Study highlights 'substantial need' to provide DAA therapy to all patients with HCV
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Direct-acting antiviral treatment significantly lowered the risk for mortality and liver and non-liver outcomes in patients with chronic hepatitis C virus infection, regardless of disease stage, researchers reported.
“Since 2014, major improvements have been made in therapies for HCV, most notably direct-acting antiviral agents,” Eiichi Ogawa, MD, PhD, of the department of general internal medicine at Kyushu University Hospital in Japan, and colleagues wrote in JAMA Internal Medicine. “HCV elimination by DAAs has been associated with significant reductions in the risk of certain non-liver diseases such as diabetes.
“However, the effects of DAAs on most non-liver comorbidities have not been well documented. In addition, data for long-term outcomes after DAA treatment are limited.”
In a large-scale, retrospective cohort study, Ogawa and colleagues analyzed 245,596 insured U.S. patients (mean age, 58.7 years; 41% women) with chronic HCV using the Optum Clinformatics Data Mart database to assess the association between DAA treatment and the risk for long-term liver and non-liver morbidity and mortality. Of the total cohort, 40,654 patients (mean age, 59.9 years; 61.6% men) had received at least one prescription for DAAs and 204,942 patients (mean age, 58.5 years; 58.4% men) were untreated.
At baseline, DAA-treated patients were more likely to have compensated cirrhosis (44.2% vs. 29.3%), hepatocellular carcinoma (3.1% vs. 2.4%) and/or diabetes (26.3% vs. 25.4%). They also had a “significantly higher” Charlson comorbidity index (4 vs. 3.3).
According to study results, patients in the treatment group had lower incidence of liver-related outcomes such as decompensation (28.2/1,000 person-years; 95% CI, 27-29.4 vs. 40.8/1,000 person-years; 95% CI, 40.1-41.5) and HCC in compensated cirrhosis (20.1; 95% CI, 18.4-21.9 vs. 41.8; 95% CI, 40.3-43.3), as well as non-liver outcomes such as diabetes (30.2; 95% CI, 35.4-37.7 vs. 37.2; 95% CI, 36.6-37.9) and chronic kidney disease (31.1; 95% CI, 29.9-32.2 vs. 34.1; 95% CI, 33.5-34.7).
Notably, researchers reported that the all-cause mortality rate nearly doubled in untreated patients compared with patients treated with DAAs (64.7 deaths/1,000 person-years; 95% CI, 63.9-65.4 vs. 36.5; 95% CI, 35.4-37.7).
Multivariable regression analysis also showed DAA treatment was independently associated with a decreased risk for liver (HCC adjusted HR = 0.73 and decompensation aHR = 0.36), non-liver (diabetes aHR = 0.74, CKD aHR = 0.81, cardiovascular disease aHR = 0.9 and non-liver cancer aHR = 0.89) and mortality outcomes (aHR = 0.43).
“The study findings also highlight a substantial need to provide DAA therapy to all patients with HCV, regardless of disease stage or financial status,” Ogawa and colleagues concluded. “Additional national efforts are needed to reach and treat U.S. population groups that are underinsured or not insured, incarcerated and otherwise marginalized, such as users of illicit drugs, who are also at higher risk of disease complication and reinfection.”
They added, “Our findings advocate for continued efforts to promote hepatitis C screening and early diagnosis and treatment — prior to the onset of chronic HCV complications — to prevent liver and non-liver morbidity and mortality.”
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