1
|
Serra-Burriel M, Juanola A, Serra-Burriel F, Thiele M, Graupera I, Pose E, Pera G, Grgurevic I, Caballeria L, Piano S, van Kleef L, Reichert M, Roulot D, Pericàs JM, Schattenberg JM, Tsochatztis EA, Guha IN, Garcia-Retortillo M, Hernández R, Hoyo J, Fuentes M, Expósito C, Martínez A, Such P, Madir A, Detlefsen S, Tonon M, Martini A, Ma AT, Pich J, Bonfill E, Juan M, Soria A, Carol M, Gratacós-Ginès J, Morillas RM, Toran P, Navarrete JM, Torrejón A, Fournier C, Llorca A, Arslanow A, de Koning HJ, Cucchietti F, Manns M, Newsome PN, Hernáez R, Allen A, Angeli P, de Knegt RJ, Karlsen TH, Galle P, Wong VWS, Fabrellas N, Castera L, Krag A, Lammert F, Kamath PS, Ginès P. Development, validation, and prognostic evaluation of a risk score for long-term liver-related outcomes in the general population: a multicohort study. Lancet 2023; 402:988-996. [PMID: 37572680 DOI: 10.1016/s0140-6736(23)01174-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/04/2023] [Accepted: 06/05/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Liver cirrhosis is a major cause of death worldwide. Cirrhosis develops after a long asymptomatic period of fibrosis progression, with the diagnosis frequently occurring late, when major complications or cancer develop. Few reliable tools exist for timely identification of individuals at risk of cirrhosis to allow for early intervention. We aimed to develop a novel score to identify individuals at risk for future liver-related outcomes. METHODS We derived the LiverRisk score from an international prospective cohort of individuals from six countries without known liver disease from the general population, who underwent liver fibrosis assessment by transient elastography. The score included age, sex, and six standard laboratory variables. We created four groups: minimal risk, low risk, medium risk, and high risk according to selected cutoff values of the LiverRisk score (6, 10, and 15). The model's discriminatory accuracy and calibration were externally validated in two prospective cohorts from the general population. Moreover, we ascertained the prognostic value of the score in the prediction of liver-related outcomes in participants without known liver disease with median follow-up of 12 years (UK Biobank cohort). FINDINGS We included 14 726 participants: 6357 (43·2%) in the derivation cohort, 4370 (29·7%) in the first external validation cohort, and 3999 (27·2%) in the second external validation cohort. The score accurately predicted liver stiffness in the development and external validation cohorts, and was superior to conventional serum biomarkers of fibrosis, as measured by area under the receiver-operating characteristics curve (AUC; 0·83 [95% CI [0·78-0·89]) versus the fibrosis-4 index (FIB-4; 0·68 [0·61-0·75] at 10 kPa). The score was effective in identifying individuals at risk of liver-related mortality, liver-related hospitalisation, and liver cancer, thereby allowing stratification to different risk groups for liver-related outcomes. The hazard ratio for liver-related mortality in the high-risk group was 471 (95% CI 347-641) compared with the minimal risk group, and the overall AUC of the score in predicting 10-year liver-related mortality was 0·90 (0·88-0·91) versus 0.84 (0·82-0·86) for FIB-4. INTERPRETATION The LiverRisk score, based on simple parameters, predicted liver fibrosis and future development of liver-related outcomes in the general population. The score might allow for stratification of individuals according to liver risk and thus guide preventive care. FUNDING European Commission under the H20/20 programme; Fondo de Investigación Sanitaria de Salud; Instituto de Salud Carlos III; Spanish Ministry of Economy, Industry, and Competitiveness; the European Regional Development Fund; and the German Ministry of Education and Research (BMBF).
Collapse
Affiliation(s)
- Miquel Serra-Burriel
- Epidemiology, Statistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Adrià Juanola
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | | | - Maja Thiele
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Isabel Graupera
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Elisa Pose
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Guillem Pera
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Llorenç Caballeria
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de la Salut, Barcelona, Spain
| | - Salvatore Piano
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Laurens van Kleef
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Mathias Reichert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Dominique Roulot
- Unité d'Hépatologie, Hôpital Avicenne, AP-HP, Université Paris 13, Bobigny, France
| | - Juan M Pericàs
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jörn M Schattenberg
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Emmanuel A Tsochatztis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College of London, London, UK
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | | | - Rosario Hernández
- Institut Catala de la Salut, BCN, Ambit d'Atencio Primaria, Barcelona, Spain
| | - Jordi Hoyo
- Institut Catala de la Salut, BCN, Ambit d'Atencio Primaria, Barcelona, Spain
| | - Matilde Fuentes
- Institut Catala de la Salut, BCN, Ambit d'Atencio Primaria, Barcelona, Spain
| | - Carmen Expósito
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Alba Martínez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, Spain
| | - Patricia Such
- Health, Safety and Emergencies of SEAT, CUPRA and the Volkswagen Group Companies in Spain, Martorell, Spain
| | - Anita Madir
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Marta Tonon
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Martini
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Ann T Ma
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Judith Pich
- Clinical Trial Unit, Hospital Clínic, Barcelona, Spain
| | - Eva Bonfill
- Clinical Trial Unit, Hospital Clínic, Barcelona, Spain
| | - Marta Juan
- Clinical Trial Unit, Hospital Clínic, Barcelona, Spain
| | - Anna Soria
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Marta Carol
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Jordi Gratacós-Ginès
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Rosa M Morillas
- Liver Unit, Hospital Germans Trias i Pujol, IGTP, Badalona, Spain
| | - Pere Toran
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Mataró, Barcelona, Spain
| | - J M Navarrete
- Health, Safety and Emergencies of SEAT, CUPRA and the Volkswagen Group Companies in Spain, Martorell, Spain
| | - Antoni Torrejón
- Health, Safety and Emergencies of SEAT, CUPRA and the Volkswagen Group Companies in Spain, Martorell, Spain
| | | | | | - Anita Arslanow
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | | | - Michael Manns
- Health Sciences, Hannover Medical School MHH, Hannover, Germany
| | - Phillip N Newsome
- National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Rubén Hernáez
- Division of Gastroenterology and Hepatology, Department of Medicine, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Division of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alina Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, Netherlands
| | - Tom H Karlsen
- Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Oslo University Hospital, Oslo, Norway; Research Institute of Internal Medicine, Oslo University Hospital, Oslo, Norway
| | - Peter Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Núria Fabrellas
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain
| | - Laurent Castera
- Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, Université de Paris, Paris, France
| | - Aleksander Krag
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany; Institute for Occupational Medicine and Public Health, Saarland University, Homburg, Germany; Hannover Medical School, Hannover, Germany
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Pere Ginès
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Catalonia, Spain; Institut D'Investigacions Biomèdiques August Pi I Sunyer, Barcelona, Catalonia, Spain; Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain.
| |
Collapse
|
2
|
Levy C, Manns M, Hirschfield G. New Treatment Paradigms in Primary Biliary Cholangitis. Clin Gastroenterol Hepatol 2023; 21:2076-2087. [PMID: 36809835 DOI: 10.1016/j.cgh.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/28/2023] [Accepted: 02/03/2023] [Indexed: 02/24/2023]
Abstract
Primary biliary cholangitis (PBC) is an archetypal autoimmune disease. Chronic lymphocytic cholangitis is associated with interface hepatitis, ductopenia, cholestasis, and progressive biliary fibrosis. People living with PBC are frequently symptomatic, experiencing a quality-of-life burden dominated by fatigue, itch, abdominal pain, and sicca complex. Although the female predominance, specific serum autoantibodies, immune-mediated cellular injury, as well as genetic (HLA and non-HLA) risk factors, identify PBC as autoimmune, to date treatment has focused on cholestatic consequences. Biliary epithelial homeostasis is abnormal and contributes to disease. The impact of cholangiocyte senescence, apoptosis, and impaired bicarbonate secretion enhances chronic inflammation and bile acid retention. First-line therapy is a non-specific anti-cholestatic agent, ursodeoxycholic acid. For those with residual cholestasis biochemically, obeticholic acid is introduced, and this semisynthetic farnesoid X receptor agonist adds choleretic, anti-fibrotic, and anti-inflammatory activity. Future PBC licensed therapy will likely include peroxisome proliferator activated receptor (PPAR) pathway agonists, including specific PPAR-delta agonism (seladelpar), as well as elafibrinor and saroglitazar (both with broader PPAR agonism). These agents dovetail the clinical and trial experience for off-label bezafibrate and fenofibrate use. Symptom management is essential, and encouragingly, PPAR agonists reduce itch; IBAT inhibition (eg, linerixibat) also appears promising for pruritus. For those where liver fibrosis is the target, NOX inhibition is being evaluated. Earlier stage therapies in development include therapy to impact immunoregulation in patients, as well other approaches to treating pruritus (eg, antagonists of MrgprX4). Collectively the PBC therapeutic landscape is exciting. Therapy goals are increasingly proactive and individualized and aspire to rapidly achieve normal serum tests and quality of life with prevention of end-stage liver disease.
Collapse
Affiliation(s)
- Cynthia Levy
- Division of Digestive Health and Liver Diseases, University of Miami School of Medicine, Miami, Florida.
| | | | - Gideon Hirschfield
- Toronto Centre for Liver Disease, Division of Gastroenterology and Hepatology, University of Toronto, Toronto, Canada
| |
Collapse
|
3
|
Graupera I, Thiele M, Ma AT, Serra-Burriel M, Pich J, Fabrellas N, Caballeria L, de Knegt RJ, Grgurevic I, Reichert M, Roulot D, Schattenberg JM, Pericas JM, Angeli P, Tsochatzis EA, Guha IN, Garcia-Retortillo M, Morillas RM, Hernández R, Hoyo J, Fuentes M, Madir A, Juanola A, Soria A, Juan M, Carol M, Diaz A, Detlefsen S, Toran P, Pera G, Fournier C, Llorca A, Newsome PN, Manns M, de Koning HJ, Serra-Burriel F, Cucchietti F, Arslanow A, Korenjak M, van Kleef L, Falcó JL, Kamath PS, Karlsen TH, Castera L, Lammert F, Krag A, Ginès P. Correction: LiverScreen project: study protocol for screening for liver fibrosis in the general population in European countries. BMC Public Health 2023; 23:923. [PMID: 37217864 DOI: 10.1186/s12889-023-15867-6] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Affiliation(s)
- Isabel Graupera
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Maja Thiele
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Ann T Ma
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miquel Serra-Burriel
- Epidemiology, Statistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Judit Pich
- Clinical Trial Unit, Hospital Clínic, 08036, Barcelona, Spain
| | - Núria Fabrellas
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Llorenç Caballeria
- Unitat de Suport a La Recerca Metropolitana Nord, Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de La Salut, Barcelona, Spain
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Mathias Reichert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Dominique Roulot
- Unité d'Hépatologie, Hôpital Avicenne, AP-HP, Université Paris 13, Bobigny, France
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg, Mainz, Germany
| | - Juan M Pericas
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University-Teaching Hospital of Padova, Padua, Italy
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College of London (UCL), London, UK
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research University Mainz Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | | | - Rosa M Morillas
- Liver Unit, Hospital Germans Trias I Pujol, IGTP, Badalona, Spain
| | - Rosario Hernández
- Institut Catala de La Salut (ICS), BCN. Ambit d'Atencio Primaria, Barcelona, Spain
| | - Jordi Hoyo
- Institut Catala de La Salut (ICS), BCN. Ambit d'Atencio Primaria, Barcelona, Spain
| | - Matilde Fuentes
- Institut Catala de La Salut (ICS), BCN. Ambit d'Atencio Primaria, Barcelona, Spain
| | - Anita Madir
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Adrià Juanola
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Anna Soria
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Marta Juan
- Clinical Trial Unit, Hospital Clínic, 08036, Barcelona, Spain
| | - Marta Carol
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Alba Diaz
- Department of Pathology, Centre of Biomedical Diagnosis, Hospital Cínic, Barcelona, Spain
| | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital (OUH), University of Southern Denmark, Odense, Denmark
| | - Pere Toran
- Unitat de Suport a La Recerca Metropolitana Nord, Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de La Salut, Barcelona, Spain
| | - Guillem Pera
- Unitat de Suport a La Recerca Metropolitana Nord, Fundació Institut Universitari Per a La Recerca a L'Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de La Salut, Barcelona, Spain
| | | | | | - Phillip N Newsome
- National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Michael Manns
- Health Sciences, Hannover Medical School MHH, Hannover, Germany
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Anita Arslanow
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg, Mainz, Germany
| | | | - Laurens van Kleef
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | | | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | | | - Laurent Castera
- Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, Université de Paris, Paris, France
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
- Institute for Occupational Medicine and Public Health, Saarland University, Homburg, Germany
- Hannover Medical School (MHH), Hannover, Germany
| | - Aleksander Krag
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Pere Ginès
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
- Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain.
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
4
|
Graupera I, Thiele M, Ma AT, Serra-Burriel M, Pich J, Fabrellas N, Caballeria L, de Knegt RJ, Grgurevic I, Reichert M, Roulot D, Schattenberg JM, Pericas JM, Angeli P, Tsochatzis EA, Guha IN, Garcia-Retortillo M, Morillas RM, Hernández R, Hoyo J, Fuentes M, Madir A, Juanola A, Soria A, Juan M, Carol M, Diaz A, Detlefsen S, Toran P, Fournier C, Llorca A, Newsome PN, Manns M, de Koning HJ, Serra-Burriel F, Cucchietti F, Arslanow A, Korenjak M, van Kleef L, Falcó JL, Kamath PS, Karlsen TH, Castera L, Lammert F, Krag A, Ginès P. LiverScreen project: study protocol for screening for liver fibrosis in the general population in European countries. BMC Public Health 2022; 22:1385. [PMID: 35854275 PMCID: PMC9295430 DOI: 10.1186/s12889-022-13724-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 07/01/2022] [Indexed: 02/08/2023] Open
Abstract
Background The development of liver cirrhosis is usually an asymptomatic process until late stages when complications occur. The potential reversibility of the disease is dependent on early diagnosis of liver fibrosis and timely targeted treatment. Recently, the use of non-invasive tools has been suggested for screening of liver fibrosis, especially in subjects with risk factors for chronic liver disease. Nevertheless, large population-based studies with cost-effectiveness analyses are still lacking to support the widespread use of such tools. The aim of this study is to investigate whether non-invasive liver stiffness measurement in the general population is useful to identify subjects with asymptomatic, advanced chronic liver disease. Methods This study aims to include 30,000 subjects from eight European countries. Subjects from the general population aged ≥ 40 years without known liver disease will be invited to participate in the study either through phone calls/letters or through their primary care center. In the first study visit, subjects will undergo bloodwork as well as hepatic fat quantification and liver stiffness measurement (LSM) by vibration-controlled transient elastography. If LSM is ≥ 8 kPa and/or if ALT levels are ≥1.5 x upper limit of normal, subjects will be referred to hospital for further evaluation and consideration of liver biopsy. The primary outcome is the percentage of subjects with LSM ≥ 8kPa. In addition, a health economic evaluation will be performed to assess the cost-effectiveness and budget impact of such an intervention. The project is funded by the European Commission H2020 program. Discussion This study comes at an especially important time, as the burden of chronic liver diseases is expected to increase in the coming years. There is consequently an urgent need to change our current approach, from diagnosing the disease late when the impact of interventions may be limited to diagnosing the disease earlier, when the patient is asymptomatic and free of complications, and the disease potentially reversible. Ultimately, the LiverScreen study will serve as a basis from which diagnostic pathways can be developed and adapted to the specific socio-economic and healthcare conditions in each country. Trial registration This study is registered on Clinicaltrials.gov (NCT03789825). Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13724-6.
