HEPATOLOGY Changes in liver stiffness measurements and fibrosis scores following sofosbuvir based treatment regimens without interferon Aisha Elsharkawy,* Shereen Abdel Alem,* Rabab Fouad,* Maissa El Raziky,* Wafaa El Akel,* Mahmoud Abdo,* Omnia Tantawi,* Mohamed AbdAllah, † Marc Bourliere ‡ and Gamal Esmat* *Endemic Medicine and Hepatology Department, Faculty of medicine, Cairo University, Cairo, † Medical Research Division, National Research Centre, Giza, Egypt; and ‡ Department of Hepato-Gastroenterology, Hospital Saint Joseph, Marseille, France Key words chronic hepatitis C virus, fibrosis scores, Sofosbuvir-based treatment, transient elastography. Accepted for publication 30 January 2017. Correspondence Shereen Abdel Alem, Faculty of Medicine, Cairo University, Cairo, Egypt, post code11562. Email: shery_2424@yahoo.com Declaration of interest: Gamal Esmat, speaker, advisory board member and investigator for Gilead Science. Marc Bouliere, member of board and speakers for Roche, BMS, MSD, Janssen, Gilead, AbbVie, Vertex, receive grant from AbbVie, Gilead, MSD, all other authors nothing to be declared. Abstract Background and Aim: Accurate evaluation of the degree of liver fibrosis in patients with chronic liver diseases is crucial, as liver fibrosis is important in order to make therapeutic decisions, determine prognosis of liver disease and to follow-up disease progression. Mul- tiple non-invasive methods have been used successfully in the prediction of fibrosis; how- ever, early changes in non-invasive biomarkers of hepatic fibrosis under effective antiviral therapy are widely unknown. The aim of this study is to evaluate changes of transient elastography values as well as FIB-4 and AST to platelet ratio index (APRI) in patients treated with Sofosbuvir-based treatment regimen. Methods: This is a retrospective study including 337 chronic HCV Egyptian patients with genotype 4 mainly. They were treated with Sofosbuvir-based treatment regimen. Transient elastography values were recorded as well as FIB-4 and APRI were calculated at baseline and SVR12. Results: There was a significant improvement of platelets counts, ALT and AST levels, which in turn cause significant improvement in FIB-4 and APRI scores at SVR12. Liver stiffness measurements were significantly lower in SVR12 (14.8 ± 10.7 vs 11.8 ± 8.8 kPa, P = 0.000). About 77% of responders and 81.1% of cirrhotic patients showed improvement in liver stiffness measurements at SVR12.Univariate and multivari- ate regression analysis showed that failure to achieve improvement in liver stiffness mea- surements were significantly associated with relapsers and low baseline liver stiffness measurement. Conclusion: Sofosbuvir-based treatment resulted in a clinically significant improvement in parameters of liver fibrosis. Introduction Hepatitis C virus infection is one of the main causes of chronic liver disease worldwide. 1 The number of chronically infected persons worldwide is estimated to be about 180 million, but most are unaware of their infection. 2 In recent years, the treatment of HCV has been evolved with the development of direct-acting antiviral (DAAs) therapies, and they have entered the clinical practice in 2014/2015. They showed a promising future for HCV treatment with higher SVR rates, short- ened and simplified regimens, and minimal treatment-related side effects in HCV patients. 3 Regression of liver fibrosis has been a main topic of research and discussion in the community of liver experts for decades. However, recent data have demonstrated the occurrence of fibrosis regression in a wide spectrum of chronic liver diseases including chronic viral hepatitis. 4 Several studies reported that regression of liver fibrosis by using potent antiviral agents in CHC patients could be achieved by improving hepatic necroinflammation and alleviating damage in sustained responders and by slowing the progression in relapsers. 5–7 Nowadays, transient elastography (TE) is a validated non- invasive method for assessing hepatic fibrosis in HCV patients with the advantages of considerable accuracy and reproducibility. 4 Furthermore, the utility of TE has been evaluated in monitoring progression of fibrosis in the setting of HCV recurrence after liver transplantation. 8 Previously, changes in liver stiffness (LS) both during and after IFN-based regimens have been examined by several studies. 9,10 Several non-invasive laboratory methods such as FIB-4 and APRI have been demonstrated to be accurate in staging chronic liver diseases before antiviral treatment and prediction of hepatic fibrosis in HCV patients. 11–13 Moreover, they have been used to longitudinally follow patients with chronic hepatitis and to assess the effect of antiviral treatment. 14 The aim of the present study was to evaluate the impact of Sofosbuvir-based treatment regimens on the changes of LS doi:10.1111/jgh.13758 1624 Journal of Gastroenterology and Hepatology 32 (2017) 1624–1630 © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd