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Pugliese N, Polverini D, Arcari I, De Nicola S, Colapietro F, Masetti C, Ormas M, Ceriani R, Lleo A, Aghemo A. Hepatitis C Virus Infection in the Elderly in the Era of Direct-Acting Antivirals: Evidence from Clinical Trials and Real Life. Trop Med Infect Dis 2023; 8:502. [PMID: 37999621 PMCID: PMC10674442 DOI: 10.3390/tropicalmed8110502] [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] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
The introduction of direct-acting antiviral agents (DAAs) into clinical practice has revolutionized the therapeutic approach to patients with chronic hepatitis C virus (HCV) infection. According to the most recent guidelines, the first line of treatment for HCV infection involves the use of one of three pan-genotypic DAA combinations, sofosbuvir/velpatasvir (SOF/VEL), glecaprevir/pibrentasvir (GLE/PIB), and sofosbuvir/velpatasvir/voxilaprevir (SOF/VEL/VOX). These drugs have been shown to be effective and safe in numerous clinical trials and real-world studies, but special populations have been neglected. Among the special populations to be treated are elderly patients, whose numbers are increasing in clinical practice. The management of these patients can be challenging, in particular due to multiple comorbidities, polypharmacotherapy, and potential drug-drug interactions. This narrative review aims to summarize the current scientific evidence on the efficacy and safety of DAAs in the elderly population, both in clinical trials and in real-life settings. Although there is still a paucity of real-world data and no clinical trials have yet been conducted in the population aged ≥ 75 years old, some considerations about the efficacy and safety of DAAs in the elderly can be made based on the results of these studies. The pan-genotypic associations of DAAs appear to be as efficacious and safe in the elderly population as in the general population; this is both in terms of similar sustained virologic response (SVR) rates and similar frequencies of adverse events (AEs). However, further studies specifically involving this patient population would be necessary to confirm this evidence.
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Affiliation(s)
- Nicola Pugliese
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy; (N.P.); (D.P.); (I.A.); (F.C.); (A.L.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Davide Polverini
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy; (N.P.); (D.P.); (I.A.); (F.C.); (A.L.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Ivan Arcari
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy; (N.P.); (D.P.); (I.A.); (F.C.); (A.L.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Stella De Nicola
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Francesca Colapietro
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy; (N.P.); (D.P.); (I.A.); (F.C.); (A.L.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Chiara Masetti
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Monica Ormas
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Roberto Ceriani
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy; (N.P.); (D.P.); (I.A.); (F.C.); (A.L.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, MI, Italy; (N.P.); (D.P.); (I.A.); (F.C.); (A.L.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, MI, Italy; (S.D.N.); (C.M.); (M.O.); (R.C.)
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Colapietro F, Angelotti G, Masetti C, Shiffer D, Pugliese N, De Nicola S, Carella F, Desai A, Ormas M, Calatroni M, Omodei P, Ciccarelli M, Aliberti S, Reggiani F, Bartoletti M, Cecconi M, Lleo A, Aghemo A, Voza A. Ursodeoxycholic Acid Does Not Improve COVID-19 Outcome in Hospitalized Patients. Viruses 2023; 15:1738. [PMID: 37632080 PMCID: PMC10457973 DOI: 10.3390/v15081738] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Ursodeoxycholic acid (UDCA) was demonstrated to reduce susceptibility to SARS-CoV-2 infection in vitro and improve infection course in chronic liver diseases. However, real-life evidence is lacking. We analyzed the impact of UDCA on COVID-19 outcomes in patients hospitalized in a tertiary center. Between January 2020 and January 2023, among 3847 patients consecutively hospitalized for COVID19, 57 (=UDCA group) were taking UDCA. The UDCA and the control groups (n = 3790) did not differ concerning comorbidities including diabetes mellitus type 2 (15.8% vs. 12.8%) and neoplasia (12.3% vs. 9.4%). Liver diseases and vaccination rate were more common in the UDCA group (14.0% vs. 2.5% and 54.4% vs. 30.2%, respectively). Overall mortality and CPAP treatment were 22.8 % and 15.7% in the UDCA, and 21.3% and 25.9% in the control group. Mortality was similar (p = 0.243), whereas UDCA was associated with a lower rate of CPAP treatment (OR = 0.76, p < 0.05). Treatment with UDCA was not an independent predictor of survival in patients hospitalized for COVID-19.
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Affiliation(s)
- Francesca Colapietro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, 20089 Milan, Italy (M.O.)
| | - Giovanni Angelotti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Humanitas Artificial Intelligence Center, Humanitas Research Hospital IRCCS, 20089 Milan, Italy
| | - Chiara Masetti
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, 20089 Milan, Italy (M.O.)
| | - Dana Shiffer
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Emergency Department, Humanitas Research Hospital IRCCS, 20089 Milan, Italy
| | - Nicola Pugliese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, 20089 Milan, Italy (M.O.)
| | - Stella De Nicola
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, 20089 Milan, Italy (M.O.)
| | - Francesco Carella
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
| | - Antonio Desai
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Emergency Department, Humanitas Research Hospital IRCCS, 20089 Milan, Italy
| | - Monica Ormas
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, 20089 Milan, Italy (M.O.)
| | - Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Nephrology and Dialysis Unit, Humanitas Research Hospital IRCCS, 20089 Milan, Italy
| | - Paolo Omodei
- Department of Gastroenterology, Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital IRCCS, 20089 Milan, Italy;
| | - Michele Ciccarelli
- Division of Respiratory Medicine, Humanitas Research Hospital IRCCS, 20089 Milan, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Division of Respiratory Medicine, Humanitas Research Hospital IRCCS, 20089 Milan, Italy
| | - Francesco Reggiani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Nephrology and Dialysis Unit, Humanitas Research Hospital IRCCS, 20089 Milan, Italy
| | - Michele Bartoletti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Infectious Disease Unit, Humanitas Research Hospital IRCSS, 20089 Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Department of Anaesthesia and Intensive Care, Humanitas University IRCCS, 20090 Milan, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, 20089 Milan, Italy (M.O.)
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, 20089 Milan, Italy (M.O.)
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072 Milan, Italy (A.D.); (M.B.); (A.A.)
- Emergency Department, Humanitas Research Hospital IRCCS, 20089 Milan, Italy
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Tonutti A, Simonetta E, Stainer A, Suigo G, Santis MD, Selmi C, Masetti C, Lleo A, Terracciano LM, Aliberti S, Amati F. Hepatic and pulmonary involvement in a patient with PR3-ANCA vasculitis following SARS-CoV-2 vaccination: a case report. Mod Rheumatol Case Rep 2023:7005160. [PMID: 36695552 DOI: 10.1093/mrcr/rxad005] [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] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/21/2022] [Accepted: 01/24/2023] [Indexed: 01/26/2023]
Abstract
We here report the first case of anti-proteinase 3 (PR3) positive ANCA-associated vasculitis following SARS-CoV-2 Pfizer-BioNTech vaccine presenting with prominent liver involvement and alveolar hemorrhage. Two weeks after vaccination, a 49-year-old man developed inflammatory arthralgias and hypertransaminasemia. Two months later, fever and hemoptysis appeared; the patient tested positive for anti-PR3 autoantibodies. High dose steroids and rituximab were started, and complete remission was achieved. Systemic autoimmune diseases, including ANCA-associated vasculitis, should always be considered in the differential diagnosis of hypertransaminasemia, especially when the clinical context is suspicious.
