Source:

Carrat F, et al. The Lancet. 2019;doi:10.1016/s0140-6736(18)32111-1.

February 11, 2019
2 min read
Save

DAA therapy regardless of SVR reduces hepatic, extrahepatic mortality

Source:

Carrat F, et al. The Lancet. 2019;doi:10.1016/s0140-6736(18)32111-1.

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Results of a prospective study showed that treatment with direct-acting antivirals for hepatitis C correlated with significantly reduced risks for hepatocellular carcinoma and mortality, according to a study published in The Lancet.

“We saw a reduction of risk for complications related to the disease, and to mortality, and believe this treatment should be considered for all patients with chronic hepatitis C infection,” Fabrice Carrat, MD, PhD, from Sorbonne University in France, and lead study author, said in a press release.

Carrat and colleagues reviewed the data and follow-up data of 9,895 initially untreated patients with HCV who had been recruited to the ANRS CO22 Hepather cohort between Aug. 6, 2012, and Dec. 31, 2015. Median follow-up from recruitment to post-DAA treatment was 33.4 months.

During follow-up, 218 patients died including 73 liver-related deaths. The researchers also reported 258 cases of HCC and 106 cases of decompensated cirrhosis. Twenty-five patients underwent liver transplantation.

Multivariate analysis showed that exposure to DAAs correlated with a decreased risk for all-cause mortality (HR = 0.48; 95% CI, 0.33-0.7), liver-related death (HR = 0.39; 95% CI, 0.21-0.71), non-liver-related death (HR = 0.6; 95% CI, 0.36-1), and HCC (HR = 0.66; 95% CI, 0.46-0.93).

The sustained virologic response rate was 94% after excluding patients who were lost to follow-up or outcome was otherwise unknown.

“A striking finding in our study was the lower risk for non-liver-related mortality in patients treated with direct-acting antivirals compared with untreated patients,” Carrat and colleagues wrote. “Although a decrease in long-term non-liver-related mortality has been reported in patients with sustained virological response compared with those without a sustained virological response after interferon-based therapy, reverse causality could be another possibility if patients with the most severe liver disease and the highest risk for death from any cause had a lower probability of starting direct-acting antiviral treatment.”

Results from a further multivariate analysis comparing treated patients with untreated patients, SVR correlated with a significant decrease in all-cause mortality, liver-related mortality, non-liver-related mortality and HCC. In contrast, not achieving SVR correlated with a significant increase in the risk for HCC (HR = 2.23; 95% CI, 1.37-3.64).

“Direct-acting antivirals induce a sustained virological response, reducing liver damage and inflammation. This eect causes liver regeneration, decreasing risk for progression to liver-related complications or hepatocellular carcinoma,” the researchers concluded. – by Talitha Bennett

Disclosure: Carrat reports grants from INSERM-ANRS during the conduct of the study. Please see the full study for the other authors’ relevant financial disclosures.