | | | | | - Ghassan Riachi
- Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France
| | - Paul Calès
- CHU d'Angers, Service d'Hépato-Gastroentérologie, Angers, France
| | | | - Laurent Alric
- CHU Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
| | - Marc Bourlière
- Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
| | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France
| | - Lawrence Serfaty
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
| | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours, France
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
| | - Dominique Thabut
- AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | | | | | | | | | | | - David Zucman
- Hôpital Foch, Service de Médecine Interne, Suresnes, France
| | | | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027, Paris, France; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy, France; Inserm U1148, Université Paris 13, Bobigny, France
| | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, F-94000, Créteil, France
| | - Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, F-94000, Créteil, France
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21
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Allaire M, Nahon P, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, DI Martino V, Sutton A, Letouzé E, Audureau E, Roudot-Thoraval F. Extrahepatic cancers are the leading cause of death in patients achieving hepatitis B virus control or hepatitis C virus eradication. Hepatology 2018; 68:1245-1259. [PMID: 29663511 DOI: 10.1002/hep.30034] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 03/09/2018] [Accepted: 04/11/2018] [Indexed: 12/12/2022]
Abstract
UNLABELLED Data on extrahepatic cancers (EHCs) in compensated viral cirrhosis are limited. The objective of the prospective multicenter Agence Nationale de Recherche sur le SIDA et les Hépatites virales CO12 CirVir cohort was to assess the occurrence of all clinical events in patients with compensated viral cirrhosis, including all types of cancer. Patients with the following inclusion criteria were enrolled in 35 French centers: (1) biopsy-proven hepatitis B virus (HBV) or hepatitis C virus (HCV) cirrhosis, (2) Child-Pugh A, or (3) absence of previous liver complications including primary liver cancer (PLC). Patients were followed up prospectively every 6 months. The standardized mortality ratio (SMR) was calculated according to age and gender using 5-year periods. The impact of sustained viral response (SVR) in HCV patients and maintained viral suppression in HBV patients were assessed using time-dependent analysis. A total of 1,671 patients were enrolled between 2006 and 2012 (median age, 54.9 years; men, 67.3%; HCV, 1,323; HBV, 317; HCV-HBV, 31). Metabolic features and excessive alcohol and tobacco consumption were recorded in 15.2%, 36.4%, and 56.4% of cases, respectively. After a median follow-up of 59.7 months, 227 PLCs were diagnosed (5-year cumulative incidence [CumI] 13.4%) and 93 patients developed EHC (14 patients with lymphoid or related tissue cancer and 79 with solid tissue cancer; 5-year EHC CumI, 5.9%). Compared to the general French population, patients were younger at cancer diagnosis, with significantly higher risk of EHC in HCV patients (SMR, 1.31; 95 confidence interval [CI], 1.04-1.64; P = 0.017) and after SVR (SMR = 1.57; 95% CI, 1.08-2.22; P = 0.013). EHC was the fourth leading cause of death in the whole cohort and the first in patients with viral control/eradication. CONCLUSION Compared to the general French population, HCV cirrhosis is associated with a higher risk of EHC and the first cause of death in patients with viral cirrhosis who achieve virological control/eradication. (Hepatology 2018).
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Affiliation(s)
- Manon Allaire
- Service d'Hépato-gastroentérologie et Nutrition, Centre Hospitalo-Universitaire de Caen, Caen, France.,Inserm UMR 1149, Centre de recherche sur l'inflammation, Paris, France
| | - Pierre Nahon
- Service d'Hépatologie, AP-HP, Hôpital Jean Verdier, Bondy, France.,Equipe Labellisée Ligue contre le cancer, Université Paris 13, Sorbonne Paris Cité, Bobigny, France.,Génomique Fonctionnelle des Tumeurs Solides, Inserm UNR-1162, Paris, France
| | - Richard Layese
- Service de Santé Publique and Unité de Recherche Clinique (URC-Mondor), AP-HP, Hôpital Henri-Mondor; A-TVB DHU, CEpiA (Clinical Epidemiology and Aging), UPEC, Université Paris-Est, Créteil, France
| | - Valérie Bourcier
- Service d'Hépatologie, AP-HP, Hôpital Jean Verdier, Bondy, France
| | - Carole Cagnot
- ANRS (France Recherche Nord & sud Sida-hiv Hépatites), Paris, France
| | | | - Dominique Guyader
- Service d'Hépatologie, Centre Hospitalo-Universitaire Pontchaillou, Rennes, France
| | - Stanislas Pol
- Service d'Hépatologie, AP-HP, Hôpital Cochin, Paris, France.,Inserm MS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | - Dominique Larrey
- Service d'Hépatologie, Centre Hospitalo-Universitaire Saint Eloi, Montpellier, France.,Liver and Gastroenterology, Department-IRB-INSERM-1183, Bordeaux, France
| | | | - Denis Ouzan
- Service d'Hépatologie, Institut Arnaud Tzanck, Saint Laurent du Var, France
| | - Fabien Zoulim
- Service d'Hépatologie, Hospices Civils de Lyon, Lyon, France
| | | | - Albert Tran
- Service d'Hépatologie, Centre Hospitalo-Universitaire de Nice, Nice, France.,Hepatic Complications in Obesity, Inserm U1065, C3M, Team 8, Nice, France
| | - Jean-Pierre Bronowicki
- Service d'Hépatologie, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre-les-Nancy, France
| | - Jean-Pierre Zarski
- Service d'Hépatologie, Centre Hospitalo-Universitaire Michallon, Grenoble, France
| | - Ghassan Riachi
- Service d'Hépato-gastroentérologie, Centre Hospitalo-Universitaire Charles-Nicolle, Rouen, France
| | - Paul Calès
- Service d'Hépato-gastroentérologie, Centre Hospitalo-Universitaire d'Angers, Angers, France.,Laboratoire HIFIH, UPRES 3859, SFR ICAT 4208, UFR Santé, Université d'Angers, UBL, Angers, France
| | - Jean-Marie Péron
- Service d'Hépatologie, Centre Hospitalo-Universitaire Purpan, Toulouse, France
| | - Laurent Alric
- Service de Médecine Interne, Centre Hospitalo-Universitaire Purpan, Toulouse, France
| | - Marc Bourlière
- Service d'Hépatologie, Hôpital Saint Joseph, Marseille, France
| | - Philippe Mathurin
- Service d'Hépatologie, Centre Hospitalo-Universitaire Claude Huriez, Lille, France
| | - Jean-Frédéric Blanc
- Service d'Hépatologie, Centre Hospitalo-Universitaire Saint André, Bordeaux, France
| | - Armand Abergel
- Service d'Hépatologie, Centre Hospitalo-Universitaire Hôtel Dieu, Clermont-Ferrand, France
| | - Lawrence Serfaty
- Service d'Hépatologie, AP-HP, Hôpital Saint Antoine, Paris, France
| | - Ariane Mallat
- Service d'Hépatologie, AP-HP, Hôpital Henri Mondor, University Paris-Est, Créteil, France.,Inserm, U955, Créteil, France
| | | | - Pierre Attali
- Service d'Hépatologie, AP-HP, Hôpital Paul Brousse, Villejuif, France
| | - Yannick Bacq
- Service d'Hépatologie, Centre Hospitalo-Universitaire Trousseau, Tours, France
| | - Claire Wartelle
- Service d'Hépatologie, Hôpital d'Aix-en-Provence, Aix-En-Provence, France
| | - Thông Dao
- Service d'Hépato-gastroentérologie et Nutrition, Centre Hospitalo-Universitaire de Caen, Caen, France
| | - Dominique Thabut
- Service d'Hépatologie, AP-HP, Hôpital La Pitié Salpêtrière, Paris, France
| | | | - Christine Silvain
- Service d'Hépatologie, Centre Hospitalo-Universitaire de Poitiers, Poitiers, France
| | | | - Eric Nguyen-Khac
- Service d'Hépatologie, Centre Hospitalo-Universitaire d'Amiens, Amiens, France
| | | | - David Zucman
- Service de Médecine Interne, Hôpital Foch, Suresnes, France
