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Marked heterogeneity in the diagnosis of compensated cirrhosis of patients with chronic hepatitis C virus infection in a real‐world setting: A large, multicenter study from Japan
Author(s) -
Toyoda Hidenori,
Atsukawa Masanori,
Watanabe Tsunamasa,
Nakamuta Makoto,
Uojima Haruki,
Nozaki Akito,
Takaguchi Koichi,
Fujioka Shinichi,
Iio Etsuko,
Shima Toshihide,
Akahane Takehiro,
Fukunishi Shinya,
Asano Toru,
Michitaka Kojiro,
Tsuji Kunihiko,
Abe Hiroshi,
Mikami Shigeru,
Okubo Hironao,
Okubo Tomomi,
Shimada Noritomo,
Ishikawa Toru,
Moriya Akio,
Tani Joji,
Morishita Asahiro,
Ogawa Chikara,
Tachi Yoshihiko,
Ikeda Hiroki,
Yamashita Naoki,
Yasuda Satoshi,
Chuma Makoto,
Tsutsui Akemi,
Hiraoka Atsushi,
Ikegami Tadashi,
Genda Takuya,
Tsubota Akihito,
Masaki Tsutomu,
Iwakiri Katsuhiko,
Kumada Takashi,
Tanaka Yasuhito,
Okanoue Takeshi
Publication year - 2020
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14982
Subject(s) - medicine , cirrhosis , regimen , gastroenterology , hepatitis c , hepatitis c virus , virus , immunology
Background and Aim The presence of cirrhosis is an important factor for the management of patients with hepatitis C virus (HCV) infection and it determines the duration of treatment for HCV with the direct‐acting antiviral (DAA) regimen of glecaprevir (GLE) and pibrentasvir (PIB), that is, 8 or 12 weeks, if patients do not have a history of DAA failure. However, in real‐world settings, determination of cirrhosis depends on the discretion of the attending hepatologists, and it is unclear whether compensated cirrhosis was homogenously diagnosed or not. In this study, we investigated the real‐world diagnosis of cirrhosis by characterizing DAA‐naïve patients who underwent a 12‐week GLE/PIB regimen in whom cirrhosis was diagnosed, comparing their characteristics with those of patients who underwent an 8‐week regimen in whom cirrhosis was absent. Methods In a large, multicenter cohort study, we compared background characteristics and treatment outcomes among DAA‐naïve patients who underwent an 8‐week versus a 12‐week GLE/PIB regimen. Results Among 977 patients enrolled, 296 (30.3%) were determined to have cirrhosis and underwent a 12‐week regimen. Some patient characteristics largely overlapped between the two groups, including liver fibrosis indices. Sustained viral response rates were similar between groups after adjusting liver fibrosis index with propensity score matching. Conclusion Although adequately diagnosed, the determination of cirrhosis varied widely among institutions or by hepatologists in real‐world settings, and the severity of liver fibrosis overlapped significantly between patients in whom compensated cirrhosis was determined to be present and patients in whom cirrhosis was absent. Virologic efficacy was similar after adjusting for the degree of liver fibrosis.