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Affiliation(s)
- Antonio Tonutti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Anna Stainer
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital Respiratory Unit, Rozzano, Italy
| | - Giulia Suigo
- IRCCS Humanitas Research Hospital Respiratory Unit, Rozzano, Italy
| | - Maria De Santis
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital Rheumatology and Clinical immunology, Rozzano, Italy
| | - Carlo Selmi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital Rheumatology and Clinical immunology, Rozzano, Italy
| | - Chiara Masetti
- IRCCS Humanitas Research Hospital Liver Unit, Rozzano, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital Liver Unit, Rozzano, Italy
| | - Luigi Maria Terracciano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital, Institute of Pathology, Rozzano, Italy
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital Respiratory Unit, Rozzano, Italy
| | - Francesco Amati
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Research Hospital Respiratory Unit, Rozzano, Italy
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Masetti C, Colapietro F, Voza A, Aghemo A. No impact of COVID-19 epidemic on decompensation of alcoholic liver disease: Results from a single centre in Milan. Liver Int 2022; 42:2921-2922. [PMID: 36004560 DOI: 10.1111/liv.15407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/30/2022] [Indexed: 02/13/2023]
Affiliation(s)
- Chiara Masetti
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Francesca Colapietro
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,Emergency Department, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Colapietro F, Masetti C, Pugliese N, Lleo A. Recommendations for histological criteria of autoimmune hepatitis from the international AIH pathology: Validation on a monocentric cohort. Liver Int 2022; 42:2583-2584. [PMID: 35962757 DOI: 10.1111/liv.15394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/14/2022] [Accepted: 06/24/2022] [Indexed: 02/13/2023]
Affiliation(s)
- Francesca Colapietro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Chiara Masetti
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Nicola Pugliese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.,Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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Masetti C, Colapietro F, Voza A, Aghemo A. No impact of COVID-19 epidemic on decompensation of alcoholic liver disease: Results from a single-centre in Milan. Liver Int 2022; 42:2581-2582. [PMID: 36066183 PMCID: PMC9537892 DOI: 10.1111/liv.15400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 02/13/2023]
Affiliation(s)
- Chiara Masetti
- Division of Internal Medicine and Hepatology, Department of GastroenterologyIRCCS Humanitas Research HospitalRozzanoMilanItaly
| | - Francesca Colapietro
- Division of Internal Medicine and Hepatology, Department of GastroenterologyIRCCS Humanitas Research HospitalRozzanoMilanItaly,Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMilanItaly
| | - Antonio Voza
- Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMilanItaly,Emergency DepartmentIRCCS Humanitas Research HospitalRozzanoMilanItaly
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of GastroenterologyIRCCS Humanitas Research HospitalRozzanoMilanItaly,Department of Biomedical SciencesHumanitas UniversityPieve EmanueleMilanItaly
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Sapena V, Enea M, Torres F, Celsa C, Rios J, Rizzo GEM, Nahon P, Mariño Z, Tateishi R, Minami T, Sangiovanni A, Forns X, Toyoda H, Brillanti S, Conti F, Degasperi E, Yu ML, Tsai PC, Jean K, El Kassas M, Shousha HI, Omar A, Zavaglia C, Nagata H, Nakagawa M, Asahina Y, Singal AG, Murphy C, Kohla M, Masetti C, Dufour JF, Merchante N, Cavalletto L, Chemello LL, Pol S, Crespo J, Calleja JL, Villani R, Serviddio G, Zanetto A, Shalaby S, Russo FP, Bielen R, Trevisani F, Cammà C, Bruix J, Cabibbo G, Reig M. Hepatocellular carcinoma recurrence after direct-acting antiviral therapy: an individual patient data meta-analysis. Gut 2022; 71:593-604. [PMID: 33741640 DOI: 10.1136/gutjnl-2020-323663] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [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: 11/25/2020] [Revised: 01/12/2021] [Accepted: 01/29/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The benefit of direct-acting antivirals (DAAs) against HCV following successful treatment of hepatocellular carcinoma (HCC) remains controversial. This meta-analysis of individual patient data assessed HCC recurrence risk following DAA administration. DESIGN We pooled the data of 977 consecutive patients from 21 studies of HCV-related cirrhosis and HCC, who achieved complete radiological response after surgical/locoregional treatments and received DAAs (DAA group). Recurrence or death risk was expressed as HCC recurrence or death per 100 person-years (100PY). Propensity score-matched patients from the ITA.LI.CA. cohort (n=328) served as DAA-unexposed controls (no-DAA group). Risk factors for HCC recurrence were identified using random-effects Poisson. RESULTS Recurrence rate and death risk per 100PY in DAA-treated patients were 20 (95% CI 13.9 to 29.8, I2=74.6%) and 5.7 (2.5 to 15.3, I2=54.3), respectively. Predictive factors for recurrence were alpha-fetoprotein logarithm (relative risk (RR)=1.11, 95% CI 1.03 to 1.19; p=0.01, per 1 log of ng/mL), HCC recurrence history pre-DAA initiation (RR=1.11, 95% CI 1.07 to 1.16; p<0.001), performance status (2 vs 0, RR=4.35, 95% CI 1.54 to 11.11; 2 vs 1, RR=3.7, 95% CI 1.3 to 11.11; p=0.01) and tumour burden pre-HCC treatment (multifocal vs solitary nodule, RR=1.75, 95% CI 1.25 to 2.43; p<0.001). No significant difference was observed in RR between the DAA-exposed and DAA-unexposed groups in propensity score-matched patients (RR=0.64, 95% CI 0.37 to 1.1; p=0.1). CONCLUSION Effects of DAA exposure on HCC recurrence risk remain inconclusive. Active clinical and radiological follow-up of patients with HCC after HCV eradication with DAA is justified.
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Affiliation(s)
- Victor Sapena
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, Universidad de Barcelona, CIBEREHD, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Marco Enea
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
| | - Ferran Torres
- Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clinic Barcelona, Barcelona, Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Ciro Celsa
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy.,Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Sicilia, Italy
| | - Jose Rios
- Biostatistics and Data Management Core Facility, IDIBAPS, Hospital Clinic Barcelona, Barcelona, Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Giacomo Emanuele Maria Rizzo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
| | - 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 tumeurs solides", F-75000, Bondy, France
| | - Zoe Mariño
- Liver Unit, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, CIBEREHD, Barcelona, Spain
| | - Ryosuke Tateishi
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Minami
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Angelo Sangiovanni
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan, Italy.,CRC "A.M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Xavier Forns
- Liver Unit, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, CIBEREHD, Barcelona, Spain
| | - Hidenori Toyoda
- Gastroenterology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Stefano Brillanti
- Department of Medical and Surgical Sciences (DIMEC), Research Centre for the Study of Hepatitis, University of Bologna, Bologna, Italy
| | - Fabio Conti
- Department of Medical and Surgical Sciences (DIMEC), Research Centre for the Study of Hepatitis, University of Bologna, Bologna, Italy
| | - Elisabetta Degasperi
- Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Maggiore Hospital, University of Milan, Milan, Italy.,CRC "A.M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Ming-Lung Yu
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis, Center Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Internal Medicine and Hepatitis Research Center, School of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei-Chien Tsai
- Hepatobiliary Division, Department of Internal Medicine and Hepatitis, Center Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kevin Jean
- Laboratoire MESuRS (EA 4628), Conservatoire National Des Arts et Métiers, Paris, France.,Unité PACRI, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
| | - Mohamed El Kassas
- Endemic Medicine, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Hend Ibrahim Shousha
- Endemic Medicine and Hepato-Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ashraf Omar
- Endemic Medicine and Hepato-Gastroenterology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Claudio Zavaglia
- Department of Hepatology and Gastroenterology, Liver Unit, Niguarda Hospital, Milano, Lombardia, Italy
| | - Hiroko Nagata
- Gastroenterology and Hepatology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Mina Nakagawa
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan.,Institute of Education, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiro Asahina
- Department of Gastroenterology and Hepatology, Liver Disease Control, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Amit G Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Caitlin Murphy
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Mohamed Kohla
- Hepatology, National Liver Institute, Shebin El-Kom, Egypt
| | - Chiara Masetti
- Liver and Transplant Unit, Policlinico Tor Vergata, Rome, Italy
| | - Jean-François Dufour
- Hepatology, Department of Clinical Research, University Clinic for Visceral Surgery and Medicine Inselspital, Bern, Switzerland.,Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Nicolas Merchante
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Seville, Spain
| | - Luisa Cavalletto
- Department of Medicine-DIMED, Padua University, University Hospital, Clinica Medica 5, Refering Center for Liver Diseases, Padova, Italy
| | - Liliana Lc Chemello
- Department of Medicine-DIMED, Padua University, University Hospital, Clinica Medica 5, Refering Center for Liver Diseases, Padova, Italy
| | - Stanislas Pol
- l'Agence de recherche ANRS (France REcherche Nord&Sud Sida-HIV Hépatites), Paris, France
| | - Javier Crespo
- Gastroenterology and Hepatology Service, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain.,Facultad de Medicina, Universidad de Cantabria, Santander, Cantabria, Spain
| | - Jose Luis Calleja
- Gastroenterology and Hepatology, IDIPHIM, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain.,(CIBEREHD), Instituto de Salud Carlos III, Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas, Madrid, Spain
| | - Rosanna Villani
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gaetano Serviddio
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alberto Zanetto
- Gastroenterology/Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology Unit, University of Padova, Padova, Italy
| | - Sarah Shalaby
- Gastroenterology/Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology Unit, University of Padova, Padova, Italy
| | - Francesco Paolo Russo
- Gastroenterology/Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology Unit, University of Padova, Padova, Italy
| | - Rob Bielen
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Limburg, Belgium.,Department of Gastro-Enterology and Hepatology, Ziekenhuis Oost-Limburg, Genk, Limburg, Belgium
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, Semeiotics Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Calogero Cammà
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
| | - Jordi Bruix
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, Universidad de Barcelona, CIBEREHD, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Giuseppe Cabibbo
- Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, Gastroenterology & Hepatology Unit, University of Palermo, Palermo, Sicilia, Italy
| | - Maria Reig
- Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clínic de Barcelona, IDIBAPS, Universidad de Barcelona, CIBEREHD, Hospital Clinic de Barcelona, Barcelona, Spain
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8
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Abstract
INTRODUCTION Oral nucleos(t)ide analogues (NUCs) are recommended as first-line therapy for chronic hepatitis B due to higher HBV-DNA suppression rates and safety profile. Long-term treatment with NUCs is often necessary to achieve durable viral suppression. AREAS COVERED This review provides an overview of the long-term safety data that have become available since entecavir (ETV) and tenofovir disoproxil fumarate (TDF) were first approved, and recent data on tenofovir alafenamide (TAF) in patients with CHB. EXPERT OPINION NUCs generally show remarkable safety in patients taking them for long periods. Nevertheless, renal and bone toxicity may occur in a minority of patients on TDF therapy. These effects have been overcome by the recent release of TAF. Moreover, the currently available data do not allow firm conclusions on superiority of TDF on ETV about HCC risk reduction. Observational studies involving more homogeneous cohorts are therefore needed; furthermore long-term studies assessing impact of TAF on this important topic are warranted.
