Hepatitis C Clinical Trial
— GOVaSViROfficial title:
Progression of Gastroesophageal Varices After Sustained Virological Response by Interferon-free Regimens in Patients With Advanced Fibrosis / Cirrhosis Due to Chronic Hepatitis C
Chronic hepatitis C remains a public health issue because up to 70 million people are
chronically infected by hepatitis C virus (HCV) worldwide. Presence of advanced
fibrosis/cirrhosis might be associated with liver-related complications, such as
hepatocellular carcinoma and oesophageal varices bleeding. Oesophageal varices (OV) might be
present in up to 40% of patients with liver cirrhosis have and the mortality rates from
bleeding might be up to 20% per episode. Early diagnosis of advanced fibrosis/cirrhosis
associated with hepatitis C treatment are key features for preventive and therapeutic
measures to reduce liver-related mortality in HCV-infected patients.
Liver elastography is a high accurate non-invasive test for diagnosis of advanced
fibrosis/cirrhosis. Few different methods of liver elastography are currently available:
transient elastography by Fibroscan and ultrasound elastography by point-shear wave (p-SWE)
and 2D-shear wave (2D-SWE). Gastrointestinal endoscopy (GIE) has been considered the gold
standard for screening or surveillance of esophageal varices. More recently, international
guidelines have been recommending the use of non-invasive methods to indicate or avoid OV
screening: Baveno VI guidelines proposed that compensated cirrhotic patients with a liver
stiffness measurement (LSM) by transient elastography <20kPa and a platelet count >150,000/μL
can avoid screening endoscopy. The use of direct-acting agents (DAAs) has revolutionized the
treatment of chronic hepatitis C with high effectiveness shown using all-oral interferon-free
regimens. HCV cure, sustained virological response (SVR), has been associated with lower
rates of liver-related complications, increase in quality of life and decrease in
waiting-list registrations for liver transplantation in patients with chronic hepatitis C.
Preliminary studies have been reporting significant regression liver stiffness after SVR.
However, it is unclear whether SVR might decrease portal hypertension leading to OV
regression and a reduced risk of variceal bleeding. In addition, the use of non-invasive
methods to avoid OV screening must be validated in HCV patients after SVR. The aims of this
cross-sectional study with prospective inclusion of patients will be: (i) to evaluate the
impact of SVR in portal hypertension in HCV patients with advanced fibrosis/liver cirrhosis
treated by interferon-free regimens and (ii) to validate non-invasive methods to avoid OV
screening by GIE
Status | Recruiting |
Enrollment | 322 |
Est. completion date | February 28, 2024 |
Est. primary completion date | August 14, 2022 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years to 99 Years |
Eligibility |
Inclusion Criteria: - Age = 18 years - Presence of advanced fibrosis or cirrhosis (stage F=3 METAVIR) based on liver stiffness by transient elastography (= 9,5 kPa) or liver biopsy - Gastrointestinal endoscopy at least 24 months before start of direct-acting agents for HCV treatment - Liver stiffness measurement at least 18 months after SVR Exclusion Criteria: - Autoimmune hepatitis, hepatosplenic schistosomiasis or cholestasis diseases - Liver transplantation - Presence of high volume ascites or hepatocellular carcinoma - Participation in programs of esophageal band ligation for eradication of esophageal varices - Presence of signs of acute decompensated liver disease |
Country | Name | City | State |
---|---|---|---|
Brazil | Bonsucesso Federal Hospital | Rio De Janeiro | |
Brazil | Evandro Chagas National Institute of Infectious Diseases | Rio de Janeiro | Rio De Janeiro/RJ |
Lead Sponsor | Collaborator |
---|---|
Oswaldo Cruz Foundation |
Brazil,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Incidence of esophageal varices (portal hypertension) after SVR | Evaluation of presence/absence of esophageal varices after SVR in patients with advanced fibrosis or cirrhosis compared to before treatment | up to 48 months after SVR | |
Primary | Validation of the Baveno's criteria to avoid gastrointestinal endoscopy for screening of esophageal varices after SVR | Validation of the diagnostic performance of non-invasive tests (liver and splenic stiffness or biological markers) to screen esophageal varices in patients with advanced fibrosis/cirrhosis after SVR by DAA treatment for HCV | up to 48 months after SVR | |
Secondary | Incidence of regression of esophageal varices after SVR | Evaluation of absence of esophageal varices after SVR in patients with advanced fibrosis or cirrhosis and esophageal varices before treatment | up to 48 months after SVR |
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