| | - Vincent DI Martino
- Service d'Hépatologie, Centre Hospitalo-Universitaire Jean Minjoz, Besançon, France
| | - Angela Sutton
- Centre de Ressources Biologiques, Groupe Hospitalier Paris, Seine-Saint-Denis, France.,Service de Biochimie, AP-HP, Hôpital Jean Verdier, Bondy, France.,Inserm U1148, Université Paris 13, Bobigny, France
| | - Eric Letouzé
- Génomique Fonctionnelle des Tumeurs Solides, Inserm UNR-1162, Paris, France
| | - Etienne Audureau
- Service de Santé Publique and Unité de Recherche Clinique (URC-Mondor), AP-HP, Hôpital Henri-Mondor; A-TVB DHU, CEpiA (Clinical Epidemiology and Aging), UPEC, Université Paris-Est, Créteil, France
| | - Françoise Roudot-Thoraval
- Service de Santé Publique and Unité de Recherche Clinique (URC-Mondor), AP-HP, Hôpital Henri-Mondor; A-TVB DHU, CEpiA (Clinical Epidemiology and Aging), UPEC, Université Paris-Est, Créteil, France
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22
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Wendum D, Layese R, Ganne-Carrié N, Bourcier V, Merabtene F, Cagnot C, Sauce E, Barget N, Bedossa P, Terris B, Selves J, Bioulac-Sage P, Sturm N, Sattonnet C, Nahon P, Roudot-Thoraval F, Ziol M. Influence of Progenitor-Derived Regeneration Markers on Hepatitis C Virus-Related Cirrhosis Outcome (ANRS CO12 CirVir Cohort). Hepatology 2018; 68:1534-1548. [PMID: 29637581 DOI: 10.1002/hep.29927] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/22/2016] [Accepted: 10/31/2016] [Indexed: 12/20/2022]
Abstract
UNLABELLED Progenitor-derived regeneration gives rise to the aberrant expression of biliary markers such as cytokeratin 7 (K7) and epithelial cell adhesion molecule (EpCAM) in hepatocytes. We aimed to describe the expression of these molecules in patients with compensated hepatitis C virus (HCV)-related cirrhosis and to investigate its potential influence on cirrhosis complications. Among patients with Child-Pugh A uncomplicated HCV-related cirrhosis enrolled in the prospective ANRS CO12 CirVir cohort, we selected individuals with a liver biopsy collected within 2 years before inclusion in the study. K7 and EpCAM immunostaining identified intermediate hepatobiliary cells. The influence of biliary marker expres-sion in hepatocytes on decompensation events and the occurrence of hepatocellular carcinoma (HCC) was studied using a multivariate Cox proportional hazards regression model. Among the 337 patients eligible for the study (men, 67%; median age, 52 years), 198 (58.8%) had biopsies with K7-positive hepatocytes including extensive staining in 40 (11.9%) and 203 had EpCAM-positive hepatocytes (60.6%). During follow-up (median, 54.2 months), 47 patients (14%) experienced a decompensation event, and HCC was diagnosed in 37 patients (11%). Extensive K7 staining was independently associated with the occurrence of a decompensation event (hazard ratio [HR], 3.00; 95% confidence interval [CI], 1.30-6.89; P = 0.010). EpCAM expression was independently associated with HCC occurrence (HR, 2.37; 95% CI, 1.07-5.23; P =0.033) along with age and a low prothrombin ratio. CONCLUSION Progenitor-derived regeneration depicted by K7 and EpCAM immunostaining of hepatocytes in liver biopsies of patients with compensated HCV-related cirrhosis marks a cirrhosis stage more prone to develop complications. (HEPATOLOGY 2018; 68:1534-1548).
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Affiliation(s)
- Dominique Wendum
- APHP, Hôpital St. Antoine, Anatomie Pathologiques.,Sorbonne Universités, UPMC Université Paris 06, INSERM UMRS_938 Centre de Recherche St. Antoine (CRSA), Paris, France
| | - Richard Layese
- APHP, Hôpital Henri Mondor, Unité de recherche clinique (URC-Mondor), Service de Santé Publique, AP-HP, Hôpital Henri-Mondor, Créteil, France.,Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France
| | - Nathalie Ganne-Carrié
- APHP, Hôpital Jean Verdier, Service d'hépatologie, Bondy, France.,Université Paris 13, Sorbonne Paris-Cité, Bobigny, France.,INSERM UMR 1162, Génomique fonctionnelle des tumeurs solides, Université Paris Descartes, Université Paris Diderot, France
| | - Valérie Bourcier
- APHP, Hôpital Jean Verdier, Service d'hépatologie, Bondy, France
| | - Fatiha Merabtene
- Sorbonne Universités, UPMC Université Paris 06, INSERM UMRS_938 Centre de Recherche St. Antoine (CRSA), Paris, France.,Sorbonne Universités, UMS 30 LUMIC plateforme d'histomorphologie St. Antoine
| | | | - Emmanuel Sauce
- APHP, Hôpital Jean Verdier, Anatomie Pathologique et CRB BB-0033-00027, Bondy, France
| | - Nathalie Barget
- APHP, Hôpital Jean Verdier, Anatomie Pathologique et CRB BB-0033-00027, Bondy, France
| | - Pierre Bedossa
- APHP, Hôpital Beaujon, Département de Pathologie, Clichy, France
| | - Benoit Terris
- APHP, Hôpital Cochin, Anatomie Pathologique, Paris, France
| | - Janick Selves
- IUCT-Oncopole Toulouse, Departement d'Anatomie Pathologique, Toulouse, France
| | - Paulette Bioulac-Sage
- Pathology Department, Pellegrin Hospital, CHU Bordeaux.,Inserm, UMR1053 Bordeaux Research in Translational Oncology BaRITOn.,Université Bordeaux, UMR1053 Bordeaux Research in Translational Oncology BaRITOn, Bordeaux, France
| | - Nathalie Sturm
- CHU Grenoble, Département de Pathologie, Grenoble, France
| | | | - Pierre Nahon
- APHP, Hôpital Jean Verdier, Service d'hépatologie, Bondy, France.,Université Paris 13, Sorbonne Paris-Cité, Bobigny, France.,INSERM UMR 1162, Génomique fonctionnelle des tumeurs solides, Université Paris Descartes, Université Paris Diderot, France
| | - Françoise Roudot-Thoraval
- APHP, Hôpital Henri Mondor, Unité de recherche clinique (URC-Mondor), Service de Santé Publique, AP-HP, Hôpital Henri-Mondor, Créteil, France.,Université Paris Est (UPEC), IMRB, A-TVB DHU, CEpiA EA 7376 (Clinical Epidemiology and Ageing Unit), Créteil, France
| | - Marianne Ziol
- Université Paris 13, Sorbonne Paris-Cité, Bobigny, France.,INSERM UMR 1162, Génomique fonctionnelle des tumeurs solides, Université Paris Descartes, Université Paris Diderot, France.,APHP, Hôpital Jean Verdier, Anatomie Pathologique et CRB BB-0033-00027, Bondy, France
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23
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Houssel-Debry P, Coilly A, Fougerou-Leurent C, Jezequel C, Duvoux C, De Ledinghen V, Radenne S, Kamar N, Leroy V, Martino VD, D'Alteroche L, Canva V, Conti F, Dumortier J, Montialoux H, Lebray P, Botta-Fridlund D, Tran A, Moreno C, Silvain C, Besch C, Perre P, Francoz C, Abergel A, Habersetzer F, Debette-Gratien M, Cagnot C, Diallo A, Chevaliez S, Rossignol E, Veislinger A, Duclos-Vallee JC, Pageaux GP. 12 Weeks of a Ribavirin-Free Sofosbuvir and Nonstructural Protein 5A Inhibitor Regimen Is Enough to Treat Recurrence of Hepatitis C After Liver Transplantation. Hepatology 2018; 68:1277-1287. [PMID: 29633389 DOI: 10.1002/hep.29918] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 04/02/2018] [Indexed: 12/12/2022]
Abstract