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Affiliation(s)
- Chiara Masetti
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy
| | - Nicola Pugliese
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano (MI), Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Mauro Viganò
- 3Division of Hepatology, Ospedale San Giuseppe, Milan, Italy
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9
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Colapietro F, Masetti C, Ceriani R, Morelli P, Poretti D, Pedicini V, Pugliese N, Voza A, Lleo A, Aghemo A. High prevalence of multidrug-resistant bacteria in patients with pyogenic liver abscess following liver cancer loco-regional treatments. Liver Int 2021; 41:1909-1912. [PMID: 33966352 DOI: 10.1111/liv.14933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/15/2021] [Accepted: 04/30/2021] [Indexed: 02/13/2023]
Affiliation(s)
- Francesca Colapietro
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Chiara Masetti
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Roberto Ceriani
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Paola Morelli
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Infectious Diseases Unit, Hospital Health Direction, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Dario Poretti
- Unit of Interventional Radiology, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Vittorio Pedicini
- Unit of Interventional Radiology, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Nicola Pugliese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Antonio Voza
- Emergency Department, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Milan, Italy
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10
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Masetti C, Aghemo A. Bulevirtide for treatment of patients with HDV infection and compensated cirrhosis: A (huge?) step in the right direction. Liver Int 2021; 41:1441-1442. [PMID: 34139064 DOI: 10.1111/liv.14967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Chiara Masetti
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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11
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de Salazar A, Dietz J, di Maio VC, Vermehren J, Paolucci S, Müllhaupt B, Coppola N, Cabezas J, Stauber RE, Puoti M, Arenas Ruiz Tapiador JI, Graf C, Aragri M, Jimenez M, Callegaro A, Pascasio Acevedo JM, Macias Rodriguez MA, Rosales Zabal JM, Micheli V, Garcia Del Toro M, Téllez F, García F, Sarrazin C, Ceccherini-Silberstein F, Canbay A, Port K, Cornberg M, Manns M, Reinhardt L, Ellenrieder V, Zizer E, Dikopoulos N, Backhus J, Seufferlein T, Beckebaum S, Hametner S, Schöfl R, Niederau C, Schlee P, Dreck M, Görlitz B, Hinrichsen H, Seegers B, Jung M, Link R, Mauss S, Meister V, Schnaitmann E, Sick C, Simon KG, Schmidt KJ, Andreoni M, Craxì A, Giaccone P, Perno CF, Zazzi M, Bertoli A, Angelico M, Masetti C, Giannelli V, Camillo S, Begini P, De Santis A, Taliani G, Lichtner M, Rossetti B, Caudai C, Cozzolongo R, De Bellis S, Starace M, Minichini C, Gaeta G, Pisaturo MA, Messina V, Dentone C, Bruzzone B, Landonio S, Magni C, Merli M, De Gasperi E, Policlinico GOM, Hasson H, Boeri E, Beretta I, Molteni C, Maffezzini AME, Dorigoni N, Guella L, Götze T, Canbay A, Port K, Cornberg M, Manns M, Reinhardt L, Ellenrieder V, Zizer E, Dikopoulos N, Backhus J, Seufferlein T, Beckebaum S, Hametner S, Schöfl R, Niederau C, Schlee P, Dreck M, Görlitz B, Hinrichsen H, Seegers B, Jung M, Link R, Mauss S, Meister V, Schnaitmann E, Sick C, Simon KG, Schmidt KJ, Andreoni M, Craxì A, Giaccone P, Perno CF, Zazzi M, Bertoli A, Angelico M, Masetti C, Giannelli V, Camillo S, Begini P, De Santis A, Taliani G, Lichtner M, Rossetti B, Caudai C, Cozzolongo R, De Bellis S, Starace M, Minichini C, Gaeta G, Pisaturo MA, Messina V, Dentone C, Bruzzone B, Landonio S, Magni C, Merli M, De Gasperi E, Policlinico GOM, Hasson H, Boeri E, Beretta I, Molteni C, Maffezzini AME, Dorigoni N, Guella L. Prevalence of resistance-associated substitutions and retreatment of patients failing a glecaprevir/pibrentasvir regimen. J Antimicrob Chemother 2021; 75:3349-3358. [PMID: 32772078 DOI: 10.1093/jac/dkaa304] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 06/02/2020] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To investigate resistance-associated substitutions (RASs) as well as retreatment efficacies in a large cohort of European patients with failure of glecaprevir/pibrentasvir. METHODS Patients were identified from three European Resistance Reference centres in Spain, Italy and Germany. Sequencing of NS3, NS5A and NS5B was conducted and substitutions associated with resistance to direct antiviral agents were analysed. Clinical and virological parameters were documented retrospectively and retreatment efficacies were evaluated. RESULTS We evaluated 90 glecaprevir/pibrentasvir failures [3a (n = 36), 1a (n = 23), 2a/2c (n = 20), 1b (n = 10) and 4d (n = 1)]. Ten patients were cirrhotic, two had previous exposure to PEG-interferon and seven were coinfected with HIV; 80 had been treated for 8 weeks. Overall, 31 patients (34.4%) failed glecaprevir/pibrentasvir without any NS3 or NS5A RASs, 62.4% (53/85) showed RASs in NS5A, 15.6% (13/83) in NS3 and 10% (9/90) in both NS5A and NS3. Infection with HCV genotypes 1a and 3a was associated with a higher prevalence of NS5A RASs. Patients harbouring two (n = 34) or more (n = 8) RASs in NS5A were frequent. Retreatment was initiated in 56 patients, almost all (n = 52) with sofosbuvir/velpatasvir/voxilaprevir. The overall sustained virological response rate was 97.8% in patients with end-of-follow-up data available. CONCLUSIONS One-third of patients failed glecaprevir/pibrentasvir without resistance. RASs in NS5A were more prevalent than in NS3 and were frequently observed as dual and triple combination patterns, with a high impact on NS5A inhibitor activity, particularly in genotypes 1a and 3a. Retreatment of glecaprevir/pibrentasvir failures with sofosbuvir/velpatasvir/voxilaprevir achieved viral suppression across all genotypes.
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Affiliation(s)
- Adolfo de Salazar
- Clinical Microbiology Unit, University Hospital San Cecilio, Instituto de Investigacion Ibs.Granada. Granada, Spain
| | - Julia Dietz
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany; German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Velia Chiara di Maio
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany; German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Stefania Paolucci
- Molecular Virology Unit, Microbiology and Virology Department, IRCCS Policlinic Foundation San Matteo, Pavia, Italy
| | - Beat Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Nicola Coppola
- Department of Mental Health and Public Medicine, Infectious Diseases Unit, University of Campania "L. Vanvitelli", Naples, Italy
| | - Joaquín Cabezas
- Department of Hepatology, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Rudolf E Stauber
- Department of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Massimo Puoti
- Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Christiana Graf
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany; German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Marianna Aragri
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Miguel Jimenez
- Hepatology Unit, Hospital Regional de Málaga, Málaga, Spain
| | | | | | | | | | - Valeria Micheli
- Clinical Microbiology, Virology and Bioemergencies, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
| | | | - Francisco Téllez
- Infectious Diseases Unit, Hospital Puerto Real, Puerto Real, Cádiz, Spain
| | - Federico García
- Clinical Microbiology Unit, University Hospital San Cecilio, Instituto de Investigacion Ibs.Granada. Granada, Spain
| | - Christoph Sarrazin
- Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt, Germany; German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany.,Medizinische Klinik 2, St. Josefs Hospital, Wiesbaden, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
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12
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Capogreco A, Pedicini V, Masetti C, Ceriani R. Portal hypertension determined by von Hippel Lindau syndrome. Liver Int 2021; 41:1421-1422. [PMID: 33394533 DOI: 10.1111/liv.14783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/16/2020] [Accepted: 12/31/2020] [Indexed: 02/13/2023]
Affiliation(s)
- Antonio Capogreco
- Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital IRCCS, Milan, Italy.,Division of Internal Medicine and Hepatology, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Vittorio Pedicini
- Unit of Interventional Radiology, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Chiara Masetti
- Division of Internal Medicine and Hepatology, Humanitas Research Hospital IRCCS, Milan, Italy
| | - Roberto Ceriani
- Division of Internal Medicine and Hepatology, Humanitas Research Hospital IRCCS, Milan, Italy
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13
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Masetti C, Generali E, Colapietro F, Voza A, Cecconi M, Messina A, Omodei P, Angelini C, Ciccarelli M, Badalamenti S, Canonica GW, Lleo A, Aghemo A. High mortality in COVID-19 patients with mild respiratory disease. Eur J Clin Invest 2020; 50:e13314. [PMID: 32535885 PMCID: PMC7323076 DOI: 10.1111/eci.13314] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected 189 000 people in Italy, with more than 25 000 deaths. Several predictive factors of mortality have been identified; however, none has been validated in patients presenting with mild disease. METHODS Patients with a diagnosis of interstitial pneumonia caused by SARS-CoV-2, presenting with mild symptoms, and requiring hospitalization in a non-intensive care unit with known discharge status were prospectively collected and retrospectively analysed. Demographical, clinical and biochemical parameters were recorded, as need for non-invasive mechanical ventilation and admission in intensive care unit. Univariate and multivariate logistic regression analyses were used to identify independent predictors of death. RESULTS Between 28 February and 10 April 2020, 229 consecutive patients were included in the study cohort; the majority were males with a mean age of 60 years. 54% of patients had at least one comorbidity, with hypertension being the most commonly represented, followed by diabetes mellitus. 196 patients were discharged after a mean of 9 days, while 14.4% died during hospitalization because of respiratory failure. Age higher than 75 years, low platelet count (<150 × 103 /mm3 ) and higher ferritin levels (>750 ng/mL) were independent predictors of death. Comorbidities were not independently associated with in-hospital mortality. CONCLUSIONS In-hospital mortality of patients with COVID-19 presenting with mild symptoms is high and is associated with older age, platelet count and ferritin levels. Identifying early predictors of outcome can be useful in the clinical practice to better stratify and manage patients with COVID-19.
