studies

1128A AASLD ABSTRACTS HEPATOLOGY, October, 2015
Disclosures:
Senaka Peter - Employment: Merck
Allan J. Collins - Advisory Committees or Review Panels: KDIGO, Amgen, IKEA-J,
NKF KDPN, Hospira; Board Membership: Kidney Health Australia; Consulting:
Amgen, NxStage, Keryx, Hospira, Relypsa, Bayer, ZS Pharma; Employment:
Hennepin Healthcare System; Grant/Research Support: Amgen, Merck,
NxStage, ZS Pharma, Keryx, Peer Kidney Care Initiative; Speaking and Teaching:
Hospira, Amgen
Jean Marie Arduino - Employment: Merck & Co., Inc
The following authors have nothing to disclose: Craig Solid, Tanya Bovitz, Haifeng
Guo
1884
Does pregnancy protect against fibrosis or promote SVR
in HCV infected women?
Christine Pocha 1 , Pascal Benkert 2 , Salome A. Keller 1 , Beat Müllhaupt
3 , David Semela 4 , Markus H. Heim 5 , Darius Moradpour 6 ,
Andreas Cerny 7 , Raffaele Malinverni 8 , Francesco Negro 9 ,
Jean-Francois Dufour 1 ; 1 Hepatology, University Clinic for visceral
Surgery and Medicine,, University Hospital Bern, Bern, Switzerland;
2 Clinical Trial Unit, University of Basel, Basel, Switzerland;
3 Gastroenterology and Hepatology, University of Zürich, Zürich,
Switzerland; 4 Gastroenterology and Hepatology, Kantonsspital
St. Gallen, St. Gallen, Switzerland; 5 Gastroenterology and Hepatology,
University Hospital Basel, Basel, Switzerland; 6 Gastroenterology
and Hepatology, University of Lausanne, Lausanne,
Switzerland; 7 Internal Medicine, Clinica Luganese Moncucco,
Lugano, Switzerland; 8 Internal Medicine, Hôpital Neuchâtelois,
Neuchâtel, Switzerland; 9 Gastroenterology, Hepatology and Clinical
pathology, University Hospital, Geneva, Switzerland
BACKGROUND: Sex specific differences in liver disease
account for less hepatic decompensation in female cirrhotics,
higher spontaneous HCV clearance and better chronic hepatitis
C treatment response. Preclinical evidence suggests that
relaxin, a pregnancy specific hormone, shows antifibrotic
features. We aimed to evaluate the influence of past pregnancies
on the rate of liver fibrosis progression and sustained
virologic response (SVR) in women. METHODS: We extracted
baseline and follow up demographic and clinical data on
all women enrolled in Swiss Hepatitis C Cohort Study since
2001. Differences between groups (women with/without history
of pregnancy) were investigated using Fisher’s exact test
for categorical variables and t-test for continuous variables.
To reduce potential confounders, propensity score techniques
were used. Cox proportional hazards model was used to analyze
associations between predictors and cirrhosis taking into
account the time to event (diagnosis of HCV infection to cirrhosis
diagnosis). RESULTS: Among 1669 women included in
the cohort, 1121 reported at least one pregnancy. Baseline
characteristics were similar although women with pregnancy
were significantly older at baseline, at time of first documented
HCV serology and had longer follow-up time while non-pregnant
women were more often co-infected with HIV. Overall,
19.7% of patients were cirrhotic at a mean time from first documented
HCV serology at 9.5 years, which was similar in both
groups. Associated with cirrhosis were HCV therapy (HR 2.86,
CI 2,39-3.41, p < 0.001), co-infection with HIV (HR 3.61,
CI 2.68-4.86, p < 0.001), HCC (HR 2.47, CI 1.87-3.27,
p < 0.001), diabetes (HR 2.50, CI 2.01-3.11, p < 0.001),
and alcohol abuse (HR 2.08, CI 1.69-2.57, p < 0.001). Pregnancy
was associated with a 18% risk reduction of cirrhosis
(HR 0.82, CI 0.70-0.96, p = 0.015). Overall 39% of women
received at least one HCV treatment with improvement or no
change in fibrosis score. However, influence of pregnancy was
non-conclusive. A history of pregnancy was associated with
higher likelihood of achieving SVR with interferon-alpha-based
antiviral therapy (OR 1.31, CI 0.95-1.81, p = 0.10). CONCLU-
SIONS: Our data suggest that pregnancy is associated with a
reduced risk of progression to cirrhosis as well as increased
response to interferon-alpha- based HCV therapy. To further
confirm a positive association between past pregnancies and
lower rate of fibrosis progression we will integrate different
fibrosis tests in further analyses.
Disclosures:
Francesco Negro - Advisory Committees or Review Panels: Bristol-Myers Squibb,
MSD, Gilead, AbbVie; Grant/Research Support: Gilead
Jean-Francois Dufour - Advisory Committees or Review Panels: Bayer, BMS, Gilead,
AbbVie, Novartis, Sillagen, Genfit
The following authors have nothing to disclose: Christine Pocha, Pascal Benkert,
Salome A. Keller, Beat Müllhaupt, David Semela, Markus H. Heim, Darius
Moradpour, Andreas Cerny, Raffaele Malinverni
1885
Safety and Efficacy of Interferon/Ribavirin-Free Therapy
in Septuagenerians and Octogenerians with Chronic
Hepatitis C
Rafael Stern 1 , Karin Kozbial 1 , Clarissa Freissmuth 1 , Stephanie
Hametner 2 , Ramona Al Zoairy 3 , Stephan Moser 4 , Asia
Karpi 4 , Hermann Laferl 5 , Rudolf E. Stauber 6 , Heinz M. Zoller 3 ,
Andreas Maieron 2 , Wolfgang Vogel 3 , Ivo Graziadei 7 , Michael
Gschwantler 4 , Harald Hofer 1 , Peter Ferenci 1 ; 1 Department of Internal
Medicine III, Medical University of Vienna, Vienna, Austria;
2 Department of Gastroenterology, Elisabethinen Hospital, Linz,
Austria; 3 Department of Medicine II, Medical University of Innsbruck,
Innsbruck, Austria; 4 Department of Medicine IV, Wilheminen-Hospital,
Vienna, Austria; 5 Department of Internal Medicine,
Kaiser-Franz-Josef-Hospital, Vienna, Austria; 6 Department of Internal
Medicine, Medical University of Graz, Graz, Austria; 7 Department
of Internal Medicine, Krankenhaus Hall, Hall, Austria
Specific objective: Direct acting antivirals (DAA) have revolutionized
treatment of chronic hepatitis C. Septua- and octogenarians
were not included in clinical studies and therefore
data on efficacy and safety of IFN-free treatments in the elderly
population are missing. Elderly patients may have a decreased
renal and hepatic function. Furthermore many are at risk for
drug-drug interactions of DAA with drugs required for longterm
treatment of other medical conditions. We investigated
safety and efficacy of interferon (IFN) and ribavirin (RBV)-free
treatments in patients >70 years with advanced liver disease
due to chronic hepatitis C. Methods: 44 otherwise healthy
patients >70 years (mean age: 74.6, range 70-88, m/f:
19/26, cirrhosis: 32, F3:12, median HCV RNA 1.18x10 6
IU/ml, HCV-genotype: GT-1a:6; 1b:34; 3:1; 4:2; missing:
1; treatment experienced: 25; median platelet count: 137