Assessment of Fibrosis After Treatment with Direct-Acting Antiviral Drugs with or without Silymarin in Patients with Chronic Hepatitis C Related Liver Disease

Direct-Acting Antivirals (DAAs) are now the standard of care for management of chronic hepatitis C (CHC) infection.Patients who are treated from HCV infection with sustained virological response experience multiple health benefits, like a decrease in liver inflammation, regression of fibrosis. Aim: to evaluate change in hepatic fibrosis through liver and spleen stiffness measurements using fibroscan in relation to combination of DAAs and silymarin in chronic HCV patients. Methods: this prospective study included 300 chronic HCV patients. They were classified into group 1 (n= 150) who received DAAs and group 2 (n= 150) who received DAAs then fixed oral dose of silymarin (420 mg daily in three divided doses) for 9 months after end of treatment with DAAs. Assessment of liver and spleen stiffness were done twice by transient elastography, at time of inclusion before starting treatment and one year later. Results: Patients in group 1 and 2 achieved a significant improvement in all biochemical parameters in form of significant reduction in serum AST, ALT levels, (p=0.001), significant improvement in INR (p=0.001) and albumin (p < 0.05). However, there was no statistically significant difference between group 1 and 2 regarding biochemical parameters (p>0.05). A statistically significant reduction in stiffness values of liver and spleen had been established in both groups. Group 2 showed a significant greater reduction in liver stiffness values compared to group1 (p=0.007). Conclusion: Among chronic HCV patients, DAAs yielded a significant improvement in overall disease parameters. This improvement has shown to be significantly greater when silymarin was added to DAAs.