A NEW scoring system can predict which patients with decompensated cirrhosis caused by hepatitis C virus (HCV) infection would benefit the most from direct-acting antiviral (DAA) therapy, allowing a more targeted therapy for those who will really benefit. The eradication of HVC does not necessarily improve transplant-free survival of decompensated cirrhosis patients and, as such, investigators set out to find a way of identifying those who would most likely benefit from DAA.
The new scoring system worked by assigning one point for a number of different measurements: absence of encephalopathy, absence of ascites, alanine aminotransferase level >1.5-times the upper limit of normal, albumin levels >3.5 g/dL, and BMI <25 kg/m2. Researchers identified that those who scored 4 or 5 points were >50-times more likely to improve their Child–Pugh Turcotte (CPT) score to Class A cirrhosis with DAA therapy than those who scored 0 (hazard ratio: 52.3; 95% confidence interval: 15.2–179.7; p<0.001).
Researchers commented that patients with decompensated cirrhosis treated with DAA can become a ‘model for end-stage renal disease purgatory’ where they are still decompensated despite achieving sustained HCV virological response and improved model for end-stage renal disease scores. These patients waited longer for liver transplantation than if they had not received DAA therapy and were still harbouring HCV. The study group set out to identify a specific point of liver dysfunction where HCV therapy does not yield any meaningful clinical benefit.
The study amalgamated 622 patients from four studies (SOLAR-1, SOLAR2, ASTRAL-4, and GS-US-334-0125), which evaluated interferon-free sofosbuvir-based DAA therapy in patients with ledipasvir, sofosbuvir, and ribavirin or velpatasvir in combination with sofosbuvir and/or ribavirin, or 48 weeks of treatment with sofosbuvir and ribavirin.
A total of 32% and 12% of CPT Class B and C cirrhosis patients improved to Class A, respectively. Patients with scores of 1, 2, or 3 were significantly more likely to improve to Class A than patients with scores of 0 (hazard ratio ranging from 4.2 for scores of 1, to 21.2 for scores of 3). Only 23 patients scored 4 or 5, with most patients scoring 0 (n=106).
Describing the new scoring system, the research team commented that it is: “a tool that can enhance shared decision making at the point of care, quantifying the potential benefits of DAA therapy for patients with decompensated cirrhosis in the pretransplant setting.” In conclusion, this scoring system will better allow physicians and other healthcare professionals to more accurately prescribe DAA therapy to those who will truly benefit.