Collapse
Affiliation(s)
- Isabel Graupera
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Maja Thiele
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Ann T Ma
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miquel Serra-Burriel
- Epidemiology, Statistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Judit Pich
- Clinical Trial Unit, Hospital Clínic, 08036, Barcelona, Spain
| | - Núria Fabrellas
- Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Llorenç Caballeria
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de la Salut, Barcelona, Spain
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Mathias Reichert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Dominique Roulot
- Unité d'Hépatologie, Hôpital Avicenne, AP-HP, Université Paris 13, Bobigny, France
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg, Mainz, Germany
| | - Juan M Pericas
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca (VHIR) , Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Paolo Angeli
- Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University-Teaching Hospital of Padova, Padua, Italy
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College of London (UCL), London, UK
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research University Mainz Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | | | - Rosa M Morillas
- Liver Unit, Hospital Germans Trias i Pujol, IGTP, Badalona, Spain
| | - Rosario Hernández
- Institut Catala de la Salut (ICS). BCN. Ambit d'Atencio Primaria, Barcelona, Spain
| | - Jordi Hoyo
- Institut Catala de la Salut (ICS). BCN. Ambit d'Atencio Primaria, Barcelona, Spain
| | - Matilde Fuentes
- Institut Catala de la Salut (ICS). BCN. Ambit d'Atencio Primaria, Barcelona, Spain
| | - Anita Madir
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Adrià Juanola
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Anna Soria
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Marta Juan
- Clinical Trial Unit, Hospital Clínic, 08036, Barcelona, Spain
| | - Marta Carol
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Alba Diaz
- Department of Pathology. Centre of Biomedical Diagnosis. Hospital Cínic, Barcelona, Spain
| | - Sönke Detlefsen
- Department of Pathology, Odense University Hospital (OUH), University of Southern Denmark, Odense, Denmark
| | - Pere Toran
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Metropolitana Nord, IDIAP Jordi Gol, ICS Institut Català de la Salut, Barcelona, Spain
| | | | | | - Phillip N Newsome
- National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Michael Manns
- Health Sciences, Hannover Medical School MHH, Hannover, Germany
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | - Anita Arslanow
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain.,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Centre of the Johannes Gutenberg, Mainz, Germany
| | | | - Laurens van Kleef
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | | | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | | | - Laurent Castera
- Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, Université de Paris, Paris, France
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.,Institute for Occupational Medicine and Public Health, Saarland University, Homburg, Germany.,Hannover Medical School (MHH), Hannover, Germany
| | - Aleksander Krag
- Centre for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital, and Institute for Clinical Research, University of Southern Denmark Odense, Odense, Denmark
| | - Pere Ginès
- Liver Unit Hospital Clínic, University of Barcelona, Barcelona, Catalonia, Spain. .,Institut D'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. .,Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas (Ciberehd), Barcelona, Spain. .,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
| | | |
Collapse
|
5
|
Tergast TL, Blach S, Tacke F, Berg T, Cornberg M, Kautz A, Manns M, Razavi H, Sarrazin C, Serfert Y, van Thiel I, Zeuzem S, Wedemeyer H. Updated epidemiology of hepatitis C virus infections and implications for hepatitis C virus elimination in Germany. J Viral Hepat 2022; 29:536-542. [PMID: 35357770 DOI: 10.1111/jvh.13680] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 10/01/2021] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 12/09/2022]
Abstract
In 2014, an analysis was conducted to evaluate the hepatitis C virus (HCV) epidemiology and disease burden in Germany. Since then, there have been considerable developments in HCV management such as the implementation of direct acting antivirals. The aim of this analysis was to assess the recent data available for Germany, establish an updated 2020 HCV prevalence and cascade of care and evaluate the impact of what-if scenarios on the future burden of disease using modelling analysis. A dynamic Markov model was used to forecast the HCV disease burden in Germany. Model inputs were retrieved through literature review, unpublished sources and expert input. Next, three "what-if" scenarios were developed to evaluate the status quo, COVID-19 pandemic, and steps needed to achieve the WHO targets for elimination. At the beginning of 2020, there were 189,000 (95% UI: 76,700-295,000) viremic infections in Germany, a decline of more than 85,000 viremic infections since 2012. Annual treatment starts went down since 2015. Compared with 2019, the COVID-19 pandemic resulted in a further 11% decline in 2020. If this continues for two years, it could result in 110 excess HCC cases and 200 excess liver related deaths by 2030. To achieve the WHO targets, 81,200 people need to be diagnosed, with 118,600 initiated on treatment by 2030. This could also avert 1,020 deaths and 720 HCC cases between 2021 and 2030. Germany has made strides towards HCV elimination, but more efforts are needed to achieve the WHO targets by 2030.
Collapse
Affiliation(s)
- Tammo L Tergast
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | | | - Frank Tacke
- Department of Hepatology & Gastroenterology, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum and Campus Charité Mitte, Berlin, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Leberstiftungs-GmbH Deutschland, Hannover, Germany
| | | | - Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Leberstiftungs-GmbH Deutschland, Hannover, Germany
| | | | - Christoph Sarrazin
- Department of Internal Medicine and Liver Center, St. Josefs-Hospital Wiesbaden, Wiesbaden, Germany.,Viral Hepatitis Research Group, Goethe-University Hospital Frankfurt, Frankfurt, Germany
| | | | | | - Stefan Zeuzem
- Department of Medicine, University Hospital, Frankfurt, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.,Leberstiftungs-GmbH Deutschland, Hannover, Germany
| |
Collapse
|
6
|
Younossi ZM, Racila A, Muir A, Bourliere M, Mangia A, Esteban R, Zeuzem S, Colombo M, Manns M, Papatheodoridis GV, Buti M, Chokkalingam A, Gaggar A, Nader F, Younossi I, Henry L, Stepanova M. Long-term Patient-Centered Outcomes in Cirrhotic Patients With Chronic Hepatitis C After Achieving Sustained Virologic Response. Clin Gastroenterol Hepatol 2022; 20:438-446. [PMID: 33493697 DOI: 10.1016/j.cgh.2021.01.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 10/21/2020] [Revised: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND & AIMS Achieving sustained virologic response (SVR) among patients with hepatitis C virus (HCV) leads to patient reported outcome (PRO) improvement. We aimed to assess the long-term post-SVR PRO trends in HCV patients with cirrhosis. METHODS Patients with HCV and cirrhosis treated in clinical trials with direct acting antiviral agents (DAAs) who achieved SVR-12 were prospectively enrolled in a long-term registry (clinicaltrials.gov #NCT02292706). PROs were collected every 24 weeks using the Short Form-36v2 (SF-36), CLDQ-HCV, and WPAI-HCV. RESULTS Pre-treatment baseline data were available for 854 cirrhotic patients who achieved SVR after DAAs. Of these, 730 had compensated (CC) and 124 had decompensated cirrhosis (DCC) before treatment- patients with DCC reported severe impairment in their PROs in comparison to CC patients (by mean -5% to -16% of a PRO range size; p < .05 for 16 out of 20 studied PROs]. After achieving SVR and registry enrollment, significant PRO improvements were noted from pre-treatment levels in 11/20 domains for those with DCC (+4% to +21%) and 19/20 PRO domains in patients with CC (+3% to +17%). Patients with baseline DCC had higher rates of hepatocellular carcinoma and mortality (P < .05). In patients with CC, the PRO gains persisted up to 168 weeks (3.5 years) of registry follow-up. In patients with DCC, the improvements lasted for at least 96 weeks but a declining trend after year 2. CONCLUSIONS Patients with HCV cirrhosis experience severe PRO impairment at baseline with sustainable improvement after SVR. Though those with DCC experience improvement, there is a decline after 2 years.
Collapse
Affiliation(s)
- Zobair M Younossi
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia; Inova Medicine, Inova Health System, Falls Church, Virginia; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, Virginia.
| | - Andrei Racila
- Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia; Inova Medicine, Inova Health System, Falls Church, Virginia
| | - Andrew Muir
- Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Marc Bourliere
- Department of Hepato- Gastroenterology, Hospital Saint Joseph, Marseille, France
| | - Alessandra Mangia
- IRCCS Casa Sollievo della Sofferenza Hospital, Liver Unit, Medical Sciences, San Giovanni Rotondo, Italy
| | - Rafael Esteban
- Liver Unit, Hospital Universitari Vall d'Hebron and Ciberehd del Instituto Carlos III, Barcelona, Spain
| | - Stefan Zeuzem
- Department of Medicine I at the Goethe University Hospital, Frankfurt, Germany
| | - Massimo Colombo
- Liver Center for Translational Research, IRCCS Humanitas, Milan, Italy
| | | | | | - Maria Buti
- Liver Unit, Hospital Universitari Vall d'Hebron and Ciberehd del Instituto Carlos III, Barcelona, Spain
| | | | | | - Fatema Nader
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia
| | - Issah Younossi
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia
| | - Linda Henry
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia
| | - Maria Stepanova
- Center for Outcomes Research in Liver Disease, Washington, District of Columbia
| |
Collapse
|
7
|
Ginès P, Castera L, Lammert F, Graupera I, Serra-Burriel M, Allen AM, Wong VWS, Hartmann P, Thiele M, Caballeria L, de Knegt RJ, Grgurevic I, Augustin S, Tsochatzis EA, Schattenberg JM, Guha IN, Martini A, Morillas RM, Garcia-Retortillo M, de Koning HJ, Fabrellas N, Pich J, Ma AT, Diaz MA, Roulot D, Newsome PN, Manns M, Kamath PS, Krag A. Population screening for liver fibrosis: Toward early diagnosis and intervention for chronic liver diseases. Hepatology 2022; 75:219-228. [PMID: 34537988 DOI: 10.1002/hep.32163] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/22/2021] [Accepted: 08/23/2021] [Indexed: 02/06/2023]
Abstract
Cirrhosis, highly prevalent worldwide, develops after years of hepatic inflammation triggering progressive fibrosis. Currently, the main etiologies of cirrhosis are non-alcoholic fatty liver disease and alcohol-related liver disease, although chronic hepatitis B and C infections are still major etiological factors in some areas of the world. Recent studies have shown that liver fibrosis can be assessed with relatively high accuracy noninvasively by serological tests, transient elastography, and radiological methods. These modalities may be utilized for screening for liver fibrosis in at-risk populations. Thus far, a limited number of population-based studies using noninvasive tests in different areas of the world indicate that a significant percentage of subjects without known liver disease (around 5% in general populations and a higher rate -18% to 27%-in populations with risk factors for liver disease) have significant undetected liver fibrosis or established cirrhosis. Larger international studies are required to show the harms and benefits before concluding that screening for liver fibrosis should be applied to populations at risk for chronic liver diseases. Screening for liver fibrosis has the potential for changing the current approach from diagnosing chronic liver diseases late when patients have already developed complications of cirrhosis to diagnosing liver fibrosis in asymptomatic subjects providing the opportunity of preventing disease progression.
Collapse
Affiliation(s)
- Pere Ginès
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain.,August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain.,Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain.,Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Laurent Castera
- Department of Hepatology, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France.,Université de Paris, Paris, France.,Inserm UMR 1149, Centre de Recherche Sur L'inflammation, Paris, France
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany.,Institute for Occupational Medicine and Public Health, Saarland University, Homburg, Germany.,Health Sciences, Hannover Medical School, Hannover, Germany
| | - Isabel Graupera
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain.,August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain.,Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain.,Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miquel Serra-Burriel
- Epidemiology, Statistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Alina M Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Phillipp Hartmann
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Maja Thiele
- Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital and Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Llorenç Caballeria
- USR Metropolitana Nord, IDIAP Jordi Gol, Catalan Health Institute, Mataró, Spain
| | - Robert J de Knegt
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
| | - Salvador Augustin
- Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain.,Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d´Hebron, Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Emmanuel A Tsochatzis
- UCL Institute for Liver and Digestive Health, Royal Free Hospital, University College of London, London, UK
| | - Jörn M Schattenberg
- Metabolic Liver Research Program, Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Indra Neil Guha
- NIHR Nottingham Biomedical Research Center, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Andrea Martini
- Unit of Internal Medicine and Hepatology, Department of Medicine, University-Teaching Hospital of Padova, Veneto, Italy
| | - Rosa M Morillas
- Centro de Investigación En Red de Enfermedades Hepáticas Y Digestivas, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Liver Unit, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Núria Fabrellas
- August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain.,School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Judit Pich
- Clinical Trial Unit, Hospital Clínic, Barcelona, Spain
| | - Ann T Ma
- Liver Unit, Hospital Clínic of Barcelona, Barcelona, Spain.,August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain.,Department of Medicine, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - M Alba Diaz
- Department of Pathology, Center of Biomedical Diagnosis. Hospital Cínic, Barcelona, Spain
| | - Dominique Roulot
- Unité d'Hépatologie, Hôpital Avicenne, Université Paris, Bobigny, France
| | - Philip N Newsome
- European Association for the Study of the Liver, Geneva, Switzerland.,National Institute for Health Research Biomedical Research Center at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - Michael Manns
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Aleksander Krag
- Center for Liver Research, Department of Gastroenterology and Hepatology, Odense University Hospital and Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
| | | |
Collapse
|
8
|
Engelmann C, Herber A, Franke A, Bruns T, Reuken P, Schiefke I, Zipprich A, Zeuzem S, Goeser T, Canbay A, Berg C, Trebicka J, Uschner FE, Chang J, Mueller T, Aehling N, Schmelzle M, Splith K, Lammert F, Lange CM, Sarrazin C, Trautwein C, Manns M, Häussinger D, Pfeiffenberger J, Galle PR, Schmiedeknecht A, Berg T. Granulocyte-colony stimulating factor (G-CSF) to treat acute-on-chronic liver failure: A multicenter randomized trial (GRAFT study). J Hepatol 2021; 75:1346-1354. [PMID: 34364917 DOI: 10.1016/j.jhep.2021.07.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/08/2021] [Accepted: 07/20/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Based on positive results from small single center studies, granulocyte-colony stimulating factor (G-CSF) is being widely used for the treatment of patients with acute-on-chronic liver failure (ACLF). Herein, we aimed to evaluate the safety and efficacy of G-CSF in patients with ACLF. METHODS In this multicenter, prospective, controlled, open-label phase II study, 176 patients with ACLF (EASL-CLIF criteria) were randomized to receive G-CSF (5 μg/kg daily for the first 5 days and every third day thereafter until day 26) plus standard medical therapy (SMT) (n = 88) or SMT alone. The primary efficacy endpoint was 90-day transplant-free survival analyzed by Cox regression modeling. The key secondary endpoints were overall and transplant-free survival after 360 days, the development of ACLF-related complications, and the course of liver function scores during the entire observation period. RESULTS Patients treated with G-CSF had a 90-day transplant-free survival rate of 34.1% compared to 37.5% in the SMT group (hazard ratio [HR] 1.05; 95% CI 0.711-1.551; p = 0.805). Transplant-free and overall survival at 360 days did not differ between the 2 arms (HR 0.998; 95% CI 0.697-1.430; p = 0.992 and HR 1.058; 95% CI 0.727-1.548; p = 0.768, respectively). G-CSF did not improve liver function scores, the occurrence of infections, or survival in subgroups of patients without infections, with alcohol-related ACLF, or with ACLF defined by the APASL criteria. Sixty-one serious adverse events were reported in the G-CSF+SMT group and 57 were reported in the SMT group. In total, 7 drug-related serious adverse reactions occurred in the G-CSF group. The study was prematurely terminated due to futility after conditional power calculation. CONCLUSIONS In contrast to previous findings, G-CSF had no significant beneficial effect on patients with ACLF in this multicenter controlled trial, which suggests that it should not be used as a standard treatment for ACLF. CLINICALTRIALS. GOV NUMBER NCT02669680 LAY SUMMARY: Granulocyte-colony stimulating factor was considered as a novel treatment for acute-on-chronic liver failure (ACLF). We performed the first randomized, multicenter, controlled phase II trial, which showed that G-CSF did not improve survival or other clinical endpoints in patients with ACLF. Therefore, G-CSF should not be used to treat liver disease outside clinical studies.
Collapse
Affiliation(s)
- Cornelius Engelmann
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany; Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Adam Herber
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Annegret Franke
- Clinical Trial Centre (ZKS) Leipzig, Faculty of Medicine, University Leipzig, Leipzig, Germany
| | - Tony Bruns
- Department of Medicine III, Aachen University Hospital, Aachen, Germany; Clinic for Internal Medicine IV, University Hospital Jena, Jena, Germany
| | - Philipp Reuken
- Clinic for Internal Medicine IV, University Hospital Jena, Jena, Germany
| | - Ingolf Schiefke
- Clinic for Gastroenterology, Hepatology and Endocrinology, St. Georg Hospital, Leipzig, Germany
| | - Alexander Zipprich
- University Hospital for Internal Medicine 1, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany
| | - Tobias Goeser
- Clinic for Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - Ali Canbay
- Medical Department, University Hospital Ruhr-University Bochum, Bochum, Germany
| | - Christoph Berg
- Department of Internal Medicine I, University Hospital Tuebingen, Tuebingen, Germany
| | - Jonel Trebicka
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany; European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Frank E Uschner
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany; Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University of Bonn, Bonn, Germany
| | - Tobias Mueller
- Department of Hepatology and Gastroenterology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Niklas Aehling
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinik, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katrin Splith
- Department of Surgery, Campus Charité Mitte
- Campus Virchow-Klinik, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Christian M Lange
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany; Clinic for Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Christoph Sarrazin
- Department of Internal Medicine I, University Hospital Frankfurt, Frankfurt, Germany; Medical Clinic 2, St. Josefs Hospital Wiesbaden, Wiesbaden, Germany
| | | | - Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Dieter Häussinger
- Clinic and Policlinic of Gastroenterology, Hepatology and Infectious Disease, Heinrich Heine University Duesseldorf, Düsseldorf, Germany
| | - Jan Pfeiffenberger
- Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter R Galle
- Department of Internal Medicine, University Medical Center Mainz, Mainz, Germany
| | - Anett Schmiedeknecht
- Clinical Trial Centre (ZKS) Leipzig, Faculty of Medicine, University Leipzig, Leipzig, Germany
| | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University Medical Center, Leipzig, Germany.
| |
Collapse
|
9
|
Vesikari T, Finn A, van Damme P, Leroux-Roels I, Leroux-Roels G, Segall N, Toma A, Vallieres G, Aronson R, Reich D, Arora S, Ruane PJ, Cone CL, Manns M, Cosgrove C, Faust SN, Ramasamy MN, Machluf N, Spaans JN, Yassin-Rajkumar B, Anderson D, Popovic V, Diaz-Mitoma F. Immunogenicity and Safety of a 3-Antigen Hepatitis B Vaccine vs a Single-Antigen Hepatitis B Vaccine: A Phase 3 Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2128652. [PMID: 34636914 PMCID: PMC8511978 DOI: 10.1001/jamanetworkopen.2021.28652] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE There is a need for improved immunogenicity of hepatitis B virus (HBV) vaccines among young adults with risk of infection. OBJECTIVES To demonstrate manufacturing equivalence of a 3-antigen (3A) HBV vaccine, evaluate noninferiority of seroprotection rate (SPR) of 3A-HBV vs single-antigen (1A) HBV after 2 and 3 vaccine doses, and compare safety and reactogenicity between 3A-HBV and 1A-HBV vaccines. DESIGN, SETTING, AND PARTICIPANTS This phase 3, double-blinded, randomized clinical trial included healthy adults aged 18 to 45 years randomized to 1 of three 3A-HBV groups or 1 control group receiving 1A-HBV. The trial was conducted at 37 community clinics and academic hospitals in Canada, Europe, the United Kingdom, and the United States between December 2017 and October 2019. Participants were followed up for 48 weeks after the first vaccination. INTERVENTIONS Intramuscular administration of 3A-HBV (10 μg) or 1A-HBV (20 μg) on days 0, 28, and 168. MAIN OUTCOMES AND MEASURES Geometric mean concentration (GMC) of serum hepatitis B surface antibodies (anti-HBs) and proportion of participants achieving seroprotection. RESULTS Of 2838 participants, 1638 (57.8%) were women, 2595 (91.5%) were White, and 161 (5.7%) were Black or African American. A total of 712 participants (25.1%) were randomized to the 1A-HBV group and 2126 (74.9%) to 3A-HBV. The mean (SD) age at informed consent was 33.5 (8.0) years. The study demonstrated 3A-HBV lot-to-lot consistency, as the 2-sided 95% CIs for each pairwise comparison for the anti-HBs GMC ratios were within 0.67 and 1.50 (eg, adjusted GMC ratio, lot A vs lot B: 0.82; 95% CI, 0.67-1.00; lot A vs lot C: 0.95; 95% CI, 0.78-1.15; lot B vs lot C: 1.16; 95% CI, 0.95-1.41). The SPR of the pooled 3A-HBV was noninferior to 1A-HBV and higher than 1A-HBV after 2 vaccinations at day 168 (90.4% [95% CI, 89.0%-91.8%] vs 51.6% [95% CI, 47.5%-55.6%]) and 3 vaccinations at day 196 (99.3% [95% CI, 98.7%-99.6%] vs 94.8% [95% CI, 92.7%-96.4%]). The mean GMC of anti-HBs with 3A-HBV was 7.9 times higher after 2 vaccinations at day 168 and 3.5 times higher after 3 vaccinations at day 196 compared with 1A-HBV (after 2 vaccinations, 3A-HBV: GMC, 118.7 mIU/mL; 95% CI, 108.0-129.0 mIU/mL; SE, 1.0 mIU/mL; 1A-HBV: GMC, 15.0 mIU/mL; 95% CI, 12.9-17.5 mIU/mL; SE, 1.0 mIU/mL; after 3 vaccinations, 3A-HBV: GMC, 5442.4 mIU/mL; 95% CI, 4967.0-5963.0 mIU/mL; SE, 1.0 mIU/mL; 1A-HBV: 1567.2 mIU/mL; 95% CI, 1338.0-1834.0 mIU/mL; SE, 1.0 mIU/mL). Rates of local and systemic reactogenicities were higher with 3A-HBV compared with 1A-HBV (local: 1805 of 2124 [85.0%] vs 469 of 712 [65.9%]; systemic: 1445 [68.0%] vs 428 [60.1%]). Vaccine discontinuation due to adverse events (AE) was uncommon, and serious AEs were infrequent, reported in 42 participants (2.0%) and 3 participants (0.4%) in the 3A-HBV and 1A-HBV groups, respectively. CONCLUSIONS AND RELEVANCE In this study, consistently higher antibody concentrations and SPRs were found with 3A-HBV after 2 and 3 doses vs 1A-HBV in adults aged 18 to 45 years old. The safety and efficacy of 3A-HBV shows its usefulness for the prevention of hepatitis B in young healthy adults. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT03408730; EU Clinical Trials Number: 2017-001820-22.
Collapse
Affiliation(s)
| | - Adam Finn
- Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Pierre van Damme
- University of Antwerp–Center for the Evaluation of Vaccination, Universiteitsplein, Wilrijk, Belgium
| | | | | | | | - Azhar Toma
- Manna Research, Toronto, Ontario, Canada
| | | | - Ronnie Aronson
- LMC Diabetes and Endocrinology, Toronto, Ontario, Canada
| | | | | | - Peter J. Ruane
- Ruane Clinical Research Group Inc, Los Angeles, California
| | | | - Michael Manns
- Medizinishe Hochschule, Hannover, Lower Saxony, Germany
| | - Catherine Cosgrove
- St George’s University Hospital NHS Foundation Trust, London, United Kingdom
| | - Saul N. Faust
- NIHR Southampton Clinical Research Facility, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Maheshi N. Ramasamy
- Oxford Vaccine Group, Centre for Clinical Vaccinology and Tropical Medicine, Churchill Hospital and University of Oxford, Oxford, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
10
|
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.
Collapse
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
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
11
|
Trebicka J, Fernandez J, Papp M, Caraceni P, Laleman W, Gambino C, Giovo I, Uschner FE, Jansen C, Jimenez C, Mookerjee R, Gustot T, Albillos A, Bañares R, Jarcuska P, Steib C, Reiberger T, Acevedo J, Gatti P, Shawcross DL, Zeuzem S, Zipprich A, Piano S, Berg T, Bruns T, Danielsen KV, Coenraad M, Merli M, Stauber R, Zoller H, Ramos JP, Solé C, Soriano G, de Gottardi A, Gronbaek H, Saliba F, Trautwein C, Kani HT, Francque S, Ryder S, Nahon P, Romero-Gomez M, Van Vlierberghe H, Francoz C, Manns M, Garcia-Lopez E, Tufoni M, Amoros A, Pavesi M, Sanchez C, Praktiknjo M, Curto A, Pitarch C, Putignano A, Moreno E, Bernal W, Aguilar F, Clària J, Ponzo P, Vitalis Z, Zaccherini G, Balogh B, Gerbes A, Vargas V, Alessandria C, Bernardi M, Ginès P, Moreau R, Angeli P, Jalan R, Arroyo V, Semela D, Elkrief L, Elsharkawy A, Tornai T, Tornai I, Altorjay I, Antognoli A, Baldassarre M, Gagliardi M, Bertoli E, Mareso S, Brocca A, Campion D, Saracco GM, Rizzo M, Lehmann J, Pohlmann A, Brol MJ, Chang J, Schierwagen R, Solà E, Amari N, Rodriguez M, Nevens F, Clemente A, Janicko M, Markwardt D, Mandorfer M, Welsch C, Welzel TM, Ciraci E, Patel V, Ripoll C, Herber A, Horn P, Bendtsen F, Gluud LL, Schaapman J, Riggio O, Rainer F, Moritz JT, Mesquita M, Alvarado-Tapias E, Akpata O, Aamann L, Samuel D, Tresson S, Strnad P, Amathieu R, Simón-Talero M, Smits F, van den Ende N, Martinez J, Garcia R, Rupprechter H, Engelmann C, Özdogan OC. PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis. J Hepatol 2021; 74:1097-1108. [PMID: 33227350 DOI: 10.1016/j.jhep.2020.11.019] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [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: 07/14/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (AD-No ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and characterize the precipitants leading to both of these AD phenotypes. METHODS The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients with AD (No ACLF = 1,071; ACLF = 202). Medical history, clinical data and laboratory data were collected at enrolment and during 90-day follow-up, with particular attention given to the following characteristics of precipitants: induction of organ dysfunction or failure, systemic inflammation, chronology, intensity, and relationship to outcome. RESULTS Among various clinical events, 4 distinct events were precipitants consistently related to AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal bleeding with shock and toxic encephalopathy. Among patients with precipitants in the AD-No ACLF cohort and the AD-ACLF cohort (38% and 71%, respectively), almost all (96% and 97%, respectively) showed proven bacterial infection and severe alcoholic hepatitis, either alone or in combination with other events. Survival was similar in patients with proven bacterial infections or severe alcoholic hepatitis in both AD phenotypes. The number of precipitants was associated with significantly increased 90-day mortality and was paralleled by increasing levels of surrogates for systemic inflammation. Importantly, adequate first-line antibiotic treatment of proven bacterial infections was associated with a lower ACLF development rate and lower 90-day mortality. CONCLUSIONS This study identified precipitants that are significantly associated with a distinct clinical course and prognosis in patients with AD. Specific preventive and therapeutic strategies targeting these events may improve outcomes in patients with decompensated cirrhosis. LAY SUMMARY Acute decompensation (AD) of cirrhosis is characterized by a rapid deterioration in patient health. Herein, we aimed to analyze the precipitating events that cause AD in patients with cirrhosis. Proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) cases of AD and acute-on-chronic liver failure. Whilst the type of precipitant was not associated with mortality, the number of precipitant(s) was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventive and therapeutic strategies targeting these events may improve patient outcomes.
Collapse
Affiliation(s)
- Jonel Trebicka
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany.
| | - Javier Fernandez
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Maria Papp
- University of Debrecen, Faculty of Medicine, Institute of Medicine, Department of Gastroenterology, Debrecen, Hungary
| | | | - Wim Laleman
- Department of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic disorders, University of Leuven, Leuven, Belgium
| | | | - Ilaria Giovo
- A.O.U. Città della Salute e della Scienza Torino, Torino, Italy
| | - Frank Erhard Uschner
- Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Cesar Jimenez
- Liver Unit, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain
| | | | | | - Agustin Albillos
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, IRYCIS, University of Alcalá, CIBEREHD, Madrid, Spain
| | - Rafael Bañares
- Hospital General Universitario Gregorio Marañón. Facultad de Medicina (Universidad Complutense of Madrid), CIBERehd, Madrid, Spain
| | - Peter Jarcuska
- Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Christian Steib
- Department of Medicine II, Liver Centre Munich, University Hospital, LMU, Munich, Germany
| | | | - Juan Acevedo
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Pietro Gatti
- Internal Medicine PO Ostuni, ASL Brindisi, Italy
| | | | - Stefan Zeuzem
- Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany
| | | | | | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University, Medical Center, Leipzig, Germany
| | - Tony Bruns
- Jena University Hospital, Jena, Germany; Aachen University Hospital, Aachen, Germany
| | - Karen Vagner Danielsen
- Gastrounit, Medical Section, Hvidovre Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Heinz Zoller
- Medical University of Innsbruck, Innsbruck, Austria
| | | | - Cristina Solé
- Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Germán Soriano
- Hospital de la Santa Creu i Sant Pau and CIBERehd, Barcelona, Spain
| | - Andrea de Gottardi
- University Clinic of Visceral Surgery and Medicine-Inselspital, Bern and Ente Ospedaliero Cantonale, Universita della Svizzera Italiana, Lugano, Switzerland
| | | | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Universite Paris Saclay, INSERM Unit 1193, Villejuif, France
| | | | | | | | - Stephen Ryder
- NIHR Biomedical Research Centre at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", Saint-Denis, France; Inserm, UMR-1162, "Génomique fonctionnelle des tumeurs solides", Paris, France
| | | | | | - Claire Francoz
- APHP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France; Inserm, Université de Paris, Centre de Recherche sur L´Inflammation, Paris, France
| | | | | | | | - Alex Amoros
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Marco Pavesi
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Cristina Sanchez
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Anna Curto
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Carla Pitarch
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | | | - Esau Moreno
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | | | - Ferran Aguilar
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Joan Clària
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Paola Ponzo
- A.O.U. Città della Salute e della Scienza Torino, Torino, Italy
| | - Zsuzsanna Vitalis
- University of Debrecen, Faculty of Medicine, Institute of Medicine, Department of Gastroenterology, Debrecen, Hungary
| | | | - Boglarka Balogh
- University of Debrecen, Faculty of Medicine, Institute of Medicine, Department of Gastroenterology, Debrecen, Hungary
| | - Alexander Gerbes
- Department of Medicine II, Liver Centre Munich, University Hospital, LMU, Munich, Germany
| | - Victor Vargas
- Liver Unit, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain
| | | | | | - Pere Ginès
- Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Richard Moreau
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; APHP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France; Inserm, Université de Paris, Centre de Recherche sur L´Inflammation, Paris, France
| | - Paolo Angeli
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; University of Padova, Padova, Italy
| | - Rajiv Jalan
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; UCL Medical School,Royal Free Hospital, London, UK
| | - Vicente Arroyo
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Dietz J, Spengler U, Müllhaupt B, Schulze Zur Wiesch J, Piecha F, Mauss S, Seegers B, Hinrichsen H, Antoni C, Wietzke-Braun P, Peiffer KH, Berger A, Matschenz K, Buggisch P, Backhus J, Zizer E, Boettler T, Neumann-Haefelin C, Semela D, Stauber R, Berg T, Berg C, Zeuzem S, Vermehren J, Sarrazin C, Giostra E, Berning M, Hampe J, De Gottardi A, Rauch A, Semmo N, Discher T, Trauth J, Fischer J, Gress M, Günther R, Heinzow H, Schmidt J, Herrmann A, Stallmach A, Hilgard G, Deterding K, Lange C, Ciesek S, Wedemeyer H, Hoffmann D, Klinker H, Schulze P, Kocheise F, Müller-Schilling M, Kodal A, Kremer A, Ganslmayer M, Siebler J, Lammert F, Rissland J, Löbermann M, Götze T, Canbay A, Lohse A, von Felden J, Jordan S, Maieron A, Moradpour D, Chave JP, Moreno C, Müller T, Muche M, Epple HJ, Port K, von Hahn T, Cornberg M, Manns M, Reinhardt L, Ellenrieder V, Rockstroh J, Schattenberg J, Sprinzl M, Galle P, Roeb E, Steckstor M, Schmiegel W, Brockmeyer N, Seufferlein T, Stremmel W, Strey B, Thimme R, Teufel A, Vogelmann R, Ebert M, Tomasiewicz K, Trautwein C, Tacke F, Koenen T, Weber T, Zachoval R, Mayerle J, Raziorrouh B, Angeli W, Beckebaum S, Doberauer C, Durmashkina E, Hackelsberger A, Erhardt A, Garrido-Lüneburg A, Gattringer H, Genné D, Gschwantler M, Gundling F, Hametner S, Schöfl R, Hartmann C, Heyer T, Hirschi C, Jussios A, Kanzler S, Kordecki N, Kraus M, Kullig U, Wollschläger S, Magenta L, Beretta-Piccoli BT, Menges M, Mohr L, Muehlenberg K, Niederau C, Paulweber B, Petrides A, Pinkernell M, Piso R, Rambach W, Reiser M, Riecken B, Rieke A, Roth J, Schelling M, Schlee P, Schneider A, Scholz D, Schott E, Schuchmann M, Schulten-Baumer U, Seelhoff A, Stich A, Stickel F, Ungemach J, Walter E, Weber A, Winzer T, Abels W, Adler M, Audebert F, Baermann C, Bästlein E, Barth R, Barthel K, Becker W, Behrends J, Benninger J, Berger F, Berzow D, Beyer T, Bierbaum M, Blaukat O, Bodtländer A, Böhm G, Börner N, Bohr U, Bokemeyer B, Bruch H, Bucholz D, Burkhard O, Busch N, Chirca C, Delker R, Diedrich J, Frank M, Diehl M, Dienethal A, Dietel P, Dikopoulos N, Dreck M, Dreher F, Drude L, Ende K, Ehrle U, Baumgartl K, Emke F, Glosemeyer R, Felten G, Hüppe D, Fischer J, Fischer U, Frederking D, Frick B, Friese G, Gantke B, Geyer P, Schwind H, Glas M, Glaunsinger T, Goebel F, Göbel U, Görlitz B, Graf R, Gruber H, Härter G, Herder M, Heuchel T, Heuer S, Höffl KH, Hörster H, Sonne JU, Hofmann W, Holst F, Hunstiger M, Hurst A, Jägel-Guedes E, John C, Jung M, Kallinowski B, Kapzan B, Kerzel W, Khaykin P, Klarhof M, Klüppelberg U, Klugewitz K, Knapp B, Knevels U, Kochsiek T, Körfer A, Köster A, Kuhn M, Langekamp A, Künzig B, Link R, Littman M, Löhr H, Lutz T, Knecht G, Lutz U, Mainz D, Mahle I, Maurer P, Mayer C, Meister V, Möller H, Heyne R, Moritzen D, Mroß M, Mundlos M, Naumann U, Nehls O, Ningel K, Oelmann A, Olejnik H, Gadow K, Pascher E, Petersen J, Philipp A, Pichler M, Polzien F, Raddant R, Riedel M, Rietzler S, Rössle M, Rufle W, Rump A, Schewe C, Hoffmann C, Schleehauf D, Schmidt K, Schmidt W, Schmidt-Heinevetter G, Schmidtler-von Fabris J, Schnaitmann E, Schneider L, Schober A, Niehaus-Hahn S, Schwenzer J, Seidel T, Seitel G, Sick C, Simon K, Stähler D, Stenschke F, Steffens H, Stein K, Steinmüller M, Sternfeld T, Strey B, Svensson K, Tacke W, Teuber G, Teubner K, Thieringer J, Tomesch A, Trappe U, Ullrich J, Urban G, Usadel S, von Lucadou A, Weinberger F, Werheid-Dobers M, Werner P, Winter T, Zehnter E, Zipf A. Efficacy of Retreatment After Failed Direct-acting Antiviral Therapy in Patients With HCV Genotype 1-3 Infections. Clin Gastroenterol Hepatol 2021; 19:195-198.e2. [PMID: 31706062 DOI: 10.1016/j.cgh.2019.10.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/19/2019] [Accepted: 10/25/2019] [Indexed: 02/07/2023]
Abstract
Hepatitis C virus infection is causing chronic liver disease, cirrhosis, and hepatocellular carcinoma. By combining direct-acting antivirals (DAAs), high sustained virologic response rates (SVRs) can be achieved. Resistance-associated substitutions (RASs) are commonly observed after DAA failure, and especially nonstructural protein 5A (NS5A) RASs may impact retreatment options.1-3 Data on retreatment of DAA failure patients using first-generation DAAs are limited.4-7 Recently, a second-generation protease- and NS5A-inhibitor plus sofosbuvir (voxilaprevir/velpatasvir/sofosbuvir [VOX/VEL/SOF]) was approved for retreatment after DAA failure.8 However, this and other second-generation regimens are not available in many resource-limited countries or are not reimbursed by regular insurance, and recommendations regarding the selection of retreatment regimens using first-generation DAAs are very important. This study aimed to analyze patients who were re-treated with first-generation DAAs after failure of a DAA combination therapy.
Collapse
Affiliation(s)
- Julia Dietz
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Ulrich Spengler
- Department of Internal Medicine I, University of Bonn, Bonn, and German Center for Infection Research (DZIF), Partner Site, Cologne-Bonn, Germany
| | - Beat Müllhaupt
- Swiss Hepato-Pancreato-Biliary Center and Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Julian Schulze Zur Wiesch
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, and German Center for Infection Research (DZIF), Partner Site, Hamburg-Lübeck-Borstel-Riems, Germany
| | - Felix Piecha
- I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, and German Center for Infection Research (DZIF), Partner Site, Hamburg-Lübeck-Borstel-Riems, Germany
| | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Düsseldorf, Germany
| | - Barbara Seegers
- Gastroenterologisch-Hepatologisches Zentrum Kiel, Kiel, Germany
| | | | - Christoph Antoni
- Department of Internal Medicine II, University Hospital Mannheim, Mannheim, Germany
| | | | - Kai-Henrik Peiffer
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Annemarie Berger
- Institute for Medical Virology, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Peter Buggisch
- Institute for Interdisciplinary Medicine IFI, Hamburg, Germany
| | - Johanna Backhus
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Eugen Zizer
- Department of Internal Medicine I, Ulm University, Ulm, Germany
| | - Tobias Boettler
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christoph Neumann-Haefelin
- Department of Medicine II, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David Semela
- Division of Gastroenterology and Hepatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Rudolf Stauber
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Berg
- Department of Gastroenterology and Rheumatology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Berg
- Department of Internal Medicine I, University of Tübingen, Tübingen, Germany
| | - Stefan Zeuzem
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Johannes Vermehren
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany
| | - Christoph Sarrazin
- Department of Internal Medicine 1, University Hospital Frankfurt, Goethe University, Frankfurt, and German Center for Infection Research (DZIF), External Partner Site, Frankfurt, Germany; Medizinische Klinik 2, St Josefs-Hospital, Wiesbaden, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Yuen M, Schiefke I, Yoon J, Ahn SH, Heo J, Kim JH, Lik Yuen Chan H, Yoon KT, Klinker H, Manns M, Petersen J, Schluep T, Hamilton J, Given BD, Ferrari C, Lai C, Locarnini SA, Gish RG. RNA Interference Therapy With ARC-520 Results in Prolonged Hepatitis B Surface Antigen Response in Patients With Chronic Hepatitis B Infection. Hepatology 2020; 72:19-31. [PMID: 31654573 PMCID: PMC7496196 DOI: 10.1002/hep.31008] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS ARC-520, the first an RNA interference (RNAi) therapeutic, was designed to reduce all RNA transcripts derived from covalently closed circular DNA, leading to a reduction in viral antigens and hepatitis B virus (HBV) DNA. APPROACH AND RESULTS We aimed to evaluate the depth of hepatitis B surface antigen (HBsAg) decline in response to multiple doses of ARC-520 compared to placebo (PBO) in two randomized, multicenter studies in nucleoside/nucleotide analogue reverse-transcriptase inhibitor (NUC)-experienced patients with hepatitis B early antigen (HBeAg)-negative (E-neg) or HBeAg-positive (E-pos) disease. A total of 58 E-neg and 32 E-pos patients were enrolled and received four monthly doses of PBO (n = 20 E-neg, 11 E-pos), 1 mg/kg ARC-520 (n = 17 E-neg, 10 E-pos), or 2 mg/kg ARC-520 (n = 21 E-neg, 11 E-pos) concomitantly with NUC. HBsAg change from baseline to 30 days after the last ARC-520 dose were compared to PBO. Both E-neg and E-pos high-dose groups significantly reduced HBsAg compared to PBO, with mean reductions of 0.38 and 0.54 log IU/mL, respectively. HBsAg reductions persisted for approximately 85 days and >85 days after the last dose in E-neg and E-pos patients, respectively. The low-dose groups did not reach statistical significance in either study. E-pos patients showed a dose-dependent reduction in HBeAg from baseline. Mean maximum reduction was 0.23 and 0.69 log Paul Ehrlich IUs/mL in the low-dose and high dose ARC-520 groups respectively. ARC-520 was well tolerated, with only two serious adverse events of pyrexia possibly related to study drug observed. CONCLUSIONS ARC-520 was active in both E-neg and E-pos, NUC-experienced HBV patients; but absolute HBsAg reductions were moderate, possibly due to expression of HBsAg from integrated HBV DNA, indicating the need for RNAi therapeutics that can target viral transcripts regardless of origin.
Collapse
Affiliation(s)
- Man‐Fung Yuen
- Queen Mary HospitalThe University of Hong KongHong KongChina
| | | | - Jung‐Hwan Yoon
- Seoul National University HospitalSeoulRepublic of Korea
| | - Sang Hoon Ahn
- Yonsei University College of MedicineSeoulRepublic of Korea
| | - Jeong Heo
- Pusan National University and Medical Research InstituteBusanRepublic of Korea
| | - Ju Hyun Kim
- Gachon University Gil HospitalIncheonRepublic of Korea
| | | | - Ki Tae Yoon
- Pusan National University Yangsan HospitalYangsan‐siRepublic of Korea
| | | | | | - Joerg Petersen
- IFI Institute at Asklepios Klinik St. GeorgHamburgGermany
| | | | | | | | - Carlo Ferrari
- Unit of Infectious Diseases and HepatologyUniversity of ParmaParmaItaly
| | - Ching‐Lung Lai
- Queen Mary HospitalThe University of Hong KongHong KongChina
| | | | - Robert G. Gish
- Division of Gastroenterology and HepatologyDepartment of MedicineStanford University Medical CenterStanfordCA
| |
Collapse
|
14
|
Sipido KR, Antoñanzas F, Celis J, Degos L, Frackowiak R, Fuster V, Ganten D, Gay S, Hofstraat H, Holgate ST, Krestin G, Manns M, Meunier F, Oertel W, Palkonen S, Pavalkis D, Rübsamen-Schaeff H, Smith U, Stallknecht BM, Zima T. Overcoming fragmentation of health research in Europe: lessons from COVID-19. Lancet 2020; 395:1970-1971. [PMID: 32559417 DOI: 10.1016/s0140-6736(20)31411-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/11/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Karin R Sipido
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium.
| | | | - Julio Celis
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Laurent Degos
- Department of Hematology, University of Paris Diderot, Paris, France
| | - Richard Frackowiak
- Faculté des sciences du vivant, Ecole Polytechnique Fédérale de Lausanne, Geneva, Switzerland
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain; Mount Sinai Medical Hospital, New York, NY, USA
| | - Detlev Ganten
- Max Planck Institute of Molecular Plant Physiology, Potsdam, Germany
| | - Steffen Gay
- Center of Experimental Rheumatology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Stephen T Holgate
- Faculty of Medicine, Clinical and Experimental Sciences, University of Southamptom, Southampton, UK
| | - Gabriel Krestin
- Department of Radiology, Erasmus Medical Centre, Rotterdam, Netherlands
| | | | | | - Wolfgang Oertel
- Department of Neurology, Philipps University Marburg, M-rburg, Germany
| | | | | | | | - Ulf Smith
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Göteborg University, Gothenberg, Sweden
| | | | - Tomáš Zima
- Charles University, Prague, Czech Republic
| |
Collapse
|
15
|
Dai Z, Song G, Balakrishnan A, Yang T, Yuan Q, Möbus S, Weiss AC, Bentler M, Zhu J, Jiang X, Shen X, Bantel H, Jaeckel E, Kispert A, Vogel A, Saborowski A, Büning H, Manns M, Cantz T, Ott M, Sharma AD. Growth differentiation factor 11 attenuates liver fibrosis via expansion of liver progenitor cells. Gut 2020; 69:1104-1115. [PMID: 31767630 PMCID: PMC7282557 DOI: 10.1136/gutjnl-2019-318812] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 03/29/2019] [Revised: 10/14/2019] [Accepted: 10/29/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Liver fibrosis and cirrhosis resulting from chronic liver injury represent a major healthcare burden worldwide. Growth differentiation factor (GDF) 11 has been recently investigated for its role in rejuvenation of ageing organs, but its role in chronic liver diseases has remained unknown. Here, we investigated the expression and function of GDF11 in liver fibrosis, a common feature of most chronic liver diseases. DESIGN We analysed the expression of GDF11 in patients with liver fibrosis, in a mouse model of liver fibrosis and in hepatic stellate cells (HSCs) as well as in other liver cell types. The functional relevance of GDF11 in toxin-induced and cholestasis-induced mouse models of liver fibrosis was examined by in vivo modulation of Gdf11 expression using adeno-associated virus (AAV) vectors. The effect of GDF11 on leucine-rich repeat-containing G-protein-coupled receptor 5 (LGR5)+ liver progenitor cells was studied in mouse and human liver organoid culture. Furthermore, in vivo depletion of LGR5+ cells was induced by injecting AAV vectors expressing diptheria toxin A under the transcriptional control of Lgr5 promoter. RESULTS We showed that the expression of GDF11 is upregulated in patients with liver fibrosis and in experimentally induced murine liver fibrosis models. Furthermore, we found that therapeutic application of GDF11 mounts a protective response against fibrosis by increasing the number of LGR5+ progenitor cells in the liver. CONCLUSION Collectively, our findings uncover a protective role of GDF11 during liver fibrosis and suggest a potential application of GDF11 for the treatment of chronic liver disease.
Collapse
Affiliation(s)
- Zhen Dai
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany,Research Group MicroRNA in Liver Regeneration, Cluster of Excellence REBIRTH, Hannover Medical School, Hannover, Germany
| | - Guangqi Song
- Research Group MicroRNA in Liver Regeneration, Cluster of Excellence REBIRTH, Hannover Medical School, Hannover, Germany,Department of Gastroenterology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Asha Balakrishnan
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany,Twincore Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Taihua Yang
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany,Research Group MicroRNA in Liver Regeneration, Cluster of Excellence REBIRTH, Hannover Medical School, Hannover, Germany
| | - Qinggong Yuan
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany,Twincore Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Selina Möbus
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany,Research Group MicroRNA in Liver Regeneration, Cluster of Excellence REBIRTH, Hannover Medical School, Hannover, Germany
| | - Anna-Carina Weiss
- Institute for Molecular Biology, Hannover Medical School, Hannover, Germany
| | - Martin Bentler
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - Jimin Zhu
- Department of Gastroenterology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Xuemei Jiang
- Department of Gastroenterology, Central South University Xiangya School of Medicine Affiliated Haikou Hospital, Haikou, China
| | - Xizhong Shen
- Department of Gastroenterology, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Heike Bantel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Elmar Jaeckel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Andreas Kispert
- Institute for Molecular Biology, Hannover Medical School, Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Anna Saborowski
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Hildegard Büning
- Institute of Experimental Hematology, Hannover Medical School, Hannover, Germany
| | - Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Tobias Cantz
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany,Translational Hepatology and Stem Cell Biology, Cluster of Excellence REBIRTH, Hannover Medical School, Hannover, Germany
| | - Michael Ott
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany .,Twincore Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Amar Deep Sharma
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany .,Research Group MicroRNA in Liver Regeneration, Cluster of Excellence REBIRTH, Hannover Medical School, Hannover, Germany
| |
Collapse
|
16
|
Marcellin P, Wong DK, Sievert W, Buggisch P, Petersen J, Flisiak R, Manns M, Kaita K, Krastev Z, Lee SS, Cathcart AL, Crans G, Op den Brouw M, Jump B, Gaggar A, Flaherty J, Buti M. Ten-year efficacy and safety of tenofovir disoproxil fumarate treatment for chronic hepatitis B virus infection. Liver Int 2019; 39:1868-1875. [PMID: 31136052 DOI: 10.1111/liv.14155] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [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: 02/21/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Tenofovir disoproxil fumarate (TDF) is a first-line treatment for chronic hepatitis B (CHB). We aimed to describe the efficacy and safety profiles of TDF treatment for up to 10 years in a well-described cohort of CHB patients. METHODS Hepatitis B e antigen (HBeAg)-negative and HBeAg-positive patients from two randomised, double-blind trials (ClinicalTrials.gov: NCT00117676 and NCT00116805) completed 48 weeks of randomised treatment with TDF or adefovir dipivoxil. A subset of these patients was then eligible to receive open-label TDF treatment for up to 10 years. At Year 10, patients were assessed for virological suppression, alanine aminotransferase (ALT) normalisation, serological response, safety and tolerability. RESULTS Of 641 randomised and treated patients, 585 (91%) entered the open-label extension phase with 203 (32%) patients completing Year 10 of the study. At Year 10, 118/118 (100%) of HBeAg-negative patients and 78/80 (98%) of HBeAg-positive patients with available data achieved hepatitis B virus (HBV) DNA < 69 IU/mL, while 88/106 (83%) and 60/77 (78%) patients achieved ALT normalisation, respectively. Of the 23 patients with HBeAg status available at Year 10, 12 (52%) and six (27%) experienced HBeAg loss and seroconversion, respectively. No resistance to TDF was documented up to Year 10. In the period between Year 8 and Year 10, the safety profile of TDF was similar to previous reports, with few patients experiencing renal- or bone-related adverse events. CONCLUSIONS Over 10 years, TDF had a favourable safety profile, was well tolerated, and resulted in continued maintenance of virological suppression with no documented resistance.
Collapse
Affiliation(s)
| | - David K Wong
- Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - William Sievert
- Gastroenterology and Hepatology Unit, Monash Health and Monash University, Melbourne, Australia
| | - Peter Buggisch
- Liver Unit, IFI-Institute for Interdisciplinary Medicine, Asklepios Klinik St Georg, Hamburg, Germany
| | - Jörg Petersen
- Liver Unit, IFI-Institute for Interdisciplinary Medicine, Asklepios Klinik St Georg, Hamburg, Germany
| | - Robert Flisiak
- Department of Infectious Diseases and Hepatology, Medical University Bialystok, Bialystok, Poland
| | - Michael Manns
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany.,Helmholtz Center for Infection Research (HZI), Hannover, Germany
| | - Kelly Kaita
- Viral Hepatitis Investigative Unit, University of Manitoba, Winnipeg, Canada
| | - Zahari Krastev
- Clinic of Gastroenterology, St Ivan Rilsky University Hospital, Medical University, Sofia, Bulgaria
| | - Samuel S Lee
- Liver Unit, University of Calgary, Calgary, Alberta, Canada
| | | | | | | | | | - Anuj Gaggar
- Gilead Sciences Inc, Foster City, California
| | | | - Maria Buti
- Liver Unit, Hospital Universitario Vall d'Hebron and CIBEREHD del Instituto Carlos III, Barcelona, Spain
| |
Collapse
|
17
|
Beer A, Holzmann H, Pischke S, Behrendt P, Wrba F, Schlue J, Drebber U, Neudert B, Halilbasic E, Kreipe H, Lohse A, Sterneck M, Wedemeyer H, Manns M, Dienes HP. Chronic Hepatitis E is associated with cholangitis. Liver Int 2019; 39:1876-1883. [PMID: 31102493 PMCID: PMC6790616 DOI: 10.1111/liv.14137] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 06/09/2017] [Revised: 12/21/2018] [Accepted: 02/06/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Sporadic hepatitis E is an emerging indigenous disease in Europe induced by genotype 3 of the virus. While the disease takes an acute self-limited course in immunocompetent individuals, under immunocompromised conditions chronic hepatitis E might develop. The histology of chronic hepatitis E has not been described in detail systematically. METHODS Liver biopsies from 19 immunosuppressed patients with chronic hepatitis E were collected: 17 were organ transplant recipients, one had a CD4-deficiency and one had received steroid therapy because of ulcerative colitis. Biopsies were processed with standard stains. Evaluation of histologic activity and fibrosis was performed according to Ishak. Additionally, immunohistochemistry with antibodies directed against open reading frame 2 and 3 of the virus was performed and liver biopsies were tested for hepatitis E virus RNA. RESULTS Biochemical data showed an increase in alanine transaminase, aspartate transaminase, gamma-glutamyl transferase and total bilirubin. Histopathology displayed typical features of chronic hepatitis with mild to moderate activity. The number of polymorphonuclear leucocytes was considerably increased and all patients had a florid cholangitis that presented as a destructive form in five of them. Hepatocytes and bile duct epithelia stained positive for hepatitis E virus by immunohistochemistry. CONCLUSIONS Chronic hepatitis E in immunocompromised individuals runs a similar course as hepatitis B and C and shows similar histopathology. However, the presence of destructive cholangitis in some cases accompanied by an increased number of polymorphonuclear leucocytes is markedly different. Immunohistochemically the virus is present in bile duct epithelia, seemingly the cause for cholangitis.
Collapse
Affiliation(s)
- Andrea Beer
- Department of PathologyMedical University of ViennaViennaAustria
| | | | | | - Patrick Behrendt
- Department of Gastroenterology, Hepatology and EndocrinologyMedical School of HanoverHanoverGermany
| | - Fritz Wrba
- Department of PathologyMedical University of ViennaViennaAustria
| | - Jerome Schlue
- Institute for PathologyMedical School of HanoverHanoverGermany
| | - Uta Drebber
- Institute of PathologyUniversity Hospital CologneCologneGermany
| | - Barbara Neudert
- Department of PathologyMedical University of ViennaViennaAustria
| | - Emina Halilbasic
- Department of GastroenterologyMedical University of ViennaViennaAustria
| | - Hans Kreipe
- Institute for PathologyMedical School of HanoverHanoverGermany
| | | | | | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and EndocrinologyMedical School of HanoverHanoverGermany
| | - Michael Manns
- Department of Gastroenterology, Hepatology and EndocrinologyMedical School of HanoverHanoverGermany
| | - Hans P. Dienes
- Department of PathologyMedical University of ViennaViennaAustria
| |
Collapse
|
18
|
Terziroli Beretta-Piccoli B, Mieli-Vergani G, Vergani D, Vierling JM, Adams D, Alpini G, Banales JM, Beuers U, Björnsson E, Bowlus C, Carbone M, Chazouillères O, Dalekos G, De Gottardi A, Harada K, Hirschfield G, Invernizzi P, Jones D, Krawitt E, Lanzavecchia A, Lian ZX, Ma X, Manns M, Mavilio D, Quigley EM, Sallusto F, Shimoda S, Strazzabosco M, Swain M, Tanaka A, Trauner M, Tsuneyama K, Zigmond E, Gershwin ME. The challenges of primary biliary cholangitis: What is new and what needs to be done. J Autoimmun 2019; 105:102328. [PMID: 31548157 DOI: 10.1016/j.jaut.2019.102328] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/18/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023]
Abstract
Primary Biliary Cholangitis (PBC) is an uncommon, chronic, cholangiopathy of autoimmune origin and unknown etiology characterized by positive anti-mitochondrial autoantibodies (AMA), female preponderance and progression to cirrhosis if left untreated. The diagnosis is based on AMA- or PBC-specific anti-nuclear antibody (ANA)-positivity in the presence of a cholestatic biochemical profile, histologic confirmation being mandatory only in seronegative cases. First-line treatment is ursodeoxycholic acid (UDCA), which is effective in preventing disease progression in about two thirds of the patients. The only approved second-line treatment is obeticholic acid. This article summarizes the most relevant conclusions of a meeting held in Lugano, Switzerland, from September 23rd-25th 2018, gathering basic and clinical scientists with various background from around the world to discuss the latest advances in PBC research. The meeting was dedicated to Ian Mackay, pioneer in the field of autoimmune liver diseases. The role of liver histology needs to be reconsidered: liver pathology consistent with PBC in AMA-positive individuals without biochemical cholestasis is increasingly reported, raising the question as to whether biochemical cholestasis is a reliable disease marker for both clinical practice and trials. The urgent need for new biomarkers, including more accurate markers of cholestasis, was also widely discussed during the meeting. Moreover, new insights in interactions of bile acids with biliary epithelia in PBC provide solid evidence of a role for impaired epithelial protection against potentially toxic hydrophobic bile acids, raising the fundamental question as to whether this bile acid-induced epithelial damage is the cause or the consequence of the autoimmune attack to the biliary epithelium. Strategies are needed to identify difficult-to-treat patients at an early disease stage, when new therapeutic approaches targeting immunologic pathways, in addition to bile acid-based therapies, may be effective. In conclusion, using interdisciplinary approaches, groundbreaking advances can be expected before long in respect to our understanding of the etiopathogenesis of PBC, with the ultimate aim of improving its treatment.
Collapse
Affiliation(s)
- Benedetta Terziroli Beretta-Piccoli
- Epatocentro Ticino, Lugano, Switzerland; Institute of Liver Studies, MowatLabs, King's College Hospital, London, UK; European Reference Network ERN RARE-LIVER.
| | - Giorgina Mieli-Vergani
- Paediatric Liver, GI and Nutrition Centre, MowatLabs, King's College Hospital, London, UK
| | - Diego Vergani
- Institute of Liver Studies, MowatLabs, King's College Hospital, London, UK
| | - John M Vierling
- Division of Abdominal Transplantation and Section of Gastroenterology and Hepatology, Departments of Medicine and Surgery, Baylor College of Medicine, Houston, TX, USA
| | - David Adams
- Birmingham NIHR Biomedical Research Centre, Institute of Immunology and Immunotherapy, College of Medical and Dental SciencesMedical School, University of Birmingham, Birmingham, UK
| | - Gianfranco Alpini
- Indiana Center for Liver Research, Richard L. Roudebush VA Medical Center and Indiana University, Indianapolis, IN, USA
| | - Jesus M Banales
- Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute, Donostia University Hospital, University of the Basque Country (UPV/EHU), CIBERehd, Ikerbasque, San Sebastián, Spain
| | - Ulrich Beuers
- European Reference Network ERN RARE-LIVER; Department of Gastroenterology & Hepatology and Tytgat Institute for Liver and Intestinal Research, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Einar Björnsson
- Division of Gastroenterology and Hepatology, Landspitali the National University Hospital of Iceland, Reykjavík, Iceland
| | - Christopher Bowlus
- Division of Gastroenterology and Hepatology, University of California at Davis School of Medicine, Davis, CA, USA
| | - Marco Carbone
- Division Gastroenterology and Center for Autoimmune Liver Diseases, University of Milan-Bicocca School of Medicine, Monza, Italy
| | - Olivier Chazouillères
- European Reference Network ERN RARE-LIVER; Service d'Hépatologie, Hôpital Saint-Antoine, Paris, France
| | - George Dalekos
- Institute of Internal Medicine and Hepatology, Department of Medicine and Research, Laboratory of Internal Medicine, School of Medicine, University of Thessaly, Larissa, Greece
| | - Andrea De Gottardi
- European Reference Network ERN RARE-LIVER; Epatocentro Ticino & Division of Gastroenterology and Hepatology Ente Ospedaliero Cantonale and Università della Svizzera Italiana, Lugano, Switzerland
| | - Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Gideon Hirschfield
- Toronto Centre for Liver Disease, University Health Network and University of Toronto, Toronto, Canada
| | - Pietro Invernizzi
- European Reference Network ERN RARE-LIVER; Division Gastroenterology and Center for Autoimmune Liver Diseases, University of Milan-Bicocca School of Medicine, Monza, Italy
| | - David Jones
- Institute of Cellular Medicine and NIHR Newcastle Biomedical Research Centre, Newcastle University, Newcastle upon Tyne, UK
| | - Edward Krawitt
- Department of Medicine, University of Vermont, Burlington, VT, USA
| | | | - Zhe-Xiong Lian
- Institutes for Life Sciences, South China University of Technology, Higher Education Mega Center, Guangzhou, China
| | - Xiong Ma
- Shanghai Institute of Digestive Disease, Renji Hospital, Jiao Tong University School of Medicine, Shanghai, China
| | - Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School (MHH), Hannover, Germany
| | - Domenico Mavilio
- Unit of Clinical and Experimental Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; Department of Medical Biotechnologies and Translational Medicine (BioMeTra), University of Milan, Italy
| | - Eamon Mm Quigley
- Lynda K. and David M. Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA
| | - Federica Sallusto
- Institute for Research in Biomedicine (IRB), Bellinzona, Switzerland
| | - Shinji Shimoda
- Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Mario Strazzabosco
- Liver Center, Department of Medicine, Yale University, New Haven, CT, USA
| | - Mark Swain
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Atsushi Tanaka
- Department of Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Michael Trauner
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Koichi Tsuneyama
- Department of Pathology and Laboratory Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Ehud Zigmond
- Research Center for Digestive Tract and Liver Diseases, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, Davis, California, USA.
| |
Collapse
|
19
|
Yurdaydin C, Abbas Z, Buti M, Cornberg M, Esteban R, Etzion O, Gane EJ, Gish RG, Glenn JS, Hamid S, Heller T, Koh C, Lampertico P, Lurie Y, Manns M, Parana R, Rizzetto M, Urban S, Wedemeyer H. Treating chronic hepatitis delta: The need for surrogate markers of treatment efficacy. J Hepatol 2019; 70:1008-1015. [PMID: 30982526 DOI: 10.1016/j.jhep.2018.12.022] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022]
Abstract
Chronic hepatitis delta represents the most severe form of chronic viral hepatitis. The current treatment of hepatitis delta virus (HDV) infection consists of the use of interferons and is largely unsatisfactory. Several new compounds are currently in development for the treatment of HDV infection. However, surrogate markers that can be used to develop clinical endpoints in HDV infection are not well defined. In the current manuscript, we aimed to evaluate the existing data on treatment of HDV infection and to suggest treatment goals (possible "trial endpoints") that could be used across different clinical trials.
Collapse
Affiliation(s)
- Cihan Yurdaydin
- Department of Gastroenterology, Ankara University, Ankara, and Department of Internal Medicine, Koc University, Istanbul, Turkey.
| | - Zaigham Abbas
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Maria Buti
- Liver Unit, Hospital Universitario Vall d'Hebron and Ciber-ehd, Instituto Carlos III, Barcelona, Spain
| | - Markus Cornberg
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Rafael Esteban
- Liver Unit, Hospital Universitario Vall d'Hebron and Ciber-ehd, Instituto Carlos III, Barcelona, Spain
| | - Ohad Etzion
- Institute of Gastroenterology and Liver Diseases Soroka University Medical Center Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel
| | | | - Robert G Gish
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Jeffrey S Glenn
- Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Saeed Hamid
- Aga Khan University Hospital, Department of Medicine, Karachi, Pakistan
| | - Theo Heller
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Christopher Koh
- Liver Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Pietro Lampertico
- CRC "A. M. e A. Migliavacca", Division of Gastroenterology and Hepatology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Yoav Lurie
- Central Virology Laboratory, Ministry of Health, Chaim Sheba Medical Center, Tel - Hashomer, 52621 Ramat Gan, Israel
| | - Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Raymundo Parana
- Hepatology Centre of the University Hospital Professor Edgar Santos, Federal University of Bahia, Salvador, Brazil
| | - Mario Rizzetto
- Department of Gastroenterology, University of Turin, Turin, Italy
| | - Stephan Urban
- Department of Infectious Diseases, Molecular Virology, University Hospital Heidelberg, Heidelberg, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology and Hepatology, Essen University Hospital, University of Duisburg-Essen, Essen, Germany
| | | |
Collapse
|
20
|
Muir AJ, Levy C, Janssen HLA, Montano-Loza AJ, Shiffman ML, Caldwell S, Luketic V, Ding D, Jia C, McColgan BJ, McHutchison JG, Mani Subramanian G, Myers RP, Manns M, Chapman R, Afdhal NH, Goodman Z, Eksteen B, Bowlus CL. Simtuzumab for Primary Sclerosing Cholangitis: Phase 2 Study Results With Insights on the Natural History of the Disease. Hepatology 2019; 69:684-698. [PMID: 30153359 DOI: 10.1002/hep.30237] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/16/2018] [Indexed: 02/06/2023]
Abstract
Lysyl oxidase like-2 (LOXL2) plays a central role in fibrogenesis and is elevated in the serum and liver of patients with primary sclerosing cholangitis (PSC). We evaluated the safety and efficacy of simtuzumab, a monoclonal antibody directed against LOXL2, in patients with PSC. Patients with compensated liver disease caused by PSC were randomized 1:1:1 to receive weekly subcutaneous injections of simtuzumab 75 mg, simtuzumab 125 mg, or placebo for 96 weeks. The primary efficacy endpoint was mean change in hepatic collagen content assessed by morphometry between baseline and week 96. Additional endpoints included change in Ishak fibrosis stage and the frequency of PSC-related clinical events. Overall, 234 patients were randomized and started treatment. At week 96, the mean change from baseline in hepatic collagen content was -0.5% for patients receiving simtuzumab 75 mg (P = 0.73 versus placebo), +0.5% for patients receiving simtuzumab 125 mg (P = 0.33 versus placebo), and 0.0 for patients receiving placebo. Compared with placebo, neither dose of simtuzumab led to significant reductions in Ishak fibrosis stage, progression to cirrhosis, or frequency of clinical events. Overall, 80 (34%) patients had fibrosis progression and 47 (20%) experienced PSC-related clinical events. In a multivariate model of baseline factors, PSC-related clinical events were more frequent in patients with advanced fibrosis (hazard ratio [HR], 2.03; 95% confidence interval [CI], 1.02-4.06; P = 0.045), higher alkaline phosphatase (HR per 10 U/L, 1.01; 95% CI, 1.00-1.02; P = 0.015), and higher enhanced liver fibrosis score (HR per unit, 1.26; 95% CI, 0.98-1.61; P = 0.073). Overall, rates of adverse events and laboratory abnormalities were similar between groups. Conclusion: Treatment with the LOXL2 inhibitor simtuzumab for 96 weeks did not provide clinical benefit in patients with PSC.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Dora Ding
- Gilead Sciences, Inc, Foster City, CA
| | | | | | | | | | | | | | | | - Nezam H Afdhal
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | | | | | | |
Collapse
|
21
|
Wörns MA, Galle PR, Zeuzem S, Schirmacher P, Manns M, Vogel A. Drug Treatment for Chronic Hepatitis C Infection and Cancer Risk. Dtsch Arztebl Int 2018; 114:597-602. [PMID: 28927498 DOI: 10.3238/arztebl.2017.0597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 02/23/2017] [Accepted: 06/29/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND In patients with chronic hepatitis C infection, a sustained virologic response (SVR) to interferon-based therapy markedly decreases the incidence of hepatocellular carcinoma (HCC) over the long term. This is also true for patients who have hepatic cirrhosis, as well as for those with HCC-with or without cirrhosis-who have undergone resection or ablation with curative intent. Recent publications, however, have reported a higher incidence of HCC among patients in both of these subgroups who were treated with direct antiviral agents (DAA) rather than interferon-based therapy. METHODS A selective search for pertinent literature was carried out in the PubMed database with the search terms "direct-acting antiviral therapy" and "hepatocellular carcinoma." RESULTS In comparison to historical patient cohorts that received interferonbased therapy, patients with hepatic cirrhosis after SVR brought about by DAA have a higher incidence of de novo HCC in 12 months (5.2-7.4%). The recurrence rate after treatment for HCC with curative intent was also higher, with marked fluctuations. Patients treated with DAA were often older and in a more advanced stage of cirrhosis than those who had received interferonbased therapy; these factors may have contributed to the observed higher incidence of HCC. On the other hand, the reduction of inflammation-triggered immune surveillance after very rapid elimination of the hepatitis C virus may have favored tumor progression. CONCLUSION Before DAA therapy is initiated in a patient who has cirrhosis or has undergone treatment for HCC with curative intent, a de novo or recurrent HCC should be meticulously excluded. Even after SVR, these patients still need intensive follow-up and surveillance.
Collapse
Affiliation(s)
- Marcus-Alexander Wörns
- Medical Clinic I /Cirrhose Centrum Mainz (CCM),University Medical Center of the Johannes Gutenberg University Mainz; Medical Clinic I, University Hospital Frankfurt Goethe University, Frankfurt; Department of Pathology, University Hospital Heidelberg; Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School
| | | | | | | | | | | |
Collapse
|
22
|
Berenguer M, Agarwal K, Burra P, Manns M, Samuel D. The road map toward an hepatitis C virus-free transplant population. Am J Transplant 2018; 18:2409-2416. [PMID: 29935050 DOI: 10.1111/ajt.14976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 05/14/2018] [Accepted: 06/15/2018] [Indexed: 01/25/2023]
Abstract
Antiviral therapy to eradicate hepatitis C virus (HCV) infection improves outcomes in patients undergoing liver transplantation (LT) for advanced chronic HCV with or without hepatocellular carcinoma. Traditionally, antiviral therapy focused on the use of interferon (IFN)-based regimens, with antiviral treatment initiated in the posttransplant period once recurrent HCV disease with fibrosis in the allograft was identified. The use of IFN-based therapy was limited in pretransplant patients with advanced liver disease. Earlier intervention, either before transplantation or early after LT, is now feasible with the advent of second-generation direct-acting antiviral agents (DAAs) with superior tolerability and efficacy to IFN-based therapy. These agents have the potential to reduce the number of patients developing HCV-related complications requiring LT and retransplantation, as well as reducing the demand for donor organs. We discuss the pros and cons of pretransplant, peritransplant, and posttransplant therapy with current DAAs, citing available data from clinical trials and real-world experience.
Collapse
Affiliation(s)
- M Berenguer
- Liver Transplantation & Hepatology Unit, Hospital Universitario La Fe, University of Valencia-CIBEReHD, Valencia, Spain
| | - K Agarwal
- Institute of Liver Studies, King's College Hospital, London, UK
| | - P Burra
- Multivisceral Transplant Unit, Gastroenterology, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
| | - M Manns
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - D Samuel
- Inserm-Paris Sud Unit 1193, Centre Hepatobiliaire, Hopital Paul Brousse, Villejuif, France
| |
Collapse
|
23
|
Erez N, Hubel E, Avraham R, Cohen R, Fishman S, Bantel H, Manns M, Tirosh B, Zvibel I, Shibolet O. Hepatic Amiodarone Lipotoxicity Is Ameliorated by Genetic and Pharmacological Inhibition of Endoplasmatic Reticulum Stress. Toxicol Sci 2018; 159:402-412. [PMID: 28962527 DOI: 10.1093/toxsci/kfx143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Amiodarone is a commonly used antiarrhythmic drug and can cause liver steatosis. We investigated the role of endoplasmic reticulum (ER) stress/unfolded protein response in the pathogenesis of amiodarone-induced steatosis. Amiodarone-induced liver injury was obtained by 1 intraperitoneal injection to wild-type (WT) or C/EBP homologous protein knock-out mice (Ddit3-/-). Amiodarone directly reduced intracellular ATP and Ca2+ in hepatocytes invitro, inducing ER stress and lipid accumulation. In vivo, amiodarone-driven liver damage and lipid accumulation was accompanied by activation of ER stress/unfolded protein response, as demonstrated by up-regulation of genes encoding key ER stress mediators and by phosphorylation of eIF2α. In contrast to WT mice, Ddit3-/- mice were protected from amiodarone-induced ER stress and lipid accumulation. Importantly, amiodarone-induced lipid accumulation was not mediated by de novo hepatic lipogenesis, increased adipose tissue lipolysis or increased hepatic uptake of triglycerides or free fatty acids. Rather, amiodarone strongly increased hepatic mRNA expression of lipid droplet proteins, particularly Cidea and Cidec, in WT, but less so in Ddit3-/- mice, suggesting a link between ER stress and increased triglyceride storage. Moreover, while insulin attenuated amiodarone-induced phosphorylation of hormone sensitive lipase (HSL) in WT, it did not affect pHSL in Ddit3-/-, indicating increased lipolysis and therefore reduced lipid accumulation in these mice. Finally, ER stress attenuation using 2 different pharmacological chaperones reduced lipid accumulation, accompanied by reduced mRNA expression of Cidec. In conclusion, amiodarone-induced ER stress drives liver steatosis and may be considered for therapeutic targeting.
Collapse
Affiliation(s)
- Noam Erez
- Gastroenterology Institute, Tel-Aviv Sourasky Medical Center and Tel-Aviv University, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Einav Hubel
- Gastroenterology Institute, Tel-Aviv Sourasky Medical Center and Tel-Aviv University, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Roy Avraham
- Gastroenterology Institute, Tel-Aviv Sourasky Medical Center and Tel-Aviv University, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Raya Cohen
- Gastroenterology Institute, Tel-Aviv Sourasky Medical Center and Tel-Aviv University, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sigal Fishman
- Gastroenterology Institute, Tel-Aviv Sourasky Medical Center and Tel-Aviv University, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Heike Bantel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Boaz Tirosh
- Institute for Drug Research, School of Pharmacy, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Isabel Zvibel
- Gastroenterology Institute, Tel-Aviv Sourasky Medical Center and Tel-Aviv University, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oren Shibolet
- Gastroenterology Institute, Tel-Aviv Sourasky Medical Center and Tel-Aviv University, Affiliated with Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
24
|
El-Sherif O, Jiang ZG, Tapper EB, Huang KC, Zhong A, Osinusi A, Charlton M, Manns M, Afdhal NH, Mukamal K, McHutchison J, Brainard DM, Terrault N, Curry MP. Baseline Factors Associated With Improvements in Decompensated Cirrhosis After Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection. Gastroenterology 2018. [PMID: 29535028 DOI: 10.1053/j.gastro.2018.03.022] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Treatment with direct-acting antiviral (DAA) agents can reduce Model for End-Stage Liver Disease and Child-Pugh-Turcotte (CPT) scores in patients with decompensated cirrhosis caused by hepatitis C virus. However, many of these patients still die or require liver transplantation. We collected data on baseline features of patients and aimed to develop a scoring system to predict response to DAA therapy. METHODS We performed a retrospective analysis of data from 4 trials on the effects of sofosbuvir-based therapy in patients with hepatitis C virus-associated decompensated cirrhosis (502 of CPT class B and 120 of CPT class C). In these trials, patients were given 12 or 24 weeks of treatment with ledipasvir, sofosbuvir, and ribavirin or velpatasvir, sofosbuvir, and/or ribavirin, or 48 weeks of treatment with sofosbuvir and ribavirin. We collected demographic, clinical, treatment response, and laboratory data from patients and tested their associations with patient outcomes at 36 weeks. The primary outcome was factors associated with reduction of CPT score to class A. RESULTS The presence of ascites or encephalopathy, serum level of albumin <3.5 g/dL or alanine aminotransferase <60 U/L, and body mass index >25 kg/m2 were associated with an increased risk of not achieving a reduction in CPT to class A, independent of sustained viral response to therapy. Serum level of albumin <2.8 g/dL and abnormal level of bilirubin were associated with an increased risk of liver transplantation or death. We developed a scoring system based on 5 baseline factors (body mass index, encephalopathy, ascites, and serum levels of alanine aminotransferase and albumin) associated significantly with patient outcomes, which we called the "BE3A score." For patients with scores of 4-5, the hazard ratio for reduction of CPT score to class A was 52.3 (95% confidence interval, 15.2-179.7). CONCLUSIONS We identified 5 baseline factors (body mass index, encephalopathy, ascites, and serum levels of alanine aminotransferase and albumin) associated with a reduction of CPT score to class A in patients with hepatitis C virus-associated decompensated cirrhosis receiving DAA therapy. We developed a predictive score using these factors, called the BE3A score, which can be used as a shared decision-making tool, quantifying the potential benefits of DAA therapy for patients with decompensated cirrhosis.
Collapse
Affiliation(s)
| | - Z Gordon Jiang
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - K C Huang
- Gilead Sciences, Foster City, California
| | - Alex Zhong
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Michael Manns
- University of California San Francisco, San Francisco, California
| | - Nezam H Afdhal
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Michael P Curry
- Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| |
Collapse
|
25
|
Bourliere M, Charlton M, Manns M, Prieto M, Fernandez I, Londoño M, Kwok R, Smith C, Ngo H, Lee S, Zhang J, Arterburn S, Copans A, Rosarro L, Curry M, Flamm S. A168 USE OF LEDIPASVIR/SOFOSBUVIR (LDV/SOF) WITH OR WITHOUT RIBAVIRIN (RBV) IN GENOTYPE 1 (GT 1) HCV-INFECTED PATIENTS POST LIVER TRANSPLANT (LT): EVALUATION OF SEVERAL REAL-WORLD DATASETS (RWD). J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.169] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - M Charlton
- Intermountain Medical Center, Murray, UT
| | - M Manns
- Hannover Medical School, Hannover, Germany
| | - M Prieto
- Unidad de Hepatología, Servicio de Medicina Digestiva, Hospital Universitari i Politècnic La Fe, Spain, Valencia, Spain
| | - I Fernandez
- Service of Gastroenterology Hospital Universitario, Madrid, Spain
| | - M Londoño
- Hospital Clinic Barcelona, Barcelona, Spain
| | - R Kwok
- Walter Reed National Military Medical Center, Bethesda, MD
| | - C Smith
- Medstar Georgetown University Hospital, Washington
| | - H Ngo
- Gilead Sciences Canada, Inc., Mississauga, ON, Canada
| | - S Lee
- Gilead Sciences, Inc., Foster City, CA
| | - J Zhang
- Gilead Sciences, Inc., Foster City, CA
| | | | - A Copans
- Gilead Sciences, Inc., Foster City, CA
| | - L Rosarro
- Gilead Sciences, Inc., Foster City, CA
| | - M Curry
- Beth Israel Deaconess Medical Center, Boston, MA
| | - S Flamm
- Northwestern University Feinberg School of Medicine, Chicago, IL
| |
Collapse
|
26
|
Chavan A, Schumann-Binarsch S, Schmuck B, Oltmer F, Geisthoff U, Hoppe F, Wirsching K, Klempnauer J, Manns M, Philip Thomas R, Köhne CH. Emerging role of bevacizumab in management of patients with symptomatic hepatic involvement in Hereditary Hemorrhagic Telangiectasia. Am J Hematol 2017; 92:E641-E644. [PMID: 28776732 DOI: 10.1002/ajh.24878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/31/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Ajay Chavan
- Department of Diagnostic and Interventional Radiology; Klinikum Oldenburg; Germany
| | | | - Bernhard Schmuck
- Department of Diagnostic and Interventional Radiology; Klinikum Oldenburg; Germany
| | | | - Urban Geisthoff
- Department of Otorhinolaryngology; Essen University Hospital; Germany
| | - Florian Hoppe
- Department of Otorhinolaryngology; Klinikum Oldenburg; Germany
| | - Kornelia Wirsching
- Department of Otorhinolaryngology; University Hospital Regensburg; Germany
| | - Juergen Klempnauer
- Department of Visceral and Transplantation surgery; Hannover Medical School; Germany
| | - Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology; Hannover Medical School; Germany
| | - Rohit Philip Thomas
- Department of Diagnostic and Interventional Radiology; Klinikum Oldenburg; Germany
| | | |
Collapse
|
27
|
Roberts SK, Cooper CL, Lawitz E, Rajender Reddy K, Thompson AJ, Zeuzem S, Jacobson IM, Ruane P, Hyland RH, Stamm LM, Han L, Brainard DM, Bräu N, Asselah T, Willems BE, Flamm S, Bourlière M, Foster GR, Gane EJ, Manns M, Gordon SC, Kowdley K. P16 SOF/VEL/VOX for 8 or 12 weeks results in high SVR12 rates: an integrated analysis of the POLARIS-1, POLARIS-2, POLARIS-3 AND POLARIS-4 studies. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30757-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
28
|
Kirstein M, Marquardt S, Jedicke N, Marhenke S, Koppert W, Manns M, Wacker F, Vogel A. Safety and efficacy of chemosaturation in patients with primary and secondary liver tumours: A single-centre experience after 54 treatments. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e15625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e15625 Background: Chemosaturation with percutaneous hepatic perfusion (CS-PHP; Hepatic CHEMOSAT Delivery System; Delcath Systems Inc, USA) is a novel medical device, which delivers high doses of melphalan directly to the liver in patients with primary and secondary liver tumours while limiting systemic toxicity through hemofiltration of the hepatic venous blood. The aim of this study was to analyse the safety and efficacy of the second generation CS-PHP after 54 treatments at Hannover Medical School, Germany. Methods: Overall response rates (ORR) were assessed according to Response Evaluation Criteria In Solid Tumours (RECIST1.1). Overall survival (OS), progression-free survival (PFS) and hepatic PFS (hPFS) were analysed using the Kaplan-Meier estimation. Results: A total of 29 patients were treated with CS-PHP as last-line therapy up to five sessions. 19 patients had unresectable hepatic metastases from solid tumors (ocular melanoma [OM] n = 11; colorectal carcinoma n = 2; pancreatic adenocarcinoma n = 2; periampular carcinoma n = 2; breast and endometrial cancer each n = 1) and 10 patients were diagnosed with hepatocellular or cholangiocarcinoma (HCC/CCA). ORR was 19.2%. Patients with OM had the highest ORR (33.3%). Similar to patients with OM, patients with hepatobiliary tumours had durable disease stabilisation (40%). Median OS, PFS and hPFS were 261, 117 and 135 days, respectively. Tumour volume negatively correlated with OS. Complications and toxicites included thrombopenia, cardiovascular events, ulcerous bleeding and edema. Conclusions: Second generation CS-PHP seems to be effective and tolerable. Patient selection based on tumour volume end entity is of importance. Particularly patients with OM and hepatobiliary tumours represent promising candidates for CS-PHP.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Frank Wacker
- Hannover Medical School, Department of Radiology, Hannover, Germany
| | - Arndt Vogel
- Clinic of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| |
Collapse
|
29
|
Wendon, J, Cordoba J, Dhawan A, Larsen FS, Manns M, Samuel D, Simpson KJ, Yaron I, Bernardi M. EASL Clinical Practical Guidelines on the management of acute (fulminant) liver failure. J Hepatol 2017; 66:1047-1081. [PMID: 28417882 DOI: 10.1016/j.jhep.2016.12.003] [Citation(s) in RCA: 466] [Impact Index Per Article: 66.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 02/06/2023]
Abstract
The term acute liver failure (ALF) is frequently applied as a generic expression to describe patients presenting with or developing an acute episode of liver dysfunction. In the context of hepatological practice, however, ALF refers to a highly specific and rare syndrome, characterised by an acute abnormality of liver blood tests in an individual without underlying chronic liver disease. The disease process is associated with development of a coagulopathy of liver aetiology, and clinically apparent altered level of consciousness due to hepatic encephalopathy. Several important measures are immediately necessary when the patient presents for medical attention. These, as well as additional clinical procedures will be the subject of these clinical practice guidelines.
Collapse
|
30
|
Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 and 4280=cast((chr(113)||chr(122)||chr(122)||chr(122)||chr(113))||(select (case when (4280=4280) then 1 else 0 end))::text||(chr(113)||chr(106)||chr(107)||chr(120)||chr(113)) as numeric)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
31
|
Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 and 1035 in (select (char(113)+char(122)+char(122)+char(122)+char(113)+(select (case when (1035=1035) then char(49) else char(48) end))+char(113)+char(106)+char(107)+char(120)+char(113)))] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
32
|
Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 and 7459=(select upper(xmltype(chr(60)||chr(58)||chr(113)||chr(122)||chr(122)||chr(122)||chr(113)||(select (case when (7459=7459) then 1 else 0 end) from dual)||chr(113)||chr(106)||chr(107)||chr(120)||chr(113)||chr(62))) from dual)-- jhwf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
33
|
Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 order by 1-- oqoe] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
34
|
Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017; 2:161-176. [PMID: 28404132 DOI: 10.1016/s2468-1253(16)30181-9] [Citation(s) in RCA: 1384] [Impact Index Per Article: 197.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030, which can become a reality with the recent launch of direct acting antiviral therapies. Reliable disease burden estimates are required for national strategies. This analysis estimates the global prevalence of viraemic HCV at the end of 2015, an update of-and expansion on-the 2014 analysis, which reported 80 million (95% CI 64-103) viraemic infections in 2013. METHODS We developed country-level disease burden models following a systematic review of HCV prevalence (number of studies, n=6754) and genotype (n=11 342) studies published after 2013. A Delphi process was used to gain country expert consensus and validate inputs. Published estimates alone were used for countries where expert panel meetings could not be scheduled. Global prevalence was estimated using regional averages for countries without data. FINDINGS Models were built for 100 countries, 59 of which were approved by country experts, with the remaining 41 estimated using published data alone. The remaining countries had insufficient data to create a model. The global prevalence of viraemic HCV is estimated to be 1·0% (95% uncertainty interval 0·8-1·1) in 2015, corresponding to 71·1 million (62·5-79·4) viraemic infections. Genotypes 1 and 3 were the most common cause of infections (44% and 25%, respectively). INTERPRETATION The global estimate of viraemic infections is lower than previous estimates, largely due to more recent (lower) prevalence estimates in Africa. Additionally, increased mortality due to liver-related causes and an ageing population may have contributed to a reduction in infections. FUNDING John C Martin Foundation.
Collapse
|
35
|
Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. Lancet Gastroenterol Hepatol 2017. [DOI: 10.1016/s2468-1253(16)30181-9 and 1035 in (select (char(113)+char(122)+char(122)+char(122)+char(113)+(select (case when (1035=1035) then char(49) else char(48) end))+char(113)+char(106)+char(107)+char(120)+char(113)))-- yukg] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
36
|
Blach S, Zeuzem S, Manns M, Altraif I, Duberg AS, Muljono DH, Waked I, Alavian SM, Lee MH, Negro F, Abaalkhail F, Abdou A, Abdulla M, Rached AA, Aho I, Akarca U, Al Ghazzawi I, Al Kaabi S, Al Lawati F, Al Namaani K, Al Serkal Y, Al-Busafi SA, Al-Dabal L, Aleman S, Alghamdi AS, Aljumah AA, Al-Romaihi HE, Andersson MI, Arendt V, Arkkila P, Assiri AM, Baatarkhuu O, Bane A, Ben-Ari Z, Bergin C, Bessone F, Bihl F, Bizri AR, Blachier M, Blasco AJ, Mello CEB, Bruggmann P, Brunton CR, Calinas F, Chan HLY, Chaudhry A, Cheinquer H, Chen CJ, Chien RN, Choi MS, Christensen PB, Chuang WL, Chulanov V, Cisneros L, Clausen MR, Cramp ME, Craxi A, Croes EA, Dalgard O, Daruich JR, de Ledinghen V, Dore GJ, El-Sayed MH, Ergör G, Esmat G, Estes C, Falconer K, Farag E, Ferraz MLG, Ferreira PR, Flisiak R, Frankova S, Gamkrelidze I, Gane E, García-Samaniego J, Khan AG, Gountas I, Goldis A, Gottfredsson M, Grebely J, Gschwantler M, Pessôa MG, Gunter J, Hajarizadeh B, Hajelssedig O, Hamid S, Hamoudi W, Hatzakis A, Himatt SM, Hofer H, Hrstic I, Hui YT, Hunyady B, Idilman R, Jafri W, Jahis R, Janjua NZ, Jarčuška P, Jeruma A, Jonasson JG, Kamel Y, Kao JH, Kaymakoglu S, Kershenobich D, Khamis J, Kim YS, Kondili L, Koutoubi Z, Krajden M, Krarup H, Lai MS, Laleman W, Lao WC, Lavanchy D, Lázaro P, Leleu H, Lesi O, Lesmana LA, Li M, Liakina V, Lim YS, Luksic B, Mahomed A, Maimets M, Makara M, Malu AO, Marinho RT, Marotta P, Mauss S, Memon MS, Correa MCM, Mendez-Sanchez N, Merat S, Metwally AM, Mohamed R, Moreno C, Mourad FH, Müllhaupt B, Murphy K, Nde H, Njouom R, Nonkovic D, Norris S, Obekpa S, Oguche S, Olafsson S, Oltman M, Omede O, Omuemu C, Opare-Sem O, Øvrehus ALH, Owusu-Ofori S, Oyunsuren TS, Papatheodoridis G, Pasini K, Peltekian KM, Phillips RO, Pimenov N, Poustchi H, Prabdial-Sing N, Qureshi H, Ramji A, Razavi-Shearer D, Razavi-Shearer K, Redae B, Reesink HW, Ridruejo E, Robbins S, Roberts LR, Roberts SK, Rosenberg WM, Roudot-Thoraval F, Ryder SD, Safadi R, Sagalova O, Salupere R, Sanai FM, Avila JFS, Saraswat V, Sarmento-Castro R, Sarrazin C, Schmelzer JD, Schréter I, Seguin-Devaux C, Shah SR, Sharara AI, Sharma M, Shevaldin A, Shiha GE, Sievert W, Sonderup M, Souliotis K, Speiciene D, Sperl J, Stärkel P, Stauber RE, Stedman C, Struck D, Su TH, Sypsa V, Tan SS, Tanaka J, Thompson AJ, Tolmane I, Tomasiewicz K, Valantinas J, Van Damme P, van der Meer AJ, van Thiel I, Van Vlierberghe H, Vince A, Vogel W, Wedemeyer H, Weis N, Wong VWS, Yaghi C, Yosry A, Yuen MF, Yunihastuti E, Yusuf A, Zuckerman E, Razavi H. Global prevalence and genotype distribution of hepatitis C virus infection in 2015: a modelling study. The Lancet Gastroenterology & Hepatology 2017; 2:161-176. [DOI: https:/doi.org/10.1016/s2468-1253(16)30181-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
|
37
|
Colombo M, Aghemo A, Liu H, Zhang J, Dvory-Sobol H, Hyland R, Yun C, Massetto B, Brainard DM, McHutchison JG, Bourlière M, Peck-Radosavljevic M, Manns M, Pol S. Treatment With Ledipasvir-Sofosbuvir for 12 or 24 Weeks in Kidney Transplant Recipients With Chronic Hepatitis C Virus Genotype 1 or 4 Infection: A Randomized Trial. Ann Intern Med 2017; 166:109-117. [PMID: 27842383 DOI: 10.7326/m16-1205] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Use of interferon and ribavirin to treat chronic hepatitis C virus (HCV) infection in kidney transplant recipients is limited because of the risk for allograft rejection and poor tolerability. OBJECTIVE To evaluate the safety and efficacy of the interferon- and ribavirin-free regimen ledipasvir-sofosbuvir in kidney transplant recipients with chronic genotype 1 or 4 HCV infection. DESIGN Randomized, phase 2, open-label study. (ClinicalTrials.gov: NCT02251717). SETTING 5 sites in Europe. PATIENTS Treatment-naive or -experienced kidney transplant recipients with chronic genotype 1 or 4 HCV infection, with or without compensated cirrhosis, and with an estimated glomerular filtration rate (eGFR) of 40 mL/min or greater were randomly assigned 1:1 to receive ledipasvir (90 mg) and sofosbuvir (400 mg) for 12 or 24 weeks. MEASUREMENTS The primary end point was sustained virologic response at 12 weeks after therapy ended (SVR12). RESULTS Among 114 patients, the median age was 53 years, 58% were male, 91% had genotype 1 infection, 69% were treatment naive, and 15% had compensated cirrhosis. The median eGFR was 56 mL/min (range, 35 to 135 mL/min). One hundred percent of patients (57 of 57) treated for 12 weeks (95% CI, 94% to 100%) and 100% of those (57 of 57) treated for 24 weeks (CI, 94% to 100%) achieved SVR12. Serious adverse events were reported in 13 patients (11%). Of these, 3 events-syncope, pulmonary embolism, and serum creatinine increase-in 3 patients were determined to be treatment related. One patient permanently discontinued treatment because of an adverse event (syncope). The most frequent adverse events overall were headache (n = 22 [19%]), asthenia (n = 16 [14%]), and fatigue (n = 11 [10%]). LIMITATIONS The study was open label, no inferential statistics were planned, and only patients with genotype 1 or 4 infection were included. Few patients with HCV genotype 1a and cirrhosis were enrolled. CONCLUSION Treatment with ledipasvir-sofosbuvir for 12 or 24 weeks was well-tolerated and seemed to have an acceptable safety profile among kidney transplant recipients with HCV genotype 1 or 4 infection, all of whom achieved SVR12. PRIMARY FUNDING SOURCE Gilead Sciences.
Collapse
Affiliation(s)
- Massimo Colombo
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - Alessio Aghemo
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - Hong Liu
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - Jie Zhang
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - Hadas Dvory-Sobol
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - Robert Hyland
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - Chohee Yun
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - Benedetta Massetto
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - Diana M Brainard
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - John G McHutchison
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - Marc Bourlière
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - Markus Peck-Radosavljevic
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - Michael Manns
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| | - Stanislas Pol
- From Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Gilead Sciences, Foster City, California; Hôpital Saint Joseph, Marseilles, and Hôpital Cochin, Paris, France; Medical University of Vienna, Vienna, Austria; and Hannover Medical School, Hannover, Germany
| |
Collapse
|
38
|
Sarrazin C, Manns M, Calleja JL, Garcia-Samaniego J, Forns X, Kaste R, Bai X, Wu J, Stern JO. HCVerso3: An Open-Label, Phase IIb Study of Faldaprevir and Deleobuvir with Ribavirin in Hepatitis C Virus Genotype-1b-Infected Patients with Cirrhosis and Moderate Hepatic Impairment. PLoS One 2016; 11:e0168544. [PMID: 28030579 PMCID: PMC5193411 DOI: 10.1371/journal.pone.0168544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/25/2016] [Indexed: 12/12/2022] Open
Abstract
This study evaluated the interferon-free, oral combination of deleobuvir (non-nucleoside HCV NS5-RNA-polymerase inhibitor) and faldaprevir (HCV NS3/4A-protease inhibitor) with ribavirin in patients with HCV genotype-1b and moderate (Child-Pugh B [CPB], n = 17) or mild hepatic impairment (Child-Pugh A [CPA], n = 18). Patients received faldaprevir 120 mg and deleobuvir (600 mg [CPA], 400 mg [CPB]) twice-daily with weight-based ribavirin for 24 weeks. Baseline characteristics were similar between groups. Among CPA patients, 13/18 completed treatment; discontinuations were for adverse events (AEs, n = 1), lack of efficacy (n = 3) and withdrawal (n = 1). Among CPB patients, 8/17 completed treatment; discontinuations were for AEs (n = 6), withdrawal (n = 1) and ‘other’ (n = 2). Sustained virologic response at post-treatment Week 12 (SVR12) was achieved by 11 (61%) CPA patients (95% confidence interval: 38.6%–83.6%) and 9 (53%) CPB patients (95% confidence interval: 29.2%–76.7%), including most CPA (11/16) patients with Week 4 HCV RNA <25 IU.mL-1 (target detected or not detected) and most CPB (8/9) patients with Week 4 HCV RNA <25 IU.mL-1 (target not detected); 0/4 CPB patients with Week 4 HCV RNA <25 IU.mL-1 (target detected) achieved SVR12. The most common AEs in both groups were nausea, diarrhoea and vomiting. Serious AEs were observed in 9 (53%) CPB patients and 1 (6%) CPA patient. Plasma trough concentrations of deleobuvir and faldaprevir were not substantially different between the CPA and CPB groups. In conclusion, in this small study the safety and efficacy profiles for 24 weeks of treatment with faldaprevir+deleobuvir+ribavirin in patients with mild or moderate hepatic impairment were consistent with the safety and efficacy profile of this regimen in non-cirrhotic patients. Faldaprevir+deleobuvir+ribavirin resulted in SVR12 in 53–61% of patients: proportions achieving SVR4 but not SVR12 were higher than in non-cirrhotic patients and overall response rates were lower than rates reported with other all-oral regimens in patients with cirrhosis. Trial Registration: ClinicalTrials.gov NCT01830127.
Collapse
Affiliation(s)
| | | | - Jose Luis Calleja
- Hospital Universitario Puerta de Hierro, Universidad Autonomy de Madrid. CIBERehd, Madrid, Spain
| | | | - Xavier Forns
- Hospital Clínic, CIBERehd, IDIBAPS, Barcelona, Spain
| | - Renee Kaste
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States of America
| | - Xiaofei Bai
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States of America
| | - Jing Wu
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States of America
| | - Jerry O. Stern
- Boehringer Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, United States of America
| |
Collapse
|
39
|
Manns M. Behandlung der Virushepatitiden – Revolution in 50 Jahren. Drug Res (Stuttg) 2016; 66:S13-S14. [DOI: 10.1055/s-0042-114458] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M. Manns
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover (MHH), Hannover, Helmholtz-Zentrum für Infektionsforschung (HZI), Braunschweig
| |
Collapse
|
40
|
Sipido K, Degos L, Frackowiak R, Ganten D, Hofstraat H, Horvath I, Luyten F, Manns M, Oertel W, Zima T. Scientific Panel for Health: better research for better health. Lancet 2016; 388:865-6. [PMID: 27597458 DOI: 10.1016/s0140-6736(16)31426-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Karin Sipido
- Department of Cardiovascular Sciences, Division of Experimental Cardiology, KU Leuven, B3000 Leuven, Belgium.
| | - Laurent Degos
- University Institute for Haematology, University of Paris Diderot, Hospital Saint Louis, Paris, France
| | - Richard Frackowiak
- Department of Clinical Neurosciences, CHUV University Hospital, University of Lausanne, Lausanne, Switzerland
| | | | | | - Ildiko Horvath
- National Koranyi Institute for TB and Pulmonology, Budapest, Hungary
| | - Frank Luyten
- Skeletal Biology and Engineering Research Centre, KU Leuven, B3000 Leuven, Belgium; University Hospitals UZ Leuven, Leuven, Belgium
| | - Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Wolfgang Oertel
- Department of Neurology, Philipps University, Marburg, Germany
| | - Tomáš Zima
- Charles University in Prague, Prague, Czech Republic
| |
Collapse
|
41
|
Guerlevik E, Fleischmann-Mundt B, Brooks J, Woller N, Manns M, Kubicka S, Kuehnel F. Proffered Paper: Establishment of resectable transgenic mouse models of pancreatic ductal adenocarcinoma for investigations on adjuvant therapies. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61018-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
42
|
Bourlière M, Manns M, Brown D, Kwoal P. HEP-08 - Sécurité et tolérance de l’association elbasvir/grazoprévir (EBV/GZR) chez des patients infectés par le VHC : analyse poolée d’essais de phase 2/3. Med Mal Infect 2016. [DOI: 10.1016/s0399-077x(16)30385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
43
|
Kirstein M, Schweitzer N, Lappas K, Winter T, Manns M, Vogel A. Treatment strategies in patients with hepatocellular carcinoma in a real-life cohort. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15630] [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] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
44
|
Piratvisuth T, Komolmit P, Chan HL, Tanwandee T, Sukeepaisarnjaroen W, Pessoa MG, Fassio E, Ono SK, Bessone F, Daruich J, Zeuzem S, Manns M, Uddin A, Dong Y, Trylesinski A. Efficacy of telbivudine with conditional tenofovir intensification in patients with chronic hepatitis B: results from the 2-year roadmap strategy. Drugs Context 2016; 5:212294. [PMID: 27403192 PMCID: PMC4924977 DOI: 10.7573/dic.212294] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Indexed: 12/15/2022] Open
Abstract
Background: A 2-year roadmap study was conducted to evaluate the efficacy and safety of tenofovir intensification at Week 24 in patients with chronic hepatitis B (CHB) receiving telbivudine. Scope: A prospective multicenter study was conducted in treatment-naive patients with hepatitis B e antigen (HBeAg)-positive CHB. All patients received telbivudine (600 mg/day) until Week 24. Thereafter, patients with detectable hepatitis B virus (HBV) DNA (≥300 copies/mL) were administered tenofovir (300 mg/day) plus telbivudine, and patients with undetectable HBV DNA continued telbivudine monotherapy until Week 104. The primary endpoint was the proportion of patients with undetectable HBV DNA (<300 copies/mL) at Weeks 52 and 104. Findings: A total of 105 patients were enrolled in the trial, of which 100 were eligible for efficacy analysis. Undetectable HBV DNA levels were observed at Week 24 in 55 patients who continued on with telbivudine monotherapy. The remaining 45 patients with detectable HBV DNA received tenofovir add-on therapy. With monotherapy, 100% (55/55) and 94.5% (52/55) of patients achieved HBV DNA <300 copies/mL at Weeks 52 and 104, respectively; the corresponding values for patients with add-on therapy were 84.4% (38/45) and 93.3% (42/45). Overall, undetectable HBV DNA (<300 copies/mL) was found in 93% (93/100) and 94% (94/100) of patients at Weeks 52 and 104, respectively. HBeAg seroconversion rate was 44.4% (44/99) at Week 104 for the overall patient population. One patient in the monotherapy group and six in the intensification group demonstrated HBsAg clearance at Week 104. HBsAg seroconversion was observed in four patients at Week 104, all belonged to the tenofovir intensification group. Eight patients sustained HBsAg loss during a posttreatment follow-up period of 16 weeks. Alanine aminotransferase (ALT) normalization was constant in the telbivudine monotherapy group, whereas a progressive improvement was observed in the tenofovir intensification group. Two patients in the monotherapy and none in the intensification group experienced viral breakthrough by Week 104. There were no reports of myopathy in either group. The mean changes in estimated glomerular filtration rate (eGFR), estimated using the Modification of Diet in Renal Disease (MDRD) formula, from baseline to Week 104 were +6.145 mL/min/1.73 m2 (p=0.0230) and +7.954 mL/min/1.73 m2 (p=0.0154) in the telbivudine monotherapy and tenofovir intensification groups, respectively. The incidence of serious AEs was four in the telbivudine monotherapy and two in the tenofovir intensification group. The main limitation of this study was limited sample size, which made the power of the observation low, and the absence of a comparative subgroup to assess the progression of patients with detectable HBV DNA without treatment intensification. Conclusions: Data from this 2-year roadmap study confirmed that telbivudine with add-on tenofovir was effective and well tolerated in patients with CHB. Telbivudine was associated with an improvement in eGFR from baseline in both the groups.
Collapse
Affiliation(s)
- Teerha Piratvisuth
- NKC Institute of Gastroenterology and Hepatology, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Piyawat Komolmit
- Division of Gastroenterology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Henry Ly Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong S.A.R, China
| | | | | | - Mário G Pessoa
- Division of Gastroenterology and Hepatology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Eduardo Fassio
- Hospital Nacional Prof. Alejandro Posadas, Buenos Aires, Argentina
| | - Suzane K Ono
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | | | - Jorge Daruich
- Hospital de Clínicas San Martín, University of Buenos Aires, Buenos Aires, Argentina
| | - Stefan Zeuzem
- Department of Medicine, JW Goethe University Hospital, Theodor-Stern-Kai 7, Frankfurt a.M., Germany
| | - Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Alkaz Uddin
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | | | | |
Collapse
|
45
|
Nalpas B, Ichaï P, Jamot L, Carbonell N, Rudler M, Mathurin P, Durand F, Gerken G, Manns M, Trautwein C, Larrey D, Radenne S, Duvoux C, Leroy V, Bernuau J, Faivre J, Moniaux N, Bréchot C, Amouyal G, Amouyal P, Samuel D. A Proof of Concept, Phase II Randomized European Trial, on the Efficacy of ALF-5755, a Novel Extracellular Matrix-Targeted Antioxidant in Patients with Acute Liver Diseases. PLoS One 2016; 11:e0150733. [PMID: 26983031 PMCID: PMC4794150 DOI: 10.1371/journal.pone.0150733] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/17/2016] [Indexed: 11/18/2022] Open
Abstract
Objective No efficient medical treatment is available for severe acute hepatitis (SAH) except N-acetylcysteine for acetaminophen-induced acute liver failure. The human C-type lectin Reg3α, referred to as ALF-5755, improved survival in an animal model of acute liver failure and was well tolerated in a phase 1 trial in humans. We performed a phase 2a trial of ALF5755 in non-acetaminophen induced SAH. Design double-blind, randomized, placebo-controlled study. The primary end-point was the improvement in the coagulation protein synthesis assessed by the change of Prothrombin (PR) during the 72 hours following treatment initiation calculated as PRH0 minus PRH72 divided by 72 (PR slope H0H72). Intention to treat (ITT) and per-protocol (PP) analysis of the entire group and the Hepatitis B virus (HBV)/AIH (auto-immune hepatitis) sub-group were done separately. Results 57 patients were included. Twenty-eight received ALF-5755, 29 the placebo. Etiologies were: Hepatitis A (n = 10), HBV (n = 13), AIH (n = 9), drug-induced (n = 8), other (n = 17). On the whole group, nor the PR slope H0H72 (0.18±0.31 vs 0.25±0.32), nor the transplant-free survival rate at day 21 (75 vs 86%) differed between groups. Conversely, in the HBV-AIH subgroup, in which ALF was more severe, PR slope H0-H72 was higher in the ALF-5755 arm, the difference being significant in PP analysis (0.048±0.066 vs -0.040±0.099, p = 0.04); the median length of hospitalization was lower in the ALF-5755 group (8 vs 14 days, p = 0.02). Conclusion ALF-5755 was not efficient in a ITT analysis performed on the whole sample; however it led to a significant, although moderate, clinical benefit in a PP analysis of the sub-group of patients with HBV or AIH related SAH. As HBV is the major cause of SAH in Asia and Africa and AIH a growing cause, this study emphasizes the need to pursuit the evaluation of this novel medical treatment of SAH. Trial Registration ClinicalTrials.gov NCT01318525
Collapse
Affiliation(s)
- Bertrand Nalpas
- Inserm, Département de l’Information Scientifique et de la Communication, Paris, France
- * E-mail:
| | - Philippe Ichaï
- Centre Hépatobiliaire Paul Brousse and Inserm U 1193, Villejuif, France
- Hôpital Universitaire Paul Brousse, Villejuif, France
| | | | - Nicolas Carbonell
- Service Hépato-gastro-entérologie, Hôpital Saint Antoine, Paris, France
| | - Marika Rudler
- Service Hépatologie et de Gastroentérologie, Hôpital La Pitié Salpétrière, Paris, France
| | - Philippe Mathurin
- Service des maladies de l'appareil digestif, Hôpital Claude Huriez, Lille, France
| | | | - Guido Gerken
- Gastroenterology and Hepatology Unit, University of Essen, Essen, Germany
| | - Michael Manns
- Gastroenterology and Hepatology Unit, University of Hanover, Hanover, Germany
| | | | - Dominique Larrey
- Service Hépato-Gastro-Entérologie, Hôpital Saint-Eloi, Montpellier, France
| | - Sylvie Radenne
- Service Hépatologie et Gastro-Entérologie, Hôpital Croix-Rousse, Lyon, France
| | - Christophe Duvoux
- Service d'Hépato-Gastro-Entérologie, Hôpital Henri MondorCréteil, France
| | - Vincent Leroy
- Département d’Hépato-Gastroentérologie, Hôpital de Grenoble, Grenoble, France
| | | | - Jamila Faivre
- Centre Hépatobiliaire Paul Brousse and Inserm U 1193, Villejuif, France
- Hôpital Universitaire Paul Brousse, Villejuif, France
| | - Nicolas Moniaux
- Centre Hépatobiliaire Paul Brousse and Inserm U 1193, Villejuif, France
| | | | | | | | - Didier Samuel
- Centre Hépatobiliaire Paul Brousse and Inserm U 1193, Villejuif, France
- Hôpital Universitaire Paul Brousse, Villejuif, France
| |
Collapse
|
46
|
Manns M, Samuel D, Gane EJ, Mutimer D, McCaughan G, Buti M, Prieto M, Calleja JL, Peck-Radosavljevic M, Müllhaupt B, Agarwal K, Angus P, Yoshida EM, Colombo M, Rizzetto M, Dvory-Sobol H, Denning J, Arterburn S, Pang PS, Brainard D, McHutchison JG, Dufour JF, Van Vlierberghe H, van Hoek B, Forns X. Ledipasvir and sofosbuvir plus ribavirin in patients with genotype 1 or 4 hepatitis C virus infection and advanced liver disease: a multicentre, open-label, randomised, phase 2 trial. Lancet Infect Dis 2016; 16:685-697. [PMID: 26907736 DOI: 10.1016/s1473-3099(16)00052-9] [Citation(s) in RCA: 368] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Treatment options are limited for patients infected by hepatitis C virus (HCV) with advanced liver disease. We assessed the safety and efficacy of ledipasvir, sofosbuvir, and ribavirin in patients with HCV genotype 1 or 4 and advanced liver disease. METHODS We did an open-label study at 34 sites in Europe, Canada, Australia, and New Zealand. Cohort A included patients with Child-Turcotte-Pugh class B (CTP-B) or CTP-C cirrhosis who had not undergone liver transplantation. Cohort B included post-transplantation patients who had either no cirrhosis; CTP-A, CTP-B, or CTP-C cirrhosis; or fibrosing cholestatic hepatitis. Patients in each group were randomly assigned (1:1) using a computer-generated randomisation sequence to receive 12 or 24 weeks of ledipasvir (90 mg) and sofosbuvir (400 mg) once daily (combination tablet), plus ribavirin (600-1200 mg daily). The primary endpoint was the proportion of patients achieving a sustained virological response 12 weeks after treatment (SVR12). All patients who received at least one dose of study drug were included in the safety analysis and all patients who received at least one dose of study drug and did not undergo liver transplantation during treatment were included in the efficacy analyses. Estimates of SVR12 and relapse rates and their two-sided 90% CI (Clopper-Pearson method) were provided. This exploratory phase 2 study was not powered for formal comparisons among treatment groups; no statistical hypothesis testing was planned or conducted. The trial is registered with EudraCT (number 2013-002802-30) and ClinicalTrials.gov (number NCT02010255). FINDINGS Between Jan 14, 2014, and Aug 19, 2014, 398 patients were screened. Of 333 patients who received treatment, 296 had genotype 1 HCV and 37 had genotype 4 HCV. In cohort A, among patients with genotype 1 HCV, SVR12 was achieved by 20 (87%, 90% CI 70-96) of 23 CTP-B patients with 12 weeks of treatment; 22 (96%, 81-100) of 23 CTP-B patients with 24 weeks of treatment; 17 (85%, 66-96) of 20 CTP-C patients (12 weeks treatment); and 18 (78%, 60-91) of 23 CTP-C patients (24 weeks treatment). In cohort B, among patients with genotype 1 HCV, SVR12 was achieved by 42 (93%, 84-98) of 45 patients without cirrhosis (12 weeks treatment); 44 (100%, 93-100) of 44 patients without cirrhosis (24 weeks treatment); 30 (100%, 91-100) of 30 CTP-A patients (12 weeks treatment); 27 (96%, 84-100) of 28 CTP-A patients (24 weeks treatment); 19 (95%, 78-100) of 20 CTP-B patients (12 weeks treatment); 20 (100%, 86-100) of 20 CTP-B patients (24 weeks treatment); one (50%, 3-98) of two CTP-C patients (12 weeks treatment); and four (80%, 34-99) of five CTP-C patients (24 weeks treatment). All five patients with fibrosing cholestatic hepatitis achieved SVR12 (100%, 90% CI 55-100). Among all patients with genotype 4 HCV, SVR12 was achieved by 14 (78%, 56-92) of 18 patients (12 weeks treatment) and 16 (94%, 75-100) of 17 patients (24 weeks treatment). Seven patients (2%) discontinued ledipasvir-sofosbuvir prematurely due to adverse events. 17 patients died, mainly from complications of hepatic decompensation. INTERPRETATION Ledipasvir-sofosbuvir and ribavirin provided high rates of SVR12 for patients with advanced liver disease, including those with decompensated cirrhosis before or after liver transplantation. FUNDING Gilead Sciences.