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Affiliation(s)
- Chiara Masetti
- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Elena Generali
- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Francesca Colapietro
- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Antonio Voza
- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Maurizio Cecconi
- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Antonio Messina
- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Paolo Omodei
- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | | | | | | | - G Walter Canonica
- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Ana Lleo
- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Alessio Aghemo
- Humanitas Clinical and Research Center IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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14
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Abstract
The introduction of direct-acting antiviral agents (DAA) has revolutionized management and care of patients with chronic hepatitis C virus (HCV) infection, leading to cure rates higher than 90% in patients with advanced liver disease as well. Viral eradication has been associated with longer survival, reduced mortality from both hepatic and extrahepatic causes, improvement in liver function, and reduced incidence of HCV-related extrahepatic diseases. While patients with mild fibrosis can safely be discharged after achievement of a sustained virological response, patients with advanced fibrosis and cirrhosis remain at risk of developing complications of liver disease, thus requiring regular and life-long surveillance. Major complications of cirrhosis that need to be monitored are hepatocellular carcinoma onset and development or progression of clinically significant portal hypertension.
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Affiliation(s)
- Chiara Masetti
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Ana Lleo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Matteo Colombo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Massimo Colombo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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15
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Lanza E, Masetti C, Messana G, Muglia R, Pugliese N, Ceriani R, Lleo de Nalda A, Rimassa L, Torzilli G, Poretti D, D’Antuono F, Politi LS, Pedicini V, Aghemo A. Sarcopenia as a predictor of survival in patients undergoing bland transarterial embolization for unresectable hepatocellular carcinoma. PLoS One 2020; 15:e0232371. [PMID: 32555707 PMCID: PMC7299358 DOI: 10.1371/journal.pone.0232371] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 03/21/2020] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
Sarcopenia has been associated with lower overall survival in patients with cirrhosis and hepatocellular carcinoma (HCC) undergoing surgical resection, TACE, TARE, or transplantation. This monocentric study evaluated the prognostic significance of sarcopenia in patients affected by HCC who received bland transarterial embolization (TAE) therapy, by analyzing its impact on survival and treatment-related complications. All consecutive patients who underwent the 1st TAE between March 1st 2011 and July 1st 2019 in our Institution were retrospectively studied. To evaluate sarcopenia, the skeletal muscle index (SMI) was calculated by normalizing the cross-sectional muscle area at the level of L3 on an abdominal CT scan prior to embolization (cm2) by patient height (m2). SMI cut-off values for sarcopenia were considered ≤ 39 cm2/m2 for women and ≤55 cm2/m2 for men. Data about age, gender, body mass index (BMI), underlying liver disease, liver function, MELD score, Child-Pugh score, multifocal disease, performance status, previous interventions, length of stay (LOS), complications after the procedure, readmission rate within 30 days, survival time from TAE and total number and type of TAE received following the first procedure were collected. From 2011 to 2019, 142 consecutive patients underwent 305 TAEs. Observation time ranged from 1.4 to 100.5 months (median 20.1 SD = 22). Sarcopenia at baseline was present in 121 (85%) patients. Overall 87 (61.2%) patients died during follow-up with survival rates at 1-, 2-, 3-, 4-, and 5-year of 71%, 41%, 22%, 16% and 11% respectively. After multivariate analysis sarcopenia (HR = 2.22, p = 0.046), previous ablation/resection (HR = 0.51, p = 0.005) and multifocal disease (HR = 1.84, p = 0.02) were associated with reduced survival. Sarcopenia did not influence the safety of TAE in terms of LOS (2 days vs 1.5 days, p = 0.2), early complications rate (8% vs 5%, p = 0.5) and readmission rate within 30 days (7% vs 5%, p = 0.74). Sarcopenia, estimated by the L3SMI method, is an emerging prognostic factor in patients with HCC undergoing bland TAE therapy as it is associated with increased mortality, without impairing the safety of the locoregional treatment. Measures to ameliorate the SMI, such as nutritional support and physical exercise, should be evaluated in clinical trials for HCC patients receiving liver embolization to determine their impact on overall survival.
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Affiliation(s)
- Ezio Lanza
- Division of Interventional Radiology, Department of Radiology, Humanitas Research Hospital IRCCS, Rozzano, Italy
- * E-mail:
| | - Chiara Masetti
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Gaia Messana
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Riccardo Muglia
- Division of Interventional Radiology, Department of Radiology, Humanitas Research Hospital IRCCS, Rozzano, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Nicola Pugliese
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Roberto Ceriani
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Ana Lleo de Nalda
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Lorenza Rimassa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Guido Torzilli
- Division of Hepatobiliary & General Surgery, Department of Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Dario Poretti
- Division of Interventional Radiology, Department of Radiology, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Felice D’Antuono
- Division of Interventional Radiology, Department of Radiology, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Letterio Salvatore Politi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
- Division of Hepatobiliary & General Surgery, Department of Surgery, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
- Department of Radiology, Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Vittorio Pedicini
- Division of Interventional Radiology, Department of Radiology, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Alessio Aghemo
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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16
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Masetti C, Brega A, Angelico M. Acute Cholangitis with Atypical Clinical Presentation and Imaging. Dig Dis Sci 2019; 64:1383-1385. [PMID: 30392151 DOI: 10.1007/s10620-018-5361-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/29/2018] [Indexed: 12/09/2022]
Affiliation(s)
- Chiara Masetti
- Liver and Transplant Unit, Tor Vergata University Hospital, Rome, Italy.
| | - Arianna Brega
- Liver and Transplant Unit, Tor Vergata University Hospital, Rome, Italy
| | - Mario Angelico
- Liver and Transplant Unit, Tor Vergata University Hospital, Rome, Italy
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17
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Masetti C, Lionetti R, Lupo M, Siciliano M, Giannelli V, Ponziani FR, Teti E, Dell'Unto C, Francioso S, Brega A, Montalbano M, Visco-Comandini U, Taibi C, Galati G, Vespasiani Gentilucci U, Picardi A, Andreoni M, Pompili M, Pellicelli AM, D'Offizi G, Gasbarrini A, De Santis A, Angelico M. Lack of reduction in serum alpha-fetoprotein during treatment with direct antiviral agents predicts hepatocellular carcinoma development in a large cohort of patients with hepatitis C virus-related cirrhosis. J Viral Hepat 2018; 25:1493-1500. [PMID: 30112854 DOI: 10.1111/jvh.12982] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 04/09/2018] [Revised: 06/07/2018] [Accepted: 06/23/2018] [Indexed: 12/22/2022]
Abstract
Risk of hepatocellular carcinoma (HCC) in hepatitis C virus cirrhotic patients treated with direct-acting antiviral agents (DAA) is still debating. We investigated it in a large cohort. The cohort comprised 1045 cirrhotic patients who completed treatment with DAA, with a median follow-up of 17.3 months after end of treatment (EOT), including 943 patients without history of HCC and 102 previously treated for HCC. The majority were men (59.9%), with compensated cirrhosis (88.8%), genotype 1b (44.7%). Univariate, multivariate analysis and Kaplan-Meier curves were performed to detect predictors of HCC in patients with and without reduction in alpha-fetoprotein (AFP) during treatment. SVR12 was 95.6%. HCC developed in 95 (9.9%), including 54 of 943 (5.7%) occurrent and 41 of 102 (39%) recurrent tumours. De novo were more often unifocal (P = 0.01) and curable (P = 0.03). AFP decreased from 16.1 ± 36.2 mg/dL (baseline) to 11.4 ± 55 mg/dL (EOT). At univariate analysis, predictors were a previous HCC, older age, higher model for end-stage liver disease, prolonged INR, lower platelets, baseline and EOT AFP, virological failure and no reduction in AFP during treatment. Kaplan-Meier curves showed lower incidence of HCC in patients showing any reduction in AFP (P = 0.001). Those with AFP <6 ng/mL had the lowest risk (P = 0.0002). At logistic regression, platelets (P = 0.009, OR 0.99 CI: 0.99-1.00), previous HCC (P < 0.000 01, OR: 10.76, 95% CI: 5.89-19.34) and no reduction in AFP during treatment (P = 0.0005, OR: 2.98, CI: 1.60-5.54) were independent predictors of HCC. In conclusion, risk of HCC after DAA treatment remains substantial. It is higher among patients with previous HCC, low platelets and without reduction in AFP during treatment.
