Effect of viral suppression on hepatic venous pressure gradient in hepatitis C with cirrhosis and portal hypertension

Portal hypertension is a predictor of liver-related clinical events and mortality in patients with hepatitis C and cirrhosis. The effect of interferon-free hepatitis C treatment on portal pressure is unknown. Fifty patients with Child-Pugh-Turcotte (CPT) A and B cirrhosis and portal hypertension (hepatic venous pressure gradient [HVPG] >6mm Hg) were randomized to receive 48weeks of open-label sofosbuvir plus ribavirin at Day 1 or after a 24-week observation period. The primary endpoint was sustained virologic response 12weeks after therapy (SVR12) in patients who received 1 dose of treatment. Secondary endpoints included changes in HVPG, laboratory parameters, and MELD and CPT scores. A subset of patients was followed 48weeks posttreatment to determine late changes in HVPG. SVR12 occurred in 72% of patients (33/46). In the 37 patients with paired HVPG measurements at baseline and the end of treatment, mean HVPG decreased by -1.0 (SD 3.97) mm Hg. Nine patients (24%) had 20% decreases in HVPG during treatment. Among 39 patients with pretreatment HVPG 12mm Hg, 27 (69%) achieved SVR12. Four of the 33 (12%) patients with baseline HVPG 12mm Hg had HVPG <12mm Hg at the end of treatment. Of nine patients with pretreatment HVPG 12mm Hg who achieved SVR12 and completed 48weeks of follow-up, eight (89%) had a 20% reduction in HVPG, and three reduced their pressure to <12mm Hg. Patients with chronic HCV and compensated or decompensated cirrhosis who achieve SVR can have clinically meaningful reductions in HVPG at long-term follow-up. (EudraCT 2012-002457-29).