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1.
Ann Hepatol ; 19(4): 367-372, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32444247

RESUMEN

INTRODUCTION AND OBJECTIVES: We examined whether Mac-2-binding protein glycosylation isomer (M2BPGi) levels could be a predictive marker for the presence of esophagogastric varices (EGV) in cirrhotic patients after hepatitis C virus (HCV) eradication with direct-acting antivirals (DAAs). PATIENTS AND METHODS: A total of 102 cirrhotic patients with HCV infection treated with DAAs were enrolled. Esophagogastroduodenoscopy was performed in 84 of the patients before treatment (Cohort A), in 66 after treatment (Cohort B), and in 48 at both time points (Cohort C). We examined factors associated with EGV before and after DAA treatment. RESULTS: In Cohort A, M2BPGi levels and liver stiffness were significantly higher in the EGV-positive group than the EGV-negative group (p=0.034, and p=0.042, respectively). The proportion of EGV-positive patients with before-treatment levels of M2BPGi ≧ 7.3 C.O.I. was significantly higher than in patients with M2BPGi levels<7.3 C.O.I. (p=0.015). In Cohort B, M2BPGi levels were significantly higher in the EGV-positive group than EGV-negative group (p=0.003). The proportion of EGV-positive patients with after-treatment levels of M2BPGi ≧ 3.4 C.O.I. was significantly higher than in patients with M2BPGi levels<3.4C.O.I. (p=0.001). In Cohort C, M2BPGi levels decreased during DAA treatment regardless of EGV development, but there was no significant difference in the reduction of M2BPGi among the EGV-improvement, EGV-invariant, and EGV-exacerbation groups (p=0.659). CONCLUSIONS: M2BPGi levels may be a novel serum marker for the presence of EGV before and after DAA treatment.


Asunto(s)
Antígenos de Neoplasias/metabolismo , Antivirales/uso terapéutico , Biomarcadores de Tumor/metabolismo , Várices Esofágicas y Gástricas/metabolismo , Hepatitis C Crónica/tratamiento farmacológico , Cirrosis Hepática/metabolismo , Anciano , Anciano de 80 o más Años , Endoscopía del Sistema Digestivo , Várices Esofágicas y Gástricas/etiología , Femenino , Glicosilación , Hepatitis C Crónica/complicaciones , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Respuesta Virológica Sostenida , Resultado del Tratamiento
2.
Ann Hepatol ; 16(5): 734-741, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28809743

RESUMEN

BACKGROUND: The efficacy and safety of asunaprevir + daclatasvir combination therapy for treatment of hepatitis C virus (HCV) in compensated cirrhotic patients was not fully evaluated in real-world. Outcomes were assessed in cirrhotic patients with sustained viral response (SVR). MATERIAL AND METHODS: A total of 145 patients without resistance-associated substitutions (RASs) at L31 and Y93 in the nonstructural protein 5A of HCV genotype 1b, consisting of 49 hepatic cirrhotic and 96 non-cirrhotic patients, were enrolled to the therapy. The patients were treated with 100 mg asunaprevir twice daily plus 60 mg daclatasvir once daily for 24 weeks. The primary endpoint was SVR 24 weeks after completing treatment. In addition, we evaluated the improvement of liver function and development of HCC for 1 year from the end of treatment (EOT). RESULTS: The SVR24 rate was 96% (47/49) in the cirrhotic group and 96% (91/95) in the non-cirrhotic group (p = 0.69). During treatment, grade III/IV adverse events occurred more frequently in cirrhotic patients (10/49; 20.4%) than in non-cirrhotic patients (10/96; 10.4%) (p = 0.099). After EOT, alanine aminotransferase and AFP levels were significantly decreased in cirrhotic patients with SVR. In addition, serum levels of albumin and platelet counts were significantly increased. On the other hand, the rates of HCC recurrence (43%) and development (7.4%) were higher in cirrhotic patients than in the non-cirrhotic patients (12.5% and 1.1%, respectively). CONCLUSION: RAS-oriented asunaprevir/daclatasvir therapy has a strong anti-HCV effect in patients with HCV genotype 1b. However, careful management is necessary in patients with cirrhosis.


Asunto(s)
Antivirales/uso terapéutico , Hepacivirus/efectos de los fármacos , Hepatitis C Crónica/tratamiento farmacológico , Imidazoles/uso terapéutico , Isoquinolinas/uso terapéutico , Cirrosis Hepática/tratamiento farmacológico , Sulfonamidas/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antivirales/efectos adversos , Carbamatos , Carcinoma Hepatocelular/virología , Farmacorresistencia Viral/genética , Quimioterapia Combinada , Femenino , Genotipo , Hepacivirus/genética , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/virología , Humanos , Imidazoles/efectos adversos , Isoquinolinas/efectos adversos , Japón , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/virología , Pruebas de Función Hepática , Neoplasias Hepáticas/virología , Masculino , Persona de Mediana Edad , Pirrolidinas , Recuperación de la Función , Factores de Riesgo , Sulfonamidas/efectos adversos , Respuesta Virológica Sostenida , Factores de Tiempo , Resultado del Tratamiento , Valina/análogos & derivados , Proteínas no Estructurales Virales/genética
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