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Affiliation(s)
- Chiara Masetti
- Liver and Transplant Unit, Tor Vergata University Hospital, Rome, Italy
| | - Raffaella Lionetti
- Infectious Diseases-Hepatology, National Institute for Infectious Diseases Spallanzani, Rome, Italy
| | - Marinella Lupo
- Department of Clinical Medicine, Gastroenterology Unit, Sapienza University of Rome, Rome, Italy
| | | | - Valerio Giannelli
- Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Elisabetta Teti
- Department of Infectious Disease, Tor Vergata University Hospital, Rome, Italy
| | - Chiara Dell'Unto
- Internal Medicine and Hepatology Unit, University Campus Bio-Medico, Rome, Italy
| | - Simona Francioso
- Liver and Transplant Unit, Tor Vergata University Hospital, Rome, Italy
| | - Arianna Brega
- Liver and Transplant Unit, Tor Vergata University Hospital, Rome, Italy
| | - Marzia Montalbano
- Infectious Diseases-Hepatology, National Institute for Infectious Diseases Spallanzani, Rome, Italy
| | - Ubaldo Visco-Comandini
- Infectious Diseases-Hepatology, National Institute for Infectious Diseases Spallanzani, Rome, Italy
| | - Chiara Taibi
- Infectious Diseases-Hepatology, National Institute for Infectious Diseases Spallanzani, Rome, Italy
| | - Giovanni Galati
- Internal Medicine and Hepatology Unit, University Campus Bio-Medico, Rome, Italy
| | | | - Antonio Picardi
- Internal Medicine and Hepatology Unit, University Campus Bio-Medico, Rome, Italy
| | - Massimo Andreoni
- Department of Infectious Disease, Tor Vergata University Hospital, Rome, Italy
| | - Maurizio Pompili
- Internal Medicine, Gastroenterology and Hepatology, A. Gemelli Hospital, Rome, Italy
| | - Adriano M Pellicelli
- Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Gianpiero D'Offizi
- Infectious Diseases-Hepatology, National Institute for Infectious Diseases Spallanzani, Rome, Italy
| | | | - Adriano De Santis
- Department of Clinical Medicine, Gastroenterology Unit, Sapienza University of Rome, Rome, Italy
| | - Mario Angelico
- Liver and Transplant Unit, Tor Vergata University Hospital, Rome, Italy
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18
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Bertoli A, Sorbo MC, Aragri M, Lenci I, Teti E, Polilli E, Di Maio VC, Gianserra L, Biliotti E, Masetti C, Magni CF, Babudieri S, Nicolini LA, Milana M, Cacciatore P, Sarmati L, Pellicelli A, Paolucci S, Craxì A, Morisco F, Palitti VP, Siciliano M, Coppola N, Iapadre N, Puoti M, Rizzardini G, Taliani G, Pasquazzi C, Andreoni M, Parruti G, Angelico M, Perno CF, Cento V, Ceccherini-Silberstein F. Prevalence of Single and Multiple Natural NS3, NS5A and NS5B Resistance-Associated Substitutions in Hepatitis C Virus Genotypes 1-4 in Italy. Sci Rep 2018; 8:8988. [PMID: 29895871 PMCID: PMC5997636 DOI: 10.1038/s41598-018-26862-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [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: 01/03/2018] [Accepted: 05/16/2018] [Indexed: 12/15/2022] Open
Abstract
Natural resistance-associated substitutions (RASs) are reported with highly variable prevalence across different HCV genotypes (GTs). Frequency of natural RASs in a large Italian real-life cohort of patients infected with the 4 main HCV-GTs was investigated. NS3, NS5A and NS5B sequences were analysed in 1445 HCV-infected DAA-naïve patients. Sanger-sequencing was performed by home-made protocols on 464 GT1a, 585 GT1b, 92 GT2c, 199 GT3a, 16 GT4a and 99 GT4d samples. Overall, 20.7% (301/1455) of patients showed natural RASs, and the prevalence of multiclass-resistance was 7.3% (29/372 patients analysed). NS3-RASs were particularly common in GT1a and GT1b (45.2-10.8%, respectively), mainly due to 80K presence in GT1a (17%). Almost all GTs showed high prevalence of NS5A-RASs (range: 10.2-45.4%), and especially of 93H (5.1%). NS5A-RASs with fold-change >100x were detected in 6.8% GT1a (30H/R-31M-93C/H), 10.3% GT1b (31V-93H), 28.4% GT2c (28C-31M-93H), 8.5% GT3a (30K-93H), 45.5% GT4a (28M-30R-93H) and 3.8% GT4d (28V-30S-93H). Sofosbuvir RAS 282T was never detected, while the 159F and 316N RASs were found in GT1b (13.4-19.1%, respectively). Natural RASs are common in Italian patients infected with HCV-GTs 1-4. High prevalence of clinically-relevant RASs (such as Y93H) supports the appropriateness of HCV resistance-test to properly guide DAA-based therapy.
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Affiliation(s)
- Ada Bertoli
- Department Experimental Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Maria Chiara Sorbo
- Department Experimental Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Marianna Aragri
- Department Experimental Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | - Elisabetta Teti
- Infectious Diseases Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | - Ennio Polilli
- Infectious Diseases Unit, Pescara General Hospital, 65124, Pescara, Italy
| | - Velia Chiara Di Maio
- Department Experimental Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy
| | - Laura Gianserra
- Infectious Diseases Unit, Sant'Andrea Hospital - "Sapienza" University, 00189, Rome, Italy
| | - Elisa Biliotti
- Tropical Diseases, Umberto I Hospital -"Sapienza" University, 00161, Rome, Italy
| | - Chiara Masetti
- Hepatology Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | - Carlo F Magni
- 1st Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157, Milan, Italy
| | - Sergio Babudieri
- Clinical and Experimental Medicine, University of Sassari, 07100, Sassari, Italy
| | - Laura A Nicolini
- Infectious Diseases Unit, IRCCS AOU San Martino - IST, 16132, Genoa, Italy
| | - Martina Milana
- Hepatology Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | | | - Loredana Sarmati
- Infectious Diseases Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | | | - Stefania Paolucci
- Molecular Virology, Fondazione IRCCS Policlinico San Matteo, 27100, Pavia, Italy
| | - Antonio Craxì
- Gastroenterology, "P. Giaccone" University Hospital, 90127, Palermo, Italy
| | - Filomena Morisco
- Gastroenterology, "Federico II" University, 80131, Naples, Italy
| | | | | | - Nicola Coppola
- Infectious Diseases Unit, "L. Vanvitelli" University of Campania, 80138, Naples, Italy
| | - Nerio Iapadre
- Infectious Diseases Unit, S. Salvatore Hospital, 67100, L'Aquila, Italy
| | - Massimo Puoti
- Infectious Diseases Unit, Niguarda Ca' Granda Hospital, 20162, Milan, Italy
| | - Giuliano Rizzardini
- 1st Division of Infectious Diseases, ASST Fatebenefratelli Sacco, 20157, Milan, Italy
| | - Gloria Taliani
- Tropical Diseases, Umberto I Hospital -"Sapienza" University, 00161, Rome, Italy
| | - Caterina Pasquazzi
- Infectious Diseases Unit, Sant'Andrea Hospital - "Sapienza" University, 00189, Rome, Italy
| | - Massimo Andreoni
- Infectious Diseases Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, 65124, Pescara, Italy
| | - Mario Angelico
- Hepatology Unit, University Hospital of Rome "Tor Vergata", 00133, Rome, Italy
| | | | - Valeria Cento
- Department Experimental Medicine and Surgery, University of Rome "Tor Vergata", 00133, Rome, Italy.
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19
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Morisco F, Granata R, Camera S, Ippolito A, Milella M, Conti F, Masetti C, Smedile A, Tundo P, Santantonio T, Valvano MR, Termite A, Gatti P, Messina V, Iacobellis A, Librandi M, Caporaso N, Andriulli A. Optimization of direct anti-viral agent treatment schedule: Focus on HCV genotype 3. United European Gastroenterol J 2018; 6:225-237. [PMID: 29511552 PMCID: PMC5833227 DOI: 10.1177/2050640617717158] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 05/24/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND AIM Direct antiviral agents (DAAs) have led to high sustained virological responses (SVR) in hepatitis C virus (HCV) patients. However, genotype 3 patients respond to treatment in a suboptimal way. This study aims to identify which of the several treatment schedules recommended for genotype 3 would constitute the best option. METHODS Twenty-four Italian centers were involved in this real-life study of HCV genotype 3 patients treated with DAAs. To expand the number of cases, we conducted a systematic review of the literature on the outcome of genotype 3 patients treated with DAAs. RESULTS A total of 233 patients with HCV genotype 3 were enrolled. Cirrhotic patients accounted for 83.7%. Overall, the SVR12 rate was achieved by 205 patients (88.0%); the SVR rates were 78.8% after sofosbuvir/ribavirin, 92.5% after sofosbuvir/daclatasvir ± ribavirin, and 100% after sofosbuvir/ledipasvir (seven patients). No difference in rate of SVR was observed in cirrhotic and non-cirrhotic patients (92.2 vs 94.4) using a combination regimen of NS5A and NS5B inhibitors.The systematic review of the literature provided data of 3311 patients: The mean weighted SVR12 rate was 84.4% (CI: 80.4-87.8); the rates varied from 79.0% (CI: 70.9-85.3) with sofosbuvir/ribavirin, to 83.7% (CI: 66.2-93.1) with sofosbuvir/ledispavir, and to 88.2% (CI: 83.3-91.7) with sofosbuvir/daclatasvir. CONCLUSIONS Our results reinforce the concept that patients with HCV genotype 3 should no longer be considered difficult-to-treat individuals. The optimal therapeutic regimen for these patients appears to be the combination sofosbuvir/daclatasvir, administered for 12 weeks without the use of RBV in non-cirrhotic patients. In cirrhotics the meta-analytic approach suggests extending therapy to 24 weeks.