UNLABELLED Sofosbuvir (SOF) combined with nonstructural protein 5A (NS5A) inhibitors has demonstrated its efficacy in treating a recurrence of hepatitis C virus (HCV) after liver transplantation (LT). However, the duration of treatment and need for ribavirin (RBV) remain unclear in this population. Our aim was to determine whether LT recipients could be treated with an SOF + NS5A inhibitor-based regimen without RBV for 12 weeks post-LT. Between October 2013 and December 2015, 699 LT recipients experiencing an HCV recurrence were enrolled in the multicenter ANRS CO23 CUPILT cohort. We selected patients receiving SOF and NS5A inhibitor ± RBV and followed for at least 12 weeks after treatment discontinuation. The primary efficacy endpoint was a sustained virological response 12 weeks after the end of treatment (SVR12). Among these 699 patients, 512 fulfilled the inclusion criteria. Their main characteristics were: 70.1% genotype 1, 18.2% genotype 3, 21.1% cirrhosis, and 34.4% previously treated patients. We identified four groups of patients according to their treatment and duration: SOF + NS5A without RBV for 12 (156 patients) or 24 (239 patients) weeks; SOF + NS5A + RBV for 12 (47 patients) or 24 (70 patients) weeks. SVR12 values reached 94.9%, 97.9%, 95.7%, and 92.9%, respectively (P = 0.14). Only 20 patients experienced a treatment failure. Under multivariate analysis, factors such as fibrosis stage, previous treatment, HCV genotype, and baseline HCV viral load did not influence SVR12 rates in the four groups (P = 0.21). Hematological adverse events (AEs) were more common in the RBV group: anemia (P < 0.0001) and blood transfusion (P = 0.0001). CONCLUSION SOF + NS5A inhibitors without RBV for 12 weeks constituted reliable therapy for recurrent HCV post-LT with an excellent SVR12 whatever the fibrosis stage, HCV genotype, and previous HCV treatment. (Hepatology 2018; 00:000-000).
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Affiliation(s)
- Pauline Houssel-Debry
- Hepatology and Liver Transplant Unit, Pontchaillou University Hospital, Rennes, France
| | - Audrey Coilly
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Claire Fougerou-Leurent
- Pharmacology Unit, CHU Rennes, Rennes, France.,INSERM, CIC 1414 Clinical Investigation Centre, Rennes, France
| | - Caroline Jezequel
- Hepatology and Liver Transplant Unit, Pontchaillou University Hospital, Rennes, France
| | | | | | - Sylvie Radenne
- Hepatology Unit, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Nassim Kamar
- Nephrology and Organ Transplantation Unit, CHU Rangueil, INSERM U1043, IFR-BMT, Paul Sabatier University, Toulouse, France
| | - Vincent Leroy
- Hepato-Gastroenterolgy Unit, Pôle Digidune, CHU Grenoble, Grenoble, France
| | - Vincent Di Martino
- Hepatology Unit, CHRU Jean Minjoz Franche Comté University, Besançon, France
| | | | - Valérie Canva
- CHRU Lille, Hepatology Unit, Claude Huriez Hospital, CHRU Lille, Lille, France
| | - Filomena Conti
- Hepatology and Liver Transplant Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Jerome Dumortier
- Liver Transplant Unit, Digestive Diseases Federation, Edouard Herriot Hospital, Hospices Civils de Lyon Université Claude Bernard Lyon 1, Lyon, France
| | | | - Pascal Lebray
- Hepatology and Liver Transplant Unit, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | | | - Albert Tran
- Hepatogastroenterology Unit, Nice University Hospital, INSERM, U1065, Equipe 8, Nice Sophia Antipolis University, Faculty of Medicine, Nice, Cedex 2, Nice, France
| | - Christophe Moreno
- Hepatogastroenterology Unit, CUB Hôpital Erasme, Brussels University, Bruxelles, Belgique
| | | | - Camille Besch
- Liver Transplant and Digestive Surgery Unit, Strasbourg University, Strasbourg, France
| | - Philippe Perre
- Infectious Diseases Unit, CHD Vendée, La Roche sur Yon, Strasbourg, France
| | - Claire Francoz
- Hepatology Unit, Beaujon Hospita, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - Armando Abergel
- Hepatogastroenterology Unit, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
| | - François Habersetzer
- Universitary Hospitals of Strasbourg, Inserm U 1110, LabEx HepSYS, Strasbourg University, Strasbourg, France
| | | | - Carole Cagnot
- Unité de recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France REcherche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Alpha Diallo
- Unité de recherche Clinique et Fondamentale sur les Hépatites Virales, ANRS (France REcherche Nord&sud Sida-hiv Hépatites), Paris, France
| | - Stéphane Chevaliez
- Virology Unit, French National Reference Center for Viral Hepatitis B, C and delta French National Reference Center for Viral Hepatitis B, C and delta, Hôpital Henri Mondor, Université Paris 12, Paris, France
| | - Emilie Rossignol
- Pharmacology Unit, CHU Rennes, Rennes, France.,INSERM, CIC 1414 Clinical Investigation Centre, Rennes, France
| | - Aurélie Veislinger
- Pharmacology Unit, CHU Rennes, Rennes, France.,INSERM, CIC 1414 Clinical Investigation Centre, Rennes, France
| | - Jean-Charles Duclos-Vallee
- Hepatobiliary Center, AP-HP Paul Brousse Hospital, Villejuif, France.,Paris Sud University, Paris Sud Saclay University, UMR-S 1193, Villejuif, France.,INSERM, Unité 1193, Villejuif, France.,DHU Hepatinov, Villejuif, France
| | - Georges-Philippe Pageaux
- Liver transplant and Hepatogastroenterology Unit, CHU Saint-Eloi, Montpellier University, Montpellier, France
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24
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Costentin CE, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Nguyen-Khac E, Bernard-Chabert B, Zucman D, Di Martino V, Sutton A, Letouzé E, Imbeaud S, Zucman-Rossi J, Audureau E, Roudot-Thoraval F, Nahon P. Compliance With Hepatocellular Carcinoma Surveillance Guidelines Associated With Increased Lead-Time Adjusted Survival of Patients With Compensated Viral Cirrhosis: A Multi-Center Cohort Study. Gastroenterology 2018; 155:431-442.e10. [PMID: 29729258 DOI: 10.1053/j.gastro.2018.04.027] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 04/21/2018] [Accepted: 04/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Semi-annual surveillance for hepatocellular carcinoma (HCC) is recommended for patients with cirrhosis. We aimed to determine how compliance with HCC surveillance guidelines affects survival times of patients with hepatitis C virus- or hepatitis B virus-associated compensated cirrhosis who developed HCC. METHODS We collected data from the prospective ANRS CO12 CirVir study, from March 2006 through June 2012, on 1671 patients with biopsy-proven viral cirrhosis and no previous liver complications who were undergoing surveillance for HCC at 35 centers in France. Only 216 patients who developed HCC during the follow-up period were included in the analysis. Patients were considered to be compliant with surveillance guidelines if the time between their last surveillance image evaluation and diagnosis of HCC were fewer than 7 months and noncompliant if this time was 7 months or longer. RESULTS HCC was detected in 216 patients, at a median follow-up time of 59.7 months. Of these patients, 140 (80.5%) were Barcelona Clinic Liver Cancer stage 0/A, 135 (69.9%) received first-line curative treatment (15 underwent transplantation, 29 underwent resection, 89 received percutaneous ablation, and 2 received resection and percutaneous ablation), and 129 (60.0%) were compliant with surveillance guidelines. Seventy-nine of the patients with HCC died; 49 deaths were associated with tumor progression. After lead-time adjustment, overall survival (OS) time was longer in patients compliant with surveillance guidelines (median OS time, 53.2 months) than noncompliant patients (median OS time, 25.4 months) (P = .0107); this difference remained significant even when we changed lead time assumptions. In multivariate analysis adjusted for a propensity score, compliance with HCC surveillance guidelines was associated with low tumor burden, allocation of curative treatment, and increased OS time compared with noncompliance (hazard ratio for OS, 2.19; 95% confidence interval, 1.16-4.14; P = .0150). CONCLUSIONS In an analysis of data from the ANRS CO12 CirVir cohort, we associated compliance with HCC surveillance guidelines (fewer than 7 months between image evaluations) with early diagnosis, allocation of curative treatment, and longer adjusted OS of patients with hepatitis C virus- or hepatitis B virus-associated compensated cirrhosis and a diagnosis of HCC.
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Affiliation(s)
- Charlotte E Costentin
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France.
| | - Richard Layese
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique (Unités de Recherche Clinique Mondor), and Université Paris-Est, Ageing-Thorax- Vessels-Blood Départements Hospitalo Universitaires, Clinical Epidemiology and Aging Unit, L'Université Paris-Est Créteil, Créteil, France
| | - Valérie Bourcier
- Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, France Recherche Nord & sud Sida-HIV Hépatites, Paris, France
| | - Patrick Marcellin
- Assistance Publique-Hopitaux de Paris, Hôpital Beaujon, Service d'Hépatologie, Clichy, France
| | - Dominique Guyader
- Centre Hospitalier Universitaire Pontchaillou, Service d'Hépatologie, Rennes, France
| | - Stanislas Pol
- Assistance Publique-Hopitaux de Paris, Hôpital Cochin, Département d'Hépatologie et Institut National de la Santé et de la Recherche Médicale, Institut Pasteur, Université Paris Descartes, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Département d'Hépatologie, Lyon, France
| | - Dominique Roulot
- Assistance Publique-Hopitaux de Paris, Hôpital Avicenne, Service d'Hépatologie, Bobigny, France
| | - Albert Tran
- Centre Hospitalier Universitaire de Nice, Service d'Hépatologie, et Institut National de la Santé et de la Recherche Médicale, Université de Nice-Sophia-Antipolis, Nice, France
| | | | | | - Ghassan Riachi
- Hôpital Charles-Nicolle, Service d'Hépato-gastroentérologie, Rouen, France
| | - Paul Calès
- Centre Hospitalier Universitaire d'Angers, Service d'Hépatologie, Angers, France
| | | | - Laurent Alric
- Centre Hospitalier Universitaire Toulouse, Service de Médecine Interne-Pôle Digestif, Toulouse, France
| | - Marc Bourlière
- Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
| | | | | | - Armand Abergel
- Centre Hospitalier Universitaire Estaing, Service d'Hépatologie, Clermont-Ferrand, France
| | - Lawrence Serfaty
- Assistance Publique-Hopitaux de Paris, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
| | - Ariane Mallat
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France; L'Université Paris-Est Créteil et Institut National de la Santé et de la Recherche Médicale, Créteil, France
| | - Jean-Didier Grangé
- Assistance Publique-Hopitaux de Paris, Hôpital Tenon, Service d'Hépatologie, Paris, France
| | - Pierre Attali
- Assistance Publique-Hopitaux de Paris, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, Centres Hospitaliers Régionaux et Universitaires de Tours, Tours, France
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence, France
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
| | - Dominique Thabut
- Assistance Publique-Hopitaux de Paris, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | - Christophe Pilette
- Centre Hospitalier Universitaire Le Mans, Service d'Hépatologie, Le Mans, France
| | - Christine Silvain
- Centre Hospitalier Universitaire de Poitiers, Service d'Hépatologie, Poitiers, France
| | | | | | | | - David Zucman
- Hôpital Foch, Service d'Hépatologie, Suresnes, France
| | | | - Angela Sutton
- Liver Disease Biobank, Groupe Hospitalier Paris Seine-Saint-Denis, France; Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service de Biochimie, Bondy, France; Institut National de la Santé et de la Recherche Médicale U1148, Université Paris 13, Bobigny, France
| | - Eric Letouzé
- Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
| | - Sandrine Imbeaud
- Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
| | - Jessica Zucman-Rossi
- Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France; Assistance Publique-Hopitaux de Paris, Hôpital Européen Georges Pompidou, Département d'Oncologie, Paris, France
| | - Etienne Audureau
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Unité de Recherche Clinique (Unités de Recherche Clinique Mondor), and Université Paris-Est, Ageing-Thorax- Vessels-Blood Départements Hospitalo Universitaires, Clinical Epidemiology and Aging Unit, L'Université Paris-Est Créteil, Créteil, France
| | - Françoise Roudot-Thoraval
- Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France; Assistance Publique-Hopitaux de Paris, Hôpital Henri Mondor, Service de Santé Publique, Créteil, France
| | - Pierre Nahon
- Assistance Publique-Hopitaux de Paris, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Institut National de la Santé et de la Recherche Médicale, Functional Genomics of Solid Tumors, Université Paris Descartes, Université Paris Diderot, Université Paris, Labex Oncoimmunology, Equipe labellisée Ligue contre le Cancer, Paris, France
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Anty R, Favre G, Coilly A, Rossignol E, Houssel-Debry P, Duvoux C, De Ledinghen V, Di Martino V, Leroy V, Radenne S, Kamar N, Canva V, D'Alteroche L, Durand F, Dumortier J, Lebray P, Besch C, Tran A, Canivet CM, Botta-Fridlund D, Montialoux H, Moreno C, Conti F, Silvain C, Perré P, Habersetzer F, Abergel A, Debette-Gratien M, Dharancy S, Esnault VLM, Fougerou-Leurent C, Cagnot C, Diallo A, Veislinger A, Danjou H, Samuel D, Pageaux GP, Duclos-Vallée JC. Safety of sofosbuvir-based regimens after liver transplantation: longitudinal assessment of renal function in the prospective ANRS CO23 CUPILT study. Aliment Pharmacol Ther 2018; 47:1682-1689. [PMID: 29665081 DOI: 10.1111/apt.14639] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 01/09/2018] [Accepted: 03/07/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND In liver transplant recipients with hepatitis C virus recurrence, there is concern about renal safety of sofosbuvir-based regimens. Changes in serum creatinine or in the estimated glomerular filtration rate (eGFR) under treatment are used to look for possible renal toxicity. However, serum creatinine and eGFR are highly variable. AIM To analyse renal function trajectory with numerous assays of serum creatinine over a long period of time. METHODS In a multicentre cohort of 139 patients, the eGFR was obtained from serum creatinine using the Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation. Slopes of eGFR were defined as a change in eGFR during a period divided by time. Pre-treatment, on-treatment and post-treatment periods were 9 months, 3-9 months and 4.5 months. Interactions between eGFR slopes and the pre-treatment eGFR, use of ribavirin or mycophenolate mofetil, and stage of fibrosis were addressed. On-treatment eGFR slopes were separated in tertiles. Pre- and post-treatment eGFR slopes were compared globally and according to tertiles. RESULTS The post-treatment eGFR slope was significantly better than pre-treatment eGFR slope (+0.18 (IQR -0.76 to +1.32) vs -0.11 (IQR -1.01 to +0.73) mL/min/1.73 m2 /month, P = 0.03) independently of the pre-treatment eGFR (P = 0.99), ribavirin administration (P = 0.26), mycophenolate mofetil administration (P = 0.51) and stage of fibrosis (F3 and F4 vs lower stages, P = 0.18; F4 vs lower stages, P = 0.08; F4 Child-Pugh B and C vs lower stages, P = 0.38). Tertiles of on-treatment eGFR slopes were -1.71 (IQR -2.54 to -1.48), -0.78 (IQR -1.03 to -0.36) and +0.75 (IQR +0.28 to +1.47) mL/min/1.73 m2 /month. Pre- and post-treatment eGFR slopes were not significantly different according to tertiles (respectively, P = 0.34, 0.08, 0.73). CONCLUSION The eGFR varies during treatment and gives a confusing picture of the renal safety of sofosbuvir-based regimens. In contrast, longitudinal assessment of the eGFR shows a rising trajectory over longer time, meaning that these therapies are safe for the kidneys in our cohort of liver transplant recipients.
