Liver Stiffness measurments using Fibroscan after three months of IFN-based antiviral therapy is unlikely to predict viral response in cirrhotic patients

Background and Aims: Chronic HCV infection (CHC) is the leading cause of mortality from liver cirrhosis and hepatocellular carcinoma. Antiviral therapy can prevent disease progression.
Transient Elastografy (TE; Fibroscan) is an accurate surrogate marker to liver fibrosis, by measuring liver stiffness (LS). LS decrease has been associated with sustained virologic response (SVR). In this study we aimed to assess the changes of LS measurments in CHC patients during and one year after Interferon (IFN)-based antiviral
therapy (IFN/ribavirin) or (telaprevir+IFN/ribavirin).
Methods: This is an ongoing study, in which consecutive 69 CHC patients (53.6% females, mean age 57.9±11.4) who underwent antiviral therapy for at least 20 weeks were enrolled. LS was measured using Fibroscan at baseline, after three months, at the end of treatment and one year after treatment discontinuation.
Fibrosis was graded using METAVIR score. Results: Twenty patients were treated with triple therapy and 49 with IFN/ribavirin. Fifty patients had SVR and 19 were non-responders. LS changed significantly in all patients and
independently from the initial fibrosis stage, genotype, type of treatment, basal ALT and BMI. Twelve months after treatment discontinuation, we found that in SVR patients: F0–F1, F2 and F3 patients (39.1%, 7.2% and 17.4%; respectively) showed no significant LS decrease (P = 0.186, 0.068 and 0.075; respectively). Conversely, in
F4 patients (36.2%) LS was significantly decreased (P = 0.015) after one year of treatment completion. In all patients with no SVR, no significant decrease in LS was observed. Interestingly, all Patients with F4 fibrosis (even non-responders) showed an initial significant decrease in LS (P = 0.024) at 3 months after the start of treatment.
However, this decrease was not predictive of SVR; area under the ROC curve 0.369 (CI %: 0.145–0.592) P = 0.265.
Conclusions: Performance of LS measurements for fibrosis assessment confirmed results from previous studies. Our
preliminary data suggest that LS changes significantly in CHC patients treated with IFN-based antiviral therapy (standard and triple therapy with telaprevir) and it decreases significantly in responders with high initial LS measurements independently from the type treatment. Initial significant decrease in LS measurements
in such patients is unlikely to predict an SVR.