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Affiliation(s)
- Filomena Morisco
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, “Federico II” University, Napoli, Italy
| | - Rocco Granata
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, “Federico II” University, Napoli, Italy
| | - Silvia Camera
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, “Federico II” University, Napoli, Italy
| | - Antonio Ippolito
- Division of Gastroenterology, “Casa Sollievo della Sofferenza” Hospital, IRCCS, San Giovanni Rotondo, Italy
| | | | - Fabio Conti
- Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Italy
| | - Chiara Masetti
- Hepatology and Liver Transplantation Unit, University of Tor Vergata, Roma, Italy
| | | | - Paolo Tundo
- Division of Infectious Diseases, Hospital of Galatina, Italy
| | | | - Maria Rosa Valvano
- Division of Gastroenterology, “Casa Sollievo della Sofferenza” Hospital, IRCCS, San Giovanni Rotondo, Italy
| | | | | | - Vincenzo Messina
- Infectious and Tropical Diseases Unit, S. Anna and S. Sebastiano Hospital, Caserta, Italy
| | - Angelo Iacobellis
- Division of Gastroenterology, “Casa Sollievo della Sofferenza” Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Marta Librandi
- Department of Physiology, Faculty of Pharmacy, “La Sapienza” University, Roma, Italy
| | - Nicola Caporaso
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, “Federico II” University, Napoli, Italy
| | - Angelo Andriulli
- Division of Gastroenterology, “Casa Sollievo della Sofferenza” Hospital, IRCCS, San Giovanni Rotondo, Italy
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20
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Barone M, Iannone A, Shahini E, Ippolito AM, Brancaccio G, Morisco F, Milella M, Messina V, Smedile A, Conti F, Gatti P, Santantonio T, Tundo P, Lauletta G, Napoli N, Masetti C, Termite AP, Francavilla R, Di Leo A, Pesce F, Andriulli A. A different perspective on sofosbuvir-ledipasvir treatment of patients with HCV genotype 1b cirrhosis: The ital-c network study. J Viral Hepat 2018; 25:56-62. [PMID: 28787102 DOI: 10.1111/jvh.12765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 06/02/2017] [Accepted: 07/11/2017] [Indexed: 02/07/2023]
Abstract
The effectiveness of a 12-week course of sofosbuvir-ledipasvir in treatment-experienced HCV genotype 1b-infected patients with cirrhosis is still under debate. Our primary endpoint was to compare the sustained virological response at post-treatment week 12 (SVR12) of sofosbuvir-ledipasvir in combination with ribavirin for 12 weeks, and sofosbuvir-ledipasvir alone for 24 weeks. This was a prospective observational study that enrolled 424 (195 naive, 229 experienced; 164 treated for 12 weeks with Ribavirin and 260 with sofosbuvir-ledipasvir alone for 24 weeks) consecutive HCV genotype 1b-infected patients with cirrhosis. The SVR12 rates were 93.9% and 99.2% in patients treated for 12 and 24 weeks, respectively (P = .002). The baseline characteristics of patients treated for 12 weeks were significantly different from those treated for 24 weeks as regards their younger age (P = .002), prevalence of Child-Pugh class A (P = .002), lower MELD scores (P = .001) and smaller number of nonresponders (P = .04). The shorter treatment was significantly associated with a lower SVR12 in univariate and multivariate analyses (P = .007 and P = .008, respectively). The SVR rate was unaffected by age, gender, BMI, Child-Pugh class, MELD score or previous antiviral treatment. Patients receiving ribavirin experienced more episodes of ascites and headache but less recurrence of hepatocellular carcinoma (HCC), and were prescribed more diuretics and cardiopulmonary drugs. No patient discontinued treatment. The therapeutic regimen of sofosbuvir-ledipasvir plus ribavirin administered for 12 weeks was less effective than sofosbuvir-ledipasvir alone given for 24 weeks. At odds with European guidelines, the recommended 12-week treatment with sofosbuvir-ledipasvir alone might be suboptimal for this setting of patients.
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Affiliation(s)
- M Barone
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, AOU Policlinico, University of Bari, Bari, Italy
| | - A Iannone
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, AOU Policlinico, University of Bari, Bari, Italy
| | - E Shahini
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, AOU Policlinico, University of Bari, Bari, Italy
| | - A M Ippolito
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - G Brancaccio
- Clinics of Infectious Diseases, "Federico II" University of Naples, Naples, Italy
| | - F Morisco
- Division of Gastroenterology, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - M Milella
- Clinics of Infectious Diseases, University of Bari, Bari, Italy
| | - V Messina
- Infectious and Tropical Diseases Unit, S. Anna and S. Sebastiano Hospital, Caserta, Italy
| | - A Smedile
- Department of Medical Sciences, University of Turin, Turin, Italy
- Department of Gastroenterology and Hepatology, Azienda Ospedaliera Cittàdella Salute e della Scienza, Turin, Italy
| | - F Conti
- Department of Medical and Surgical Sciences (DIMEC), Centre for the Study of Hepatitis, University of Bologna, Bologna, Italy
| | - P Gatti
- Internal Medicine, Hospital of Ostuni, Ostuni, Italy
| | - T Santantonio
- Clinics of Infectious Diseases, University of Foggia, Foggia, Italy
| | - P Tundo
- Division of Infectious Diseases, Hospital of Galatina, Galatina, Italy
| | - G Lauletta
- Clinics of Internal Medicine "G. Baccelli", University of Bari, Bari, Italy
| | - N Napoli
- Clinics of Internal Medicine "C. Frugoni", University of Bari, Bari, Italy
| | - C Masetti
- Hepatology and Liver Transplantation Unit, University of Tor Vergata, Rome, Italy
| | - A P Termite
- Liver Unit, Hospital of Castellaneta, Castellaneta, Italy
| | - R Francavilla
- Unit of Infectious Diseases, Hospital of Bisceglie, Bisceglie, Italy
| | - A Di Leo
- Department of Emergency and Organ Transplantation, Section of Gastroenterology, AOU Policlinico, University of Bari, Bari, Italy
| | - F Pesce
- Department of Emergency and Organ Transplantation, Section of Nephrology, AOU Policlinico, University of Bari, Bari, Italy
| | - A Andriulli
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
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21
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Ippolito AM, Milella M, Messina V, Conti F, Cozzolongo R, Morisco F, Brancaccio G, Barone M, Santantonio T, Masetti C, Tundo P, Smedile A, Carretta V, Gatti P, Termite AP, Valvano MR, Bruno G, Fabrizio C, Andreone P, Zappimbulso M, Gaeta GB, Napoli N, Fontanella L, Lauletta G, Cuccorese G, Metrangolo A, Francavilla R, Ciracì E, Rizzo S, Andriulli A. HCV clearance after direct-acting antivirals in patients with cirrhosis by stages of liver impairment: The ITAL-C network study. Dig Liver Dis 2017; 49:1022-1028. [PMID: 28487083 DOI: 10.1016/j.dld.2017.03.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 11/26/2016] [Revised: 03/27/2017] [Accepted: 03/30/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sustained virological response (SVR12) rates at 12 weeks after treatment for HCV-infected patients with decompensated cirrhosis are used when referring to those with moderate functional impairment, while few data are available for those with more severe impairment. The use of the cirrhosis staging system proposed by D'Amico might provide new insights on timing for antiviral therapy. METHODS We investigated efficacy (SVR12), safety, and post-treatment variations in clinical and laboratory parameters in 2612 patients with advanced fibrosis (n=575) or cirrhosis (n=2037). Cirrhosis was in the compensated phase (without/with varices) or had previously been in the decompensated stage. Different direct-acting antiviral (DAA) regimens were administered in accordance with scientific guidelines. RESULTS The SVR12 rate was 97.6% in patients with advanced fibrosis. For patients with cirrhosis, the rate was 96.5% in stage 1, 95.1% in stage 2, 100% in stage 3, 95.7% in stage 4, and 93.6% in stage 5. These rates were independent of gender, age, HCV genotype, and treatment schedule. Positive changes in biochemical parameters and CPT classes following therapy were evident in compensated and previously decompensated patients. CONCLUSION Our findings support the use of DAAs in patients with advanced cirrhosis (stages 3-5) who are at greatest risk and have the most to gain from therapy.
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Affiliation(s)
- Antonio Massimo Ippolito
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy.