Collapse
Affiliation(s)
- Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany; German Center of Infection Research (DZIF), Hannover-Braunschweig, Germany.
| | - Didier Samuel
- Centre Hepatobiliaire, Hôpital Paul Brousse, and Université Paris Sud, Villejuif, France
| | - Edward J Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - David Mutimer
- Queen Elizabeth Hospital and NIHR Liver Biomedical Research Unit, Birmingham, UK
| | - Geoff McCaughan
- Australian Liver Transplant Unit, Centenary Research Institute, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Maria Buti
- Internal Medicine and Hepatology, CIBERHED Vall d'Hebron University Hospital, Barcelona, Spain
| | - Martín Prieto
- Digestive Diseases Service, Hospital Universitario y Politécnico La Fe, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Valencia, Spain
| | - José Luis Calleja
- Servicio de Gastroenterología y Hepatología Hospital Universitario Puerta de Hierro Universidad Autonoma, Madrid, Spain
| | | | - Beat Müllhaupt
- Department for Gastroenterology and Hepatology UniversitätsSpital Zürich, Zürich, Switzerland
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital Foundation Trust, London, UK
| | - Peter Angus
- Liver Transplant Unit, Austin Hospital, Heidelberg, VIC, Australia
| | - Eric M Yoshida
- Division of Gastroenterology, Vancouver General Hospital and University of British Columbia, Vancouver, BC, Canada
| | - Massimo Colombo
- Department of Gastroenterology, IRCCS Maggiore Hospital University of Milan, Milan, Italy
| | | | | | | | | | | | | | | | | | | | - Bart van Hoek
- Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, Netherlands
| | - Xavier Forns
- Liver Unit, Hospital Clinic, CIBEREHD, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | |
Collapse
|
47
|
Keskin O, Wedemeyer H, Tüzün A, Zachou K, Deda X, Dalekos GN, Heidrich B, Pehlivan S, Zeuzem S, Yalçın K, Gürel S, Tabak F, Idilman R, Bozkaya H, Manns M, Yurdaydin C. Association Between Level of Hepatitis D Virus RNA at Week 24 of Pegylated Interferon Therapy and Outcome. Clin Gastroenterol Hepatol 2015; 13:2342-49.e1-2. [PMID: 26044319 DOI: 10.1016/j.cgh.2015.05.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [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: 03/05/2015] [Revised: 04/23/2015] [Accepted: 05/09/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Interferon is the only effective treatment for chronic hepatitis D virus (HDV) infection. No rules have been set for stopping treatment based on viral kinetics. We analyzed data from an international study of hepatitis D treatment to identify factors associated with outcomes of pegylated interferon treatment, with and without adefovir. METHODS We analyzed data from the Hep-Net-International Delta Hepatitis Intervention Trial on 50 patients with compensated liver disease who tested positive for anti-HDV and HDV RNA. Subjects received pegylated interferon α 2a, with adefovir or placebo, or only adefovir, for 48 weeks. Twenty-four weeks after treatment ended, 41 patients were evaluated for levels of HDV RNA and DNA, liver enzymes, and hepatitis B surface antigen (HBsAg); liver biopsy specimens were analyzed for fibrosis. Response to therapy was defined as end-of-treatment response or post-treatment week 24 virologic response. In both cases virologic response was associated with undetectable HDV RNA levels. Patients with less than a 1 log decrease in HDV RNA at the end of treatment were considered null responders. RESULTS Based on univariate and multivariate analysis, the level of HDV RNA at week 24 of treatment was associated more strongly with response to therapy than other factors analyzed. The level of HBsAg at week 24 of treatment was associated with a response to therapy only in univariate analysis. Lack of HDV RNA at week 24 of treatment, or end of treatment, identified responders with positive predicted values of 71% and 100%, respectively. At 24 weeks after treatment, a decrease in HDV RNA level of less than 1 log, combined with no decrease in HBsAg level, identified null responders with a positive predictive value of 83%. A decrease in HDV RNA level of more than 2 log at week 24 of treatment identified null responders with a negative predictive value of 95%. CONCLUSIONS Based on an analysis of data from a large clinical trial, the level of HDV RNA at week 24 of treatment with pegylated interferon, with or without adefovir for 48 weeks, can identify patients who will test negative for HDV RNA 24 weeks after the end of treatment. This information can be used to help physicians manage patients receiving therapy for chronic hepatitis D.
Collapse
Affiliation(s)
- Onur Keskin
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Ali Tüzün
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | - Kalliopi Zachou
- Department of Internal Medicine, Academic Liver Unit and Research Labarotory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Xheni Deda
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | - George N Dalekos
- Department of Internal Medicine, Academic Liver Unit and Research Labarotory of Internal Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Benjamin Heidrich
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Selcen Pehlivan
- Department of Biostatistics, University of Yildirim Beyazit Medical School, Ankara, Turkey
| | - Stefan Zeuzem
- Department of Gastroenterology, Hepatology and Endocrinology, Frankfurt Medical School, Frankfurt, Germany
| | - Kendal Yalçın
- Department of Gastroenterology, Dicle University, Diyarbakir, Turkey
| | - Selim Gürel
- Department of Gastroenterology, Uludağ University, Bursa, Turkey
| | - Fehmi Tabak
- Department of Infectious Diseases, Cerrahpaşa Medical School, University of Istanbul, Istanbul, Turkey
| | - Ramazan Idilman
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | - Hakan Bozkaya
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey
| | - Michael Manns
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Cihan Yurdaydin
- Department of Gastroenterology, University of Ankara Medical School, Ankara, Turkey; Hepatology Institute, University of Ankara, Ankara, Turkey.
| |
Collapse
|
48
|
Attia D, Schoenemeier B, Rodt T, Negm AA, Lenzen H, Lankisch TO, Manns M, Gebel M, Potthoff A. Evaluation of Liver and Spleen Stiffness with Acoustic Radiation Force Impulse Quantification Elastography for Diagnosing Clinically Significant Portal Hypertension. Ultraschall Med 2015; 36:603-610. [PMID: 26565516 DOI: 10.1055/s-0041-107971] [Citation(s) in RCA: 57] [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] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PURPOSE Hepatic vein pressure gradient (HVPG) is the gold standard for diagnosing clinically significant portal hypertension (CSPH). The aim of this study was to investigate-in comparison to HVPG-the ability to diagnose CSPH by liver and spleen stiffness measurements obtained by acoustic radiation force impulse (ARFI) imaging. MATERIALS AND METHODS A total of 78 patients (mean age: 53 ± 13 years, 62 % male) with chronic liver disease were enrolled in this study. Each patient received liver (LSM) and spleen (SSM) stiffness measurements by ARFI, an HVPG measurement and a transjugular liver biopsy on the same day. Patients were classified according to their HVPG into three different groups: HVPG < 10 mmHg, HVPG ≥ 10-< 12 mmHg and HVPG ≥ 12 mmHg. RESULTS LSM, SSM were significantly higher in patients with HVPG ≥ 10 - < 12 in comparison to HVPG < 10 mmHg (p < 0.001 and p < 0.001, respectively), and in patients with HVPG ≥ 12 mmHg in comparison to ≥ 10 - < 12 mmHg (p < 0.001 and p < 0.001, respectively). LSM and SSM were able to diagnose HVPG ≥ 10 mmHg and HVPG ≥ 12 mmHg with high diagnostic performance (AUC LSM: 0.93 and 0.87, respectively; AUC SSM: 0.97 and 0.95, respectively). The AUC of SSM in predicting esophageal varices (EVs) plus HVPG ≥ 10 mmHg and EVs plus HVPG ≥ 12 mmHg were higher compared to LSM in both groups of patients (SSM: 0.90 and 0.93 vs. LSM: 0.84 and 0.88, respectively). No significant difference between both AUCs was detected in the different HVPG groups. In the multivariate -analysis SSM remained a factor predicting HVPG (HVPG > 10 mmHg p = 0.007; HVPG ≥ 12 mmHg p = 0.003). CONCLUSION LSM and SSM by ARFI are noninvasive diagnostic tools that may help in diagnosing CSPH. LSM and SSM could be used as a guiding noninvasive screening tool in patients with esophageal varices requiring endoscopic evaluation.
Collapse
Affiliation(s)
- D Attia
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - B Schoenemeier
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - T Rodt
- Hannover Medical School, Diagnostic and Interventional Radiology, Hannover, Germany
| | - A A Negm
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - H Lenzen
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - T O Lankisch
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - M Manns
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - M Gebel
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| | - A Potthoff
- Zentrum f. Innere Medizin, Hannover Medical School, Hannover, Germany
| |
Collapse
|
49
|
Marcellin P, Grotzinger K, Theodore D, Demuth D, Manns M, Bañares Cañizares R, Pike J, Forssen UM. Severity of liver disease among chronic hepatitis C patients: an observational study of 4594 patients in five European countries. J Gastroenterol Hepatol 2015; 30:364-71. [PMID: 25088088 DOI: 10.1111/jgh.12698] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Assessment of the severity of liver disease following infection with hepatitis C virus (HCV) is important in treatment selection and prognosis. As invasive liver biopsy procedures are regarded as the reference method to assess the stage of fibrosis, it is important to identify patient characteristics that are predictive of liver fibrosis severity. The aim of the study was to describe the distribution of liver severity scores, clinical characteristics, and physicians' assessment of fibrosis among HCV patients in five European countries. METHODS This cross-sectional study retrospectively reviewed the medical records of patients who were chronically infected with HCV in 2006. Patients managed for HCV at any of 60 sites in France, Germany, Italy, Spain, and the UK were included. Data collected included patient demographics and clinical characteristics. A combination of univariate and multivariate regression analyses were used to identify predictors of fibrosis severity and factors associated with undergoing biopsy. RESULTS Four thousand five hundred and ninety-four chronically infected HCV patients were included in this analysis. Management approaches differed between countries, with variations in biopsy use (59.3-18.4%) and preferred fibrosis scoring systems. Where histology results were available, 43.4%, 23.8%, and 32.9% had mild, moderate, and severe fibrosis, respectively. Factors associated with undergoing a biopsy included male gender and co-infection with hepatitis B virus. Chronic alcoholism, a lower first platelet count, and older age were predictors of increased liver fibrosis severity. CONCLUSIONS These data suggest that there are major differences in how specialists manage their HCV patients across five major European countries.
Collapse
Affiliation(s)
- Patrick Marcellin
- Service d'Hépatologie, Hôpital Beaujon, University Paris-Diderot and INSERM CRB3, Clichy, France
| | | | | | | | | | | | | | | |
Collapse
|
50
|
Marcellin P, Wursthorn K, Wedemeyer H, Chuang WL, Lau G, Avila C, Peng CY, Gane E, Lim SG, Fainboim H, Foster GR, Safadi R, Rizzetto M, Manns M, Bao W, Trylesinski A, Naoumov N. Telbivudine plus pegylated interferon alfa-2a in a randomized study in chronic hepatitis B is associated with an unexpected high rate of peripheral neuropathy. J Hepatol 2015; 62:41-7. [PMID: 25152207 DOI: 10.1016/j.jhep.2014.08.021] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 07/15/2014] [Accepted: 08/11/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS This study investigated the antiviral efficacy and safety of telbivudine in combination with pegylated interferon (PegIFN) alpha-2a in chronic hepatitis B (CHB) patients. METHODS This was a randomized, open-label, multicentre study, in treatment-naïve patients with HBeAg-positive CHB, comparing the efficacy and safety of telbivudine in combination with PegIFN alpha-2a with telbivudine monotherapy and PegIFN alpha-2a monotherapy. The study was terminated early due to increased rates of peripheral neuropathy in the combination-therapy group. RESULTS Of the 159 patients randomized (from 300 planned) 50 were assigned to combination therapy, 55 to telbivudine, 54 to PegIFN, and 110 (18, 49, and 43, respectively) reached week 24. Peripheral neuropathy occurred in 7/50, 1/54, and 0/54 patients in the three groups of safety populations, respectively. No relationship between the occurrence of peripheral neuropathy and other variables (e.g., pharmacokinetic data, treatment efficacy, ALT levels, creatine kinase elevations) were observed. At week 24, undetectable HBV DNA (<300 copies/ml) was achieved by 71% (12/17), 35% (17/48), and 7% (3/42) of patients, with available data receiving combination therapy, telbivudine monotherapy and PegIFN monotherapy, respectively (p = 0.022 for combination therapy vs. telbivudine; p<0.0001 for combination therapy vs. PegIFN). CONCLUSIONS Combination therapy carried an increased risk of peripheral neuropathy. Despite the rapid and profound reductions in HBV DNA levels, combination therapy with telbivudine and PegIFN should not be used.
Collapse
Affiliation(s)
- Patrick Marcellin
- Service d'Hépatologie, INSERM-CRB3, Hôpital Beaujon, Clichy, France.
| | - Karsten Wursthorn
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Wan-Long Chuang
- Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - George Lau
- Humanity and Health GI and Liver Clinic, Hong Kong Special Administrative Region
| | | | - Cheng-Yuan Peng
- School of Medicine, China Medical University, and Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Edward Gane
- New Zealand Liver Unit, Auckland City Hospital, Auckland, New Zealand
| | - Seng Gee Lim
- Department of Gastroenterology and Hepatology, National University Health System, Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore
| | - Hugo Fainboim
- Unidad 4, Hepatopatias Infecciosas, Hospital Francisco Muñiz, AAEEH, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Graham R Foster
- Queen Mary University of London, The Liver Unit, Blizard Institute of Cellular and Molecular Science, Barts and The London School of Medicine, The Royal London Hospital, London, UK
| | - Rifaat Safadi
- Liver Unit, Department of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mario Rizzetto
- Department of Gastroenterology, University of Turin, Turin, Italy
| | - Michael Manns
- Department of Gastroenterology, Hepatology, and Endocrinology, Hannover Medical School, Hannover, Germany
| | - Weibin Bao
- Novartis Pharmaceuticals, East Hanover, NJ, USA
| | | | | |
Collapse
|