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Impact of new direct-acting antiviral drugs on hepatitis C virus-related decompensated liver cirrhosis

Background The benefits of treatment of hepatitis C virus with direct-acting antiviral drugs in patients with decompensated liver cirrhosis (DLC) are still unclear. Aim To evaluate the degree of improvement in hepatic decompensation events and quality of life (QOL) in treated patients with DLC. Patients and methods One hundred and fifty patients with hepatitis C virus-related DLC were included; 75 of these patients received treatment (group I) [sofosbuvir (SOF) with either daclatasvir or ledipasvir for 24 weeks without ribavirin (RBV) or for 12 weeks with RBV] and 75 patients did not receive treatment as a comparable group (group II). Patients who achieved a sustained virological response at 12 weeks were assessed in terms of decompensation events, model for end-stage liver disease score, Child–Turcotte–Pugh score, biochemical changes, and QOL (applied on Mcguill QOL questionnaire) before starting treatment and 6 months after end of treatment, and were compared with untreated patients. Results Forty-two (56%) patients received SOF/daclatasvir for 24 weeks without RBV and 19 (25.3%) patients received SOF/ledipasvir for 24 weeks without RBV. The model for end-stage liver disease score improved in treated patients (mean change –1.73), but worsened in untreated patients (mean change +11.8) before and after 6 months. Also, the Child–Turcotte–Pugh score improved significantly (P<0.001). Serum albumin, prothrombin time, bilirubin, &agr;-fetoprotein, and alanine aminotransferase improved in treated patients (P<0.001). Health-related QOL improved in treated patients (mean change +17.65) and worsened in untreated ones (mean change −18.68; P<0.001). Conclusion Treated patients with DLC showed an improvement in liver tests and health-related QOL. Longer durations of follow-up for decompensation events are needed.