| | - Michele Milella
- Clinics of Infectious Diseases, University of Bari, Bari, Italy
| | - Vincenzo Messina
- Infectious and Tropical Diseases Unit, S. Anna and S. Sebastiano Hospital, Caserta, Italy
| | - Fabio Conti
- Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Raffaele Cozzolongo
- Division of Gastroenterology, "De Bellis" Hospital, IRCCS, Castellana Grotte, Italy
| | - Filomena Morisco
- Division of Gastroenterology, Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | | | - Michele Barone
- Section of Gastroenterology, Department of Emergency and Organ Transplantation, AOU Policlinico, University of Bari, Bari, Italy
| | | | - Chiara Masetti
- Hepatology and Liver Transplantation Unit, University of Tor Vergata, Rome, Italy
| | - Paolo Tundo
- Division of Infectious Diseases, "S. Caterina Novella" Hospital, Galatina, Italy
| | - Antonina Smedile
- Department of Medical Sciences, University of Turin and Department of Gastroenterology and Hepatology, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy
| | - Vito Carretta
- Liver Unit, Department of Internal Medicine, Hospital of Venosa, Venosa, Italy
| | - Pietro Gatti
- Internal Medicine, Hospital of Ostuni, Ostuni, Italy
| | | | - Maria Rosa Valvano
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Giuseppe Bruno
- Clinics of Infectious Diseases, University of Bari, Bari, Italy
| | | | - Pietro Andreone
- Centre for the Study of Hepatitis, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Marianna Zappimbulso
- Division of Gastroenterology, "De Bellis" Hospital, IRCCS, Castellana Grotte, Italy
| | | | - Nicola Napoli
- Clinica Medica "C. Frugoni", University of Bari, Bari, Italy
| | - Luca Fontanella
- Centre for Liver Disease, Fatebenefratelli Hospital, Naples, Italy
| | | | - Giuseppe Cuccorese
- Division of Internal Medicine, "Monsignor Di Miccoli" Hospital, Barletta, Italy
| | | | | | | | - Salvatore Rizzo
- Division of Internal Medicine, Hospital of Martina Franca, Martina Franca, Italy
| | - Angelo Andriulli
- Division of Gastroenterology, "Casa Sollievo Sofferenza" Hospital, IRCCS, San Giovanni Rotondo, Italy
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22
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Di Maio VC, Cento V, Lenci I, Aragri M, Rossi P, Barbaliscia S, Melis M, Verucchi G, Magni CF, Teti E, Bertoli A, Antonucci F, Bellocchi MC, Micheli V, Masetti C, Landonio S, Francioso S, Santopaolo F, Pellicelli AM, Calvaruso V, Gianserra L, Siciliano M, Romagnoli D, Cozzolongo R, Grieco A, Vecchiet J, Morisco F, Merli M, Brancaccio G, Di Biagio A, Loggi E, Mastroianni CM, Pace Palitti V, Tarquini P, Puoti M, Taliani G, Sarmati L, Picciotto A, Vullo V, Caporaso N, Paoloni M, Pasquazzi C, Rizzardini G, Parruti G, Craxì A, Babudieri S, Andreoni M, Angelico M, Perno CF, Ceccherini-Silberstein F. Multiclass HCV resistance to direct-acting antiviral failure in real-life patients advocates for tailored second-line therapies. Liver Int 2017; 37:514-528. [PMID: 28105744 DOI: 10.1111/liv.13327] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [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: 09/30/2016] [Accepted: 11/12/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Despite the excellent efficacy of direct-acting antivirals (DAA) reported in clinical trials, virological failures can occur, often associated with the development of resistance-associated substitutions (RASs). This study aimed to characterize the presence of clinically relevant RASs to all classes in real-life DAA failures. METHODS Of the 200 virological failures that were analyzed in 197 DAA-treated patients, 89 with pegylated-interferon+ribavirin (PegIFN+RBV) and 111 without (HCV-1a/1b/1g/2/3/4=58/83/1/6/24/25; 56.8% treatment experienced; 65.5% cirrhotic) were observed. Sanger sequencing of NS3/NS5A/NS5B was performed by home-made protocols, at failure (N=200) and whenever possible at baseline (N=70). RESULTS The majority of the virological failures were relapsers (57.0%), 22.5% breakthroughs, 20.5% non-responders. RAS prevalence varied according to IFN/RBV use, DAA class, failure type and HCV genotype/subtype. It was 73.0% in IFN group vs 49.5% in IFN free, with the highest prevalence of NS5A-RASs (96.1%), compared to NS3-RASs (75.9% with IFN, 70.5% without) and NS5B-RASs (66.6% with IFN, 20.4% without, in sofosbuvir failures). In the IFN-free group, RASs were higher in breakthrough/non-responders than in relapsers (90.5% vs 40.0%, P<.001). Interestingly, 57.1% of DAA IFN-free non-responders had a misclassified genotype, and 3/4 sofosbuvir breakthroughs showed the major-RAS-S282T, while RAS-L159F was frequently found in sofosbuvir relapsers (18.2%). Notably, 9.0% of patients showed also extra target RASs, and 47.4% of patients treated with ≥2 DAA classes showed multiclass resistance, including 11/11 NS3+NS5A failures. Furthermore, 20.0% of patients had baseline-RASs, which were always confirmed at failure. CONCLUSIONS In our failure setting, RAS prevalence was remarkably high in all genes, with a partial exception for NS5B, whose limited resistance is still higher than previously reported. This multiclass resistance advocates for HCV resistance testing at failure, in all three genes for the best second-line therapeutic tailoring.
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Affiliation(s)
- Velia C Di Maio
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Valeria Cento
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Lenci
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Marianna Aragri
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Piera Rossi
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Silvia Barbaliscia
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Michela Melis
- Infectious Diseases Unit, University of Sassari, Sassari, Italy
| | | | - Carlo F Magni
- Division of Infectious Disease, Hospital Sacco of Milan, Milan, Italy
| | - Elisabetta Teti
- Infectious Diseases, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Ada Bertoli
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Maria C Bellocchi
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | | | - Chiara Masetti
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Simona Landonio
- Division of Infectious Disease, Hospital Sacco of Milan, Milan, Italy
| | - Simona Francioso
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | | | - Adriano M Pellicelli
- Liver Disease Unit, Department of Liver Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Laura Gianserra
- Infectious Diseases, Sant'Andrea Hospital - Sapienza University of Rome, Rome, Italy
| | | | - Dante Romagnoli
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Raffaele Cozzolongo
- Department of Gastroenterology, Scientific Institute for Digestive Disease "Saverio de Bellis" Hospital, Castellana Grotte, Bari, Italy
| | - Antonio Grieco
- Gastroenterology, Catholic University of Rome, Rome, Italy
| | - Jacopo Vecchiet
- Infectious Disease Clinic, Hospital of Chieti, Chieti, Italy
| | - Filomena Morisco
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Manuela Merli
- Gastroenterology, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Antonio Di Biagio
- Infectious Diseases Unit, Department of Social Health (DISSAL) of the University of Genoa, IRCCS S. Martino-IST, Genoa, Italy
| | - Elisabetta Loggi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Claudio M Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University, Polo Pontino, Latina, Italy
| | | | | | - Massimo Puoti
- Department of Infectious Diseases, Hospital Niguarda Ca'Granda, Milan, Italy
| | - Gloria Taliani
- Infectious and Tropical Diseases Unit, Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - Loredana Sarmati
- Infectious Diseases, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Antonino Picciotto
- Department of Internal Medicine, Gastroenterology Unit, University of Genova, Genoa, Italy
| | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | - Nicola Caporaso
- Gastroenterology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Maurizio Paoloni
- Infectious Disease Unit, Avezzano General Hospital, Avezzano, Italy
| | - Caterina Pasquazzi
- Infectious Diseases, Sant'Andrea Hospital - Sapienza University of Rome, Rome, Italy
| | - Giuliano Rizzardini
- Division of Infectious Disease, Hospital Sacco of Milan, Milan, Italy.,School of Clinical Medicine, Faculty of Health Science University of the Witwatersrand, Johannesburg, South Africa
| | - Giustino Parruti
- Infectious Disease Unit, Pescara General Hospital, Pescara, Italy
| | - Antonio Craxì
- Gastroenterology, "P. Giaccone" University Hospital, Palermo, Italy
| | | | - Massimo Andreoni
- Infectious Diseases, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Mario Angelico
- Hepatology Unit, University Hospital of Rome Tor Vergata, Rome, Italy
| | - Carlo F Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
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Rinaldi L, Nascimbeni F, Giordano M, Masetti C, Guerrera B, Amelia A, Fascione MC, Ballestri S, Romagnoli D, Zampino R, Nevola R, Baldelli E, Iuliano N, Rosato V, Lonardo A, Adinolfi LE. Clinical features and natural history of cryptogenic cirrhosis compared to hepatitis C virus-related cirrhosis. World J Gastroenterol 2017; 23:1458-1468. [PMID: 28293093 PMCID: PMC5330831 DOI: 10.3748/wjg.v23.i8.1458] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/07/2016] [Accepted: 01/18/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To characterize natural history of cryptogenic cirrhosis (CC) and compare its clinical features and outcomes to those of hepatitis C virus (HCV)-related cirrhosis.
METHODS A prospective cohort of 102 consecutive patients at their first diagnosis of CC were enrolled in this study. The clinical data and outcomes were compared to an age- and Child-Pugh class-matched cohort of 110 patients with HCV-related cirrhosis. Diagnosis of cirrhosis was based on compatible clinical and laboratory parameters, ultrasound/endoscopic parameters and, whenever possible, on histological grounds and transient elastography. All cases of cirrhosis without a definite etiology were enrolled in the CC group. The parameters assessed were: (1) severity of liver disease at the time of first diagnosis; (2) liver decompensation during follow-up; (3) hepatocellular carcinoma (HCC); (4) orthotopic liver transplantation; and (5) death. The independent associated factors were evaluated by multiple logistic regression analysis, and survival and its determinants by the Kaplan-Meier model, log-rank test and Cox regression.
RESULTS At the first observation, median age was 66 and 65 years and male gender was 36% and 58% for CC and HCV cirrhosis, respectively. CC showed Child-Pugh class A/B/C of 47%/31%/22%, respectively. Compared to HCV cirrhosis, CC exhibited a significantly higher prevalence of metabolic syndrome (12% vs 54%, respectively), overweight/obesity, high BMI, impaired glucose tolerance, high blood pressure, dyslipidemia, hyperuricemia, cardiovascular diseases, extrahepatic cancer, and gallstones. Over a median period of 42 mo of follow-up, liver decompensation, HCC development and death for CC and HCV-related cirrhosis were 60.8%, and 54.4%, 16.7% and 17.2%, 39.2% and 30%, respectively. The median survival was 60 mo for CC. Independent predictors of death were age and Child-Pugh class at diagnosis. CC showed an approximately twofold higher incidence of HCC in Child-Pugh class A.
CONCLUSION Undiagnosed nonalcoholic fatty liver disease has an etiologic role in CC that is associated with a poor prognosis, early HCC development, high risk of cardiovascular disease and extrahepatic cancer.