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Cacoub P, Nahon P, Layese R, Blaise L, Desbois AC, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Thabut D, Pilette C, Silvain C, Christidis C, Capron D, Thiefin G, Zucman D, Di Martino V, Bagnis CI, Ziol M, Sutton A, Letouze E, Roudot-Thoraval F, Audureau E. Prognostic value of viral eradication for major adverse cardiovascular events in hepatitis C cirrhotic patients. Am Heart J 2018; 198:4-17. [PMID: 29653647 DOI: 10.1016/j.ahj.2017.10.024] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/29/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective was to examine the role of a sustained virological response (SVR) on major adverse cardiovascular events (MACEs) in patients with compensated hepatitis C virus (HCV) cirrhosis. METHODS Patients with the following criteria were enrolled in 35 French centers: (1) biopsy-proven HCV cirrhosis; (2) Child-Pugh A; (3) positive viremia; and (4) no prior liver complication, and then prospectively followed. All patients received HCV treatment after inclusion. MACEs included stroke, myocardial infarction, ischemic heart disease, heart failure, peripheral arterial disease, cardiac arrest, and cardiovascular death. SVR, defined as negative viremia 12 weeks posttreatment, was considered as a time-dependent covariate, and its effect on MACE occurrence was assessed. The median follow up was 57.5 months, ending in December 2015. RESULTS Sixty-two of 878 (7.1%) patients presented a total of 79 MACEs. The main predictive baseline factors of MACEs were Asian ethnic origin, history of MACEs, arterial hypertension, diabetes mellitus, current smoking, low serum albumin level, high total bilirubin level, and low platelet count. In multivariate analysis, SVR was associated with a decreased risk of MACEs (hazard ratio=0.35, 95% CI 0.09-0.97, P=.044), whereas Asian ethnic origin, arterial hypertension, smoking, and low serum albumin level remained predictive of MACE occurrence. The 5-year survival rate was 60.1% versus 87.5% in patients who did versus those who did not present a MACE (P<.001). CONCLUSIONS In patients with compensated HCV-related cirrhosis, Asian ethnic origin, arterial hypertension, smoking, and low serum albumin are independent predictive factors of cardiovascular events, whereas an SVR is associated with a decreased rate of cardiovascular events.
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Affiliation(s)
- Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; INSERM, UMR_S 959, Paris, France; CNRS, FRE3632, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France.
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", Saint-Denis; Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", Paris
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC-Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, Créteil
| | | | - Anne Claire Desbois
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; INSERM, UMR_S 959, Paris, France; CNRS, FRE3632, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, Paris, France
| | | | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENCH)
| | | | | | - Stanislas Pol
- Université Paris Descartes, APHP, Unité d'Hépatologie, Hôpital Cochin, INSERM U-1223 et USM20, Institut Pasteur, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var
| | | | | | - Albert Tran
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1065, Team 8, "Hepatic Complications in Obesity", Nice, France and University Hospital of Nice, Digestive Centre, Nice, France
| | | | | | - Ghassan Riachi
- Hôpital Charles-Nicolle, Service d'Hépato-gastro-entérologie, Rouen
| | - Paul Calès
- CHU d'Angers, Service d'Hépatologie, Angers
| | | | - Laurent Alric
- Service de Médecine Interne-Pôle Digestif CHU Toulouse, UMR 152, IRD, Toulouse 3 University
| | | | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand
| | | | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, CHRU de Tours
| | - Claire Wartelle
- Hôpital d'Aix-En-Provence, Service d'Hépatologie, Aix-En-Provence
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen
| | - Dominique Thabut
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris
| | | | | | | | | | | | | | | | - Corinne Isnard Bagnis
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Nephrology, Paris, France
| | - Marianne Ziol
- Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", Paris; AP-HP, Hôpital Jean Verdier, Service d'Anatomopathologie, Bondy; CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027
| | - Angela Sutton
- CRB (liver disease biobank) Groupe Hospitalier Paris Seine-Saint-Denis BB-0033-00027; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy
| | - Eric Letouze
- Inserm, UMR-1162, "Génomique fonctionnelle des tumeur solides", Paris
| | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC-Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, Créteil
| | - Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Unité de Recherche Clinique (URC-Mondor), and Université Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, UPEC, Créteil
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David-Tchouda S, Trocme C, Margier J, Hilleret MN, Roudot-thoraval F, Cagnot C, Nahon P, Zarski J. Proposition d’algorithme décisionnel impliquant les marqueurs non invasifs de fibrose pour prédire la survenue d’une complication chez les malades atteints de cirrhose virale C (ANRS CO12 cohorte prospective CirVir). Rev Epidemiol Sante Publique 2017. [DOI: 10.1016/j.respe.2017.03.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Cadier B, Bulsei J, Nahon P, Seror O, Laurent A, Rosa I, Layese R, Costentin C, Cagnot C, Durand-Zaleski I, Chevreul K. Early detection and curative treatment of hepatocellular carcinoma: A cost-effectiveness analysis in France and in the United States. Hepatology 2017; 65:1237-1248. [PMID: 28176349 DOI: 10.1002/hep.28961] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/20/2016] [Accepted: 11/17/2016] [Indexed: 12/17/2022]
Abstract
UNLABELLED Hepatocellular carcinoma (HCC) is the leading cause of death in patients with cirrhosis. Patients outside clinical trials seldom benefit from evidence-based monitoring. The objective of this study was to estimate the cost-effectiveness of complying with HCC screening guidelines. The economic evaluation compared surveillance of patients with cirrhosis as recommended by the guidelines ("gold-standard monitoring") to "real-life monitoring" from the health care system perspective. A Markov model described the history of the disease and treatment course including current first-line curative treatment: liver resection, radiofrequency ablation (RFA), and liver transplantation. Transition probabilities were derived mainly from two French cohorts, CIRVIR and CHANGH. Costs were computed using French and U.S. tariffs. Effectiveness was measured in life years gained (LYG). An incremental cost-effectiveness ratio (ICER) was calculated for a 10-year horizon and tested with one-way and probabilistic sensitivity analyses. The cost difference between the two groups was $648 ($87,476 in the gold-standard monitoring group vs. $86,829 in the real-life monitoring group) in France and $11,965 ($93,795 vs. $81,829) in the United States. Survival increased by 0.37 years (7.18 vs. 6.81 years). The ICER was $1,754 per LYG in France and $32,415 per LYG in the United States. The health gain resulted from earlier diagnosis and access to first-line curative treatments, among which RFA provided the best value for money. CONCLUSION Our results indicate that gold-standard monitoring for patients with cirrhosis is cost-effective, attributed to a higher probability of benefiting from a curative treatment and so a higher survival probability. (Hepatology 2017;65:1237-1248).
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Affiliation(s)
- Benjamin Cadier
- AP-HP, Health economics research unit, Paris, France.,ECEVE, UMRS 1123, French National Institute of Health and Medical Research, Paris, France
| | - Julie Bulsei
- AP-HP, Health economics research unit, Paris, France
| | - Pierre Nahon
- AP-HP, Department of Hepatology, Jean Verdier hospital, Bondy, France.,French League Against Cancer; Education and Research in Health Medicine and Human Biology, University Paris 13, Sorbonne Paris Cité, Paris, France.,Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France
| | - Olivier Seror
- Unité mixte de Recherche 1162, Génomique fonctionnelle des Tumeurs solides, Institut National de la Santé et de la Recherche médicale, Paris, France.,AP-HP, Department of Radiology, Jean Verdier hospital, Bondy, France
| | - Alexis Laurent
- AP-HP, Department of Hepatobiliary and Digestive Surgery, Henri Mondor hospital, Creteil l, France.,University Paris-Est, Creteil, France.,Inserm U955-Creteil, France
| | - Isabelle Rosa
- CHANGH study Group, Hepatology and Gastroenterology Department, Centre Hospitalier Intercommunal de Créteil, Creteil, France
| | - Richard Layese
- AP-HP, Department of Public Health, Henri Mondor hospital, Creteil, France.,University Paris-Est, A-TVB DHU, CEpiA (Clinical Epidemiology and Aging) Unit EA4393, University Paris-Est, Creteil, France
| | | | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France
| | - Isabelle Durand-Zaleski
- AP-HP, Health economics research unit, Paris, France.,ECEVE, UMRS 1123, French National Institute of Health and Medical Research, Paris, France.,AP-HP, Department of Public Health, Henri Mondor hospital, Creteil, France
| | - Karine Chevreul
- AP-HP, Health economics research unit, Paris, France.,ECEVE, UMRS 1123, French National Institute of Health and Medical Research, Paris, France.,University Paris Diderot, Sorbonne Paris Cite, Paris, France
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29
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Nahon P, Bourcier V, Layese R, Audureau E, Cagnot C, Marcellin P, Guyader D, Fontaine H, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Leroy V, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Dharancy S, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Zucman D, Di Martino V, Thibaut V, Salmon D, Ziol M, Sutton A, Pol S, Roudot-Thoraval F, Marcellin P, Guyader D, Pol S, Fontaine H, Larrey D, De Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Leroy V, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Thiefin G, Hillaire S, Di Martino V. Eradication of Hepatitis C Virus Infection in Patients With Cirrhosis Reduces Risk of Liver and Non-Liver Complications. Gastroenterology 2017; 152:142-156.e2. [PMID: 27641509 DOI: 10.1053/j.gastro.2016.09.009] [Citation(s) in RCA: 365] [Impact Index Per Article: 52.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 09/06/2016] [Accepted: 09/07/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS We performed a prospective study to investigate the effects of a sustained viral response (SVR) on outcomes of patients with hepatitis C virus (HCV) infection and compensated cirrhosis. METHODS We collected data from 1323 patients included in the prospective Agence Nationale pour la Recherche sur le SIDA et les hépatites virales (ANRS) viral cirrhosis (CirVir) cohort, recruited from 35 clinical centers in France from 2006 through 2012. All patients had HCV infection and biopsy-proven cirrhosis, were Child-Pugh class A, and had no prior liver complications. All patients received anti-HCV treatment before or after inclusion (with interferon then with direct antiviral agents) and underwent an ultrasound examination every 6 months, as well as endoscopic evaluations. SVR was considered as a time-dependent covariate; its effect on outcome was assessed by the Cox proportional hazard regression method. We used a propensity score to minimize confounding by indication of treatment and capacity to achieve SVR. RESULTS After a median follow-up period of 58.2 months, 668 patients (50.5%) achieved SVR. SVR was associated with a decreased incidence of hepatocellular carcinoma (hazard ratio [HR] compared with patients without an SVR, 0.29; 95% confidence interval [CI], 0.19-0.43; P < .001) and hepatic decompensation (HR, 0.26; 95% CI, 0.17-0.39; P < .001). Patients with SVRs also had a lower risk of cardiovascular events (HR, 0.42; 95% CI, 0.25-0.69; P = .001) and bacterial infections (HR, 0.44; 95% CI, 0.29-0.68; P < .001). Metabolic features were associated with a higher risk of hepatocellular carcinoma in patients with SVRs, but not in patients with viremia. SVR affected overall mortality (HR, 0.27 compared with patients without SVR; 95% CI, 0.18-0.42; P < .001) and death from liver-related and non-liver-related causes. Similar results were obtained in a propensity score-matched population. CONCLUSIONS We confirmed a reduction in critical events, liver-related or not, in a prospective study of patients with HCV infection and compensated cirrhosis included in the CirVir cohort who achieved an SVR. We found an SVR to reduce overall mortality and risk of death from liver-related and non-liver-related causes. A longer follow-up evaluation is required to accurately describe and assess specific risk factors for complications in this population.
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Affiliation(s)
- Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Université Paris 13, Sorbonne Paris Cité, "Equipe Labellisée Ligue Contre le Cancer," Saint-Denis, France; Inserm, UMR-1162, "Génomique Fonctionnelle des Tumeur Solides," Paris, France.
| | - Valérie Bourcier
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France
| | - Richard Layese
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, Ageing-Thorax-Vessels-Blood Département Hospitalo-Universitaire, Clinical Epidemiology and Aging Unit, Université Paris-Est Créteil, Créteil, France
| | - Etienne Audureau
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, Ageing-Thorax-Vessels-Blood Département Hospitalo-Universitaire, Clinical Epidemiology and Aging Unit, Université Paris-Est Créteil, Créteil, France
| | - Carole Cagnot
- Unit for Basic and Clinical Research on Viral Hepatitis, Association Nationale pour la Recherche sur le SIDA et les hépatites virales (ANRS), France REcherche Nord and sud Sida-HIV Hépatites, Paris, France
| | | | - Dominique Guyader
- Centre Hospitalo-Universitaire Pontchaillou, Service d'Hépatologie, Rennes, France
| | | | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Service d'Hépatologie, St Laurent du Var, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Service d'Hépatologie et Université de Lyon, Lyon, France
| | | | - Albert Tran
- Centre Hospitalo-Universitaire de Nice, Service d'Hépatologie, Nice, France; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity," Nice, France
| | - Jean-Pierre Bronowicki
- Inserm 954, Centre Hospitalo-Universitaire de Nancy, Université de Lorraine, Vandoeuvre-les-Nancy, France
| | | | - Vincent Leroy
- Hôpital Michallon, Service d'Hépatologie, Grenoble, France
| | - Ghassan Riachi
- Hôpital Charles-Nicolle, Service d'Hépatologie, Rouen, France
| | - Paul Calès
- Centre Hospitalo-Universitaire d'Angers, Service d'Hépato-Gastroentérologie, Angers, France
| | | | - Laurent Alric
- Centre Hospitalo-Universitaire Toulouse, Service de Médecine Interne-Pôle Digestif UMR 152, Toulouse, France
| | - Marc Bourlière
- Hôpital Saint Joseph, Service d'Hépatologie, Marseille, France
| | | | | | | | - Armand Abergel
- Hôpital Hôtel Dieu, Service d'Hépatologie, Clermont-Ferrand, France
| | - Lawrence Serfaty
- AP-HP, Hôpital Saint-Antoine, Service d'Hépatologie, Paris, France
| | - Ariane Mallat
- AP-HP, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France
| | | | - Pierre Attali
- AP-HP, Hôpital Paul Brousse, Service d'Hépatologie, Villejuif, France
| | - Yannick Bacq
- Hôpital Trousseau, Unité d'Hépatologie, Centre Hospitalier Régional Universitaire de Tours, France
| | - Claire Wartelle
- Hôpital d'Aix-en-Provence, Service d'Hépatologie, Aix-En-Provence, France
| | - Thông Dao
- Hôpital de la Côte de Nacre, Service d'Hépatologie, Caen, France
| | - Yves Benhamou
- AP-HP, Groupe Hospitalier de La Pitié-Salpêtrière, Service d'Hépatologie, Paris, France
| | - Christophe Pilette
- Centre Hospitalo-Universitaire Le Mans, Service d'Hépatologie, Le Mans, France
| | - Christine Silvain
- Centre Hospitalo-Universitaire de Poitiers, Service d'Hépatologie, Poitiers, France
| | | | | | | | - David Zucman
- Hôpital Foch, Service de Médecine Interne, Suresnes, France
| | | | - Vincent Thibaut
- Centre Hospitalo-Universitaire Pontchaillou, Service de Virologie, Rennes, France
| | - Dominique Salmon
- AP-HP, Hôpital Cochin, Service de Maladies Infectieuses, Université Paris Descartes, Paris, France
| | - Marianne Ziol
- Université Paris 13, Sorbonne Paris Cité, "Equipe Labellisée Ligue Contre le Cancer," Saint-Denis, France; Inserm, UMR-1162, "Génomique Fonctionnelle des Tumeur Solides," Paris, France; AP-HP, Hôpital Jean Verdier, Service d'Anatomopathologie, Bondy, France; Centre de Ressources Biologiques (Liver Disease Biobank) Groupe Hospitalier Paris, Seine-Saint-Denis, France
| | - Angela Sutton
- Centre de Ressources Biologiques (Liver Disease Biobank) Groupe Hospitalier Paris, Seine-Saint-Denis, France; AP-HP, Hôpital Jean Verdier, Service de Biochimie, Bondy, France; Inserm U1148, Université Paris 13, Bobigny, France
| | - Stanislas Pol
- AP-HP, Hôpital Cochin, Département d'Hépatologie, France; Inserm UMS20 et U1223, Institut Pasteur, Université Paris Descartes, Paris, France
| | - Françoise Roudot-Thoraval
- AP-HP, Hôpital Henri Mondor, Département de Santé Publique, and Université Paris-Est, Ageing-Thorax-Vessels-Blood Département Hospitalo-Universitaire, Clinical Epidemiology and Aging Unit, Université Paris-Est Créteil, Créteil, France
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Ganne-Carrié N, Layese R, Bourcier V, Cagnot C, Marcellin P, Guyader D, Pol S, Larrey D, de Lédinghen V, Ouzan D, Zoulim F, Roulot D, Tran A, Bronowicki JP, Zarski JP, Riachi G, Calès P, Péron JM, Alric L, Bourlière M, Mathurin P, Blanc JF, Abergel A, Serfaty L, Mallat A, Grangé JD, Attali P, Bacq Y, Wartelle C, Dao T, Benhamou Y, Pilette C, Silvain C, Christidis C, Capron D, Bernard-Chabert B, Zucman D, Di Martino V, Trinchet JC, Nahon P, Roudot-Thoraval F. Nomogram for individualized prediction of hepatocellular carcinoma occurrence in hepatitis C virus cirrhosis (ANRS CO12 CirVir). Hepatology 2016; 64:1136-47. [PMID: 27348075 DOI: 10.1002/hep.28702] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/13/2016] [Accepted: 06/23/2016] [Indexed: 01/10/2023]
Abstract
UNLABELLED The aim of this work was to develop an individualized score for predicting hepatocellular carcinoma (HCC) in patients with hepatitis C (HCV)-compensated cirrhosis. Among 1,323 patients with HCV cirrhosis enrolled in the French prospective ANRS CO12 CirVir cohort, 720 and 360 were randomly assigned to training and validation sets, respectively. Cox's multivariate model was used to predict HCC, after which a nomogram was computed to assess individualized risk. During follow-up (median, 51.0 months), 103 and 39 patients developed HCC in the training and validation sets, respectively. Five variables were independently associated with occurrence of HCC: age > 50 years (hazard ratio [HR], 1.94; 95% confidence interval [CI], 1.16; 3.25; P = 0.012); past excessive alcohol intake (HR, 1.55; 95% CI, 1.02; 2.36; P = 0.041); low platelet count (<100 Giga/mm(3) : HR, 2.70; 95% CI, 1.62; 4.51; P < 0.001; [100; 150] Giga/mm(3) : HR, 1.87; 95% CI, 1.10; 3.18; P = 0.021); gamma-glutamyl transpeptidase above the upper limit of normal (HR, 1.96; 95% CI, 1.11; 3.47; P = 0.021); and absence of a sustained virological response during follow-up (HR, 3.02; 95% CI, 1.67; 5.48; P < 0.001). An 11-point risk score was derived from the training cohort and validated in the validation set. Based on this score, the population was stratified into three groups, in which HCC development gradually increased, from 0% to 30.1% at 5 years for patients with the lowest (≤3) and highest (≥8) scores (P < 0.001). Using this score, a nomogram was built enabling individualized prediction of HCC occurrence at 1, 3, and 5 years. CONCLUSION This HCC score can accurately predict HCC at an individual level in French patients with HCV cirrhosis. (Hepatology 2016;64:1136-1147).
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Affiliation(s)
- Nathalie Ganne-Carrié
- AP-HP, Hospital Jean Verdier, Liver Unit, Bondy, France. .,University Paris 13, Sorbonne Paris Cité, Paris, France. .,Inserm, UMR-1162 "Genomic alterations in liver tumors", F-75010, Paris, France.