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24
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Fracanzani AL, Valenti L, Russello M, Miele L, Bertelli C, Bellia A, Masetti C, Cefalo C, Grieco A, Marchesini G, Fargion S. Gallstone disease is associated with more severe liver damage in patients with non-alcoholic fatty liver disease. PLoS One 2012; 7:e41183. [PMID: 22848440 PMCID: PMC3405067 DOI: 10.1371/journal.pone.0041183] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [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: 04/01/2012] [Accepted: 06/18/2012] [Indexed: 12/22/2022] Open
Abstract
Background Nonalcoholic fatty liver disease (NAFLD) and gallstone disease (GD) are both highly prevalent in the general population and associated with obesity and insulin resistance. We aimed to evaluate the prevalence of GD in a cross sectional study of NAFLD patients and to define whether the presence of GD is associated with diabetes and predicts more severe liver disease. Methodology/Principal Findings We merged databases of four Liver Units, comprising 524 consecutive biopsy-proven NAFLD (373 males) observed between January 2003 and June 2010. GD was diagnosed in 108 (20%), and 313 cases (60%) were classified by liver biopsy as nonalcoholic steatohepatitis (NASH). The GD subgroup was characterized by a significantly higher prevalence of females, prediabetes/diabetes, abdominal obesity and metabolic syndrome, older age, higher BMI, fasting glucose, HOMA-IR and lower ALT. The prevalence of GD progressively increased with advancing fibrosis and with the severity of necroinflammatory activity (p for trend = 0.0001 and = 0.01, respectively), without differences in the severity of steatosis. At multivariate analysis GD was associated with female gender (OR 1.37, 95% CI 1.04–1.8), age (OR 1.027, 95% CI1.003–1.05), fasting glucose (OR 1.21, 95% CI 1.10–1.33) and NASH (OR 1.40,95% CI 1.06–1.89), whereas ALT levels were associated with a lower GD risk (OR 0.98, 95% CI 0.97–0.99). When subjects with cirrhosis were excluded from analysis, the association between GD and fasting glucose, female gender, and NASH was maintained. Conclusion Patients with NAFLD have a high prevalence of GD, which characterizes subjects with altered glucose regulation and more advanced liver disease.
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Affiliation(s)
- Anna Ludovica Fracanzani
- Department of Internal Medicine, Centro Studi Malattie Metaboliche del Fegato, University of Milano, Maggiore Policlinico Hospital, IRCCS Ca’ Granda Foundation, Milano, Italy
| | - Luca Valenti
- Department of Internal Medicine, Centro Studi Malattie Metaboliche del Fegato, University of Milano, Maggiore Policlinico Hospital, IRCCS Ca’ Granda Foundation, Milano, Italy
| | | | - Luca Miele
- Department of Internal Medicine, Cattolica University, Roma, Italy
| | - Cristina Bertelli
- Department of Internal Medicine, Centro Studi Malattie Metaboliche del Fegato, University of Milano, Maggiore Policlinico Hospital, IRCCS Ca’ Granda Foundation, Milano, Italy
| | | | - Chiara Masetti
- Department of Internal Medicine, Centro Studi Malattie Metaboliche del Fegato, University of Milano, Maggiore Policlinico Hospital, IRCCS Ca’ Granda Foundation, Milano, Italy
| | - Consuelo Cefalo
- Department of Internal Medicine, Cattolica University, Roma, Italy
| | - Antonio Grieco
- Department of Internal Medicine, Cattolica University, Roma, Italy
| | - Giulio Marchesini
- Department of Internal Medicine, Alma Mater Studiorum University, Bologna, Italy
| | - Silvia Fargion
- Department of Internal Medicine, Centro Studi Malattie Metaboliche del Fegato, University of Milano, Maggiore Policlinico Hospital, IRCCS Ca’ Granda Foundation, Milano, Italy
- * E-mail:
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25
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Donati D, Masetti C, Brandolini F, Di Liddo M, Mercuri M. Evaluation of homoplastic bone graft in hip replacement revision surgery. Chir Organi Mov 1998; 83:337-47. [PMID: 10369013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
A total of 17 patients submitted to hip replacement revision surgery in our clinic between 1986 and 1994 were evaluated in order to analyze the effectiveness of homoplastic support grafting. Loss of substance involved the acetabulum and the femur. Four parameters were evaluated radiographically: fusion time, restructuring time, flattening or collapse of grafts, and, finally, graft resorption. The results showed that the homoplastic graft is characterized by excellent biological behavior, and that the success of the new implant depends mostly on surgical method used as the graft was always integrated quickly and completely. In cases with considerable loss of substance it is important to use means of support that allow for partial unloading of the forces between prosthesis and host bone, thus avoiding excessive loading in the grafts.
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Affiliation(s)
- D Donati
- 1a Clinica Ortopedica, Istituto Ortopedico Rizzoli, Bologna
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26
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Donati D, Capanna R, Casadei R, Ercolani C, Aluigi P, Masetti C, Mercuri M. Arthrodesis of the knee after tumor resection: a comparison between autografts and allografts. Chir Organi Mov 1995; 80:29-37. [PMID: 7641538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Cases of arthrodesis of the knee performed after bone tumor resection using autografts (Group I) and allografts (Group II) were compared (follow-up was comparable). The two groups show differences in type of pathology, treatment and length of resection. Nonetheless, the percentage of complications and the final results were similar. Despite the fact that arthrodesis of the knee is used less and less for reconstruction, it is our belief that the use of autografts should be substituted by allografts whenever possible.
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Affiliation(s)
- D Donati
- 1a Clinica Ortopedica, Università, Bologna
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27
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Capanna R, Donati D, Masetti C, Manfrini M, Panozzo A, Cadossi R, Campanacci M. Effect of electromagnetic fields on patients undergoing massive bone graft following bone tumor resection. A double blind study. Clin Orthop Relat Res 1994:213-21. [PMID: 8070199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Massive bone allograft after tumor resection has been used for over 20 years. Many factors negatively influence the healing of the junction between the allograft and the host bone, resulting in a low healing rate and lengthy time to union. This study evaluated whether pulsing electromagnetic field stimulation could be advantageously used in these patients. A double blind prospective randomized study was designed. Eighty three host graft junctions in 47 patients were considered. The overall host graft junction healing rate was the same (67%) in both control and active stimulated patients. Although not statistically significant, a positive effect of pulsing electromagnetic fields was observed for those host graft junctions with a cortico-cortical contact between allograft and host bone. When adjuvant postoperative chemotherapy was not employed, a definite effect of pulsing electromagnetic field stimulation was observed: the healing time decreased from 9.4 months in the control group to 6.7 months in the active stimulated group (p < 0.001). This effect would have been lost if chemotherapy was employed. There was also no advantage in supplement with iliac crest autografts at the host graft junction site if chemotherapy was used. Factors that significantly influenced the host graft junction healing rate were: chemotherapy; type of allograft host bone contact; quality of host graft junction; and, in intercalary allografts, use of the osteosynthesis device. No difference was observed between control and active groups for patient survival or number of local or distal tumor recurrences.
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Affiliation(s)
- R Capanna
- Istituto Ortopedico Rizzoli, Clinica Ortopedica I, Università di Bologna, Italy
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28
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Donati D, Capanna R, Campanacci D, Del Ben M, Ercolani C, Masetti C, Taminiau A, Exner GU, Dubousset JF, Paitout D. The use of massive bone allografts for intercalary reconstruction and arthrodeses after tumor resection. A multicentric European study. Chir Organi Mov 1993; 78:81-94. [PMID: 8344079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A multicentric study was conducted by the European Musculoskeletal Oncology Society on 113 cases of resection for tumors of the major long bones and reconstruction with massive allografts, as intercalary diaphyseal or for arthrodesis. The follow-up was at least 12 months. There was a 14% incidence of infection, with a higher frequency (18.5%) in intercalary grafts as compared to arthrodeses (7%). Fracture of the graft occurred in 15.5% of the cases with a prevalence in the humerus (28.5%) as compared to the tibia (21.4%) and femur (14.7%). Fracture constantly occurred after osteosynthesis with screws, in 16% of the cases after osteosynthesis with a plate, and in 12.5% of the cases after osteosynthesis with an intramedullary nail. It was observed in 32% of the grafts preserved at -30 degrees, in 17% of those irradiated, and in 7% and 7.6% of those preserved at -180 degrees and -80 degrees, respectively. Delayed union and non-union was observed in 57% of the cases: 63% in intercalary grafts, 48% in arthrodeses. Final results after treatment of complications were excellent and good in 63% of the entire series. The results should, however, be evaluated after 3 years, as during this period of time important transformation phenomena of the graft occur. Complications are observed in 75% of the cases, but they may be reduced if planning is correct and surgery is accurate. Each complication may be dealt with and resolved without high risks for preservation of the limb.
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29
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Arlecchini S, Busanelli L, Masetti C. Neurogenic arthropathy. Differential diagnosis. Chir Organi Mov 1992; 77:317-20. [PMID: 1297565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Neurological affections responsible for secondary arthropathic pathology are: tabes, syringomyelia, diabetes mellitus, congenital insensitivity to pain syndrome, alcoholism, leprosy. Each of the affections shows predilection for specific joints: syringomyelia the shoulder, tabes the hip and knee, diabetes mellitus the foot, congenital insensitivity to pain the lower limb, alcoholism the shoulder and knee. The authors discuss two cases of hip arthropathy in previous dorsal myelic fractures.
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Affiliation(s)
- S Arlecchini
- Servizio di Neurofisiopatologia, Istituto Ortopedico Rizzoli, Bologna
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30
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Masetti C, Mencuccini M. Régénération naturelle de Pin pignon (Pinus pinea L.) dans la Pineta Granducale di Alberese. (Parco Naturale della Maremma, Toscana, Italie). ACTA ACUST UNITED AC 1991. [DOI: 10.3406/ecmed.1991.1693] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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