| | - Richard Layese
- AP-HP, Hospital Henri Mondor, Department of Public Health, Créteil, France
| | | | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, ANRS (France REcherche Nord & Sud Sida-HIV Hépatites-FRENSH), Paris, France
| | - Patrick Marcellin
- AP-HP, Hospital Beaujon, Liver Unit, Clichy and University Paris 7, Paris, France
| | | | - Stanislas Pol
- University Paris Descartes, APHP, Liver Unit, Hospital Cochin; INSERM U-818 and USM20, Institut Pasteur, Paris, France
| | | | | | - Denis Ouzan
- Institut Arnaud Tzanck, Liver Unit, St. Laurent du Var, France
| | - Fabien Zoulim
- Hospices Civils de Lyon, Liver Unit, University and INSERM U1052, Lyon, France
| | - Dominique Roulot
- University Paris 13, Sorbonne Paris Cité, Paris, France.,AP-HP, Hospital Avicenne, Liver Unit, Bobigny, France
| | - Albert Tran
- University Hospital of Nice, Liver Unit, F-06202, Cedex 3, Nice; Inserm U1065, C3M, Team 8, "Hepatic Complications in Obesity," F-06204, Cedex 3, Nice, France
| | - Jean-Pierre Bronowicki
- Inserm 954, Universitary Hospital of Nancy, University of Lorraine, Vandoeuvre-les-Nancy, France
| | - Jean-Pierre Zarski
- Clinic of Hepato-Gastroenterology, Digidune pole, University Hospital, Grenoble, France
| | | | - Paul Calès
- University Hospital, Liver Unit and University Bretagne-Loire, Angers, France
| | - Jean-Marie Péron
- Hospital Purpan, Liver Unit and University Paul Sabatier III, Toulouse, France
| | - Laurent Alric
- University Hospital, Internal Medicine Unit - Digestive pole UMR 152, Toulouse, France
| | | | | | | | - Armand Abergel
- Hospital Hôtel Dieu, Liver Unit, Clermont-Ferrand, France
| | | | - Ariane Mallat
- AP-HP, Hospital Henri Mondor, Liver Unit, Créteil, France
| | | | - Pierre Attali
- AP-HP, Hospital Paul Brousse, Liver Unit, Villejuif, France
| | | | - Claire Wartelle
- Hospital of Aix-En-Provence, Liver Unit, Aix-En-Provence, France
| | - Thông Dao
- Hospital Côte de Nacre, Liver Unit, Caen, France
| | - Yves Benhamou
- AP-HP, Pitié-Salpêtrière Hospital, Liver Unit, Paris, France
| | | | | | | | | | | | - David Zucman
- Hospital Foch, Internal Medicine, Suresnes, France
| | | | - Jean-Claude Trinchet
- AP-HP, Hospital Jean Verdier, Liver Unit, Bondy, France.,University Paris 13, Sorbonne Paris Cité, Paris, France.,Inserm, UMR-1162 "Genomic alterations in liver tumors", F-75010, Paris, France
| | - Pierre Nahon
- AP-HP, Hospital Jean Verdier, Liver Unit, Bondy, France.,University Paris 13, Sorbonne Paris Cité, Paris, France.,Inserm, UMR-1162 "Genomic alterations in liver tumors", F-75010, Paris, France
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About F, Oudot-Mellakh T, Niay J, Rabiéga P, Pedergnana V, Duffy D, Sultanik P, Cagnot C, Carrat F, Marcellin P, Zoulim F, Larrey D, Hézode C, Fontaine H, Bronowicki JP, Pol S, Albert ML, Theodorou I, Cobat A, Abel L. Impact of IL28B, APOH and ITPA Polymorphisms on Efficacy and Safety of TVR- or BOC-Based Triple Therapy in Treatment-Experienced HCV-1 Patients with Compensated Cirrhosis from the ANRS CO20-CUPIC Study. PLoS One 2015; 10:e0145105. [PMID: 26670100 PMCID: PMC4682920 DOI: 10.1371/journal.pone.0145105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/29/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human genetic factors influence the outcome of pegylated interferon and ribavirin hepatitis C therapy. We explored the role of IL28B, APOH and ITPA SNPs on the outcomes of triple therapy including telaprevir or boceprevir in patients with compensated cirrhosis chronically infected with HCV-1. PATIENTS AND METHODS A total of 256 HCV-1 Caucasian treatment-experienced patients with compensated cirrhosis from the ANRS CO20-CUPIC cohort were genotyped for a total of 10 candidate SNPs in IL28B (rs12979860 and rs368234815), APOH (rs8178822, rs12944940, rs10048158, rs52797880, rs1801689 and rs1801690) and ITPA (rs1127354 and rs7270101). We tested the association of IL28B and APOH SNPs with sustained virological response and of ITPA SNPs with anemia related phenotypes by means of logistic regression assuming an additive genetic model. RESULTS None of the six APOH SNPs were associated with sustained virological response. The favorable alleles of the IL28B SNPs rs12979860 and rs368234815 were associated with sustained virological response (rs12979860: OR = 2.35[1.50-3.70], P = 2x10(-4)). Refined analysis showed that the effect of IL28B SNPs on sustained virological response was restricted to prior PegIFN/RBV relapse (OR = 3.80[1.82-8.92], P = 8x10(-4)). We also confirmed the association between ITPA low activity alleles and protection against early hemoglobin decline in triple therapy (P = 2x10(-5)). CONCLUSION Our results suggest that the screening of rs12979860 may remain interesting for decision making in prior relapse HCV-1 Caucasian patients with compensated cirrhosis eligible for a telaprevir- or boceprevir-based therapy.
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Affiliation(s)
- Frédégonde About
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Paris, France
- Paris Descartes University, Imagine Institute, Paris, France
| | - Tiphaine Oudot-Mellakh
- Laboratory of Immunity and Infection, Centre d’Immunologie et des Maladies Infectieuses de Paris (CIMI), INSERM U1135, Groupe Hospitalier Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Plateforme Génomique Inserm-ANRS, Groupe Hospitalier Pitié Salpétrière, AP-HP, UPMC Université Paris 6, Paris, France
| | - Jonathan Niay
- Laboratory of Immunity and Infection, Centre d’Immunologie et des Maladies Infectieuses de Paris (CIMI), INSERM U1135, Groupe Hospitalier Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Plateforme Génomique Inserm-ANRS, Groupe Hospitalier Pitié Salpétrière, AP-HP, UPMC Université Paris 6, Paris, France
| | - Pascaline Rabiéga
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Vincent Pedergnana
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Paris, France
- Paris Descartes University, Imagine Institute, Paris, France
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Darragh Duffy
- Centre for Human Immunology, Department of Immunology, Institut Pasteur, Paris, France
- The Laboratory of Dendritic Cell Biology, Department of Immunology, Institut Pasteur, INSERM U818, Paris, France
| | - Philippe Sultanik
- Département d'Hépatologie, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
- INSERM UMS20, Institut Pasteur, Paris, France
| | - Carole Cagnot
- Unit for Basic and Clinical research on Viral Hepatitis, Inserm-ANRS (France REcherche Nord & sud Sida-HIV Hépatites-FRENSH), Paris, France
| | - Fabrice Carrat
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
- Service de Santé Publique, Hôpital Saint Antoine, AP-HP, Paris, France
| | | | - Fabien Zoulim
- Centre de recherche en cancérologie de Lyon (CRCL), INSERM UMR I 1052/CNRS 5286, Lyon cedex 03, France
- Université Claude-Bernard Lyon 1, Villeurbanne, France
- Hospices civils de Lyon, Hôpital de la Croix-Rousse, service d'hépatologie et de gastroentérologie, Lyon, France
| | | | - Christophe Hézode
- Department of Hepatology and Gastroenterology, Hôpital Henri Mondor, AP-HP, Université Paris-Est Créteil (UPEC), Créteil, France
- Institut Mondor de Recherche Biomédicale (IMRB), INSERM U955, UPEC, Créteil, France
| | - Hélène Fontaine
- Département d'Hépatologie, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
- INSERM UMS20, Institut Pasteur, Paris, France
| | - Jean-Pierre Bronowicki
- Department of Hepatogastroenterology, INSERM U954, CHU de Nancy, Université de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Stanislas Pol
- Département d'Hépatologie, Hôpital Cochin, AP-HP, Université Paris Descartes, Paris, France
- INSERM UMS20, Institut Pasteur, Paris, France
| | - Matthew L. Albert
- Centre for Human Immunology, Department of Immunology, Institut Pasteur, Paris, France
- The Laboratory of Dendritic Cell Biology, Department of Immunology, Institut Pasteur, INSERM U818, Paris, France
- INSERM UMS20, Institut Pasteur, Paris, France
| | - Ioannis Theodorou
- Laboratory of Immunity and Infection, Centre d’Immunologie et des Maladies Infectieuses de Paris (CIMI), INSERM U1135, Groupe Hospitalier Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Plateforme Génomique Inserm-ANRS, Groupe Hospitalier Pitié Salpétrière, AP-HP, UPMC Université Paris 6, Paris, France
| | - Aurélie Cobat
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Paris, France
- Paris Descartes University, Imagine Institute, Paris, France
| | - Laurent Abel
- Laboratory of Human Genetics of Infectious Diseases, Necker Branch, Institut National de la Santé et de la Recherche Médicale (INSERM) U1163, Paris, France
- Paris Descartes University, Imagine Institute, Paris, France
- St. Giles Laboratory of Human Genetics of Infectious Diseases, Rockefeller Branch, The Rockefeller University, New York, NY, United States of America
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