DAA treatment ‘longitudinally continues to improve’ liver-related survival in HCV
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Key takeaways:
- Cumulative incidence rates of HCC longitudinally increased over 5 years, although recurrence plateaued.
- Survival rates at 8 years were 67.4% in the HCC-experienced group and more than 90% in the HCC-naive group.
Treatment of chronic hepatitis C virus with direct-acting antivirals improved liver-related morbidity and survival, regardless of hepatocellular carcinoma, although patients aged older than 60 years should be monitored, a presenter noted.
“Treatment of HCV with DAAs results in permanent viral clearance (SVR) in the vast majority of HCV patients,” Eiichi Ogawa, PhD, of Kyushu University Hospital, said at EASL Congress. “Many reports have shown significant reduction in development of HCC and mortality for up to approximately 5 years after SVR.
“In Japan, a huge number of HCV patients were treated with low-cost and unrestricted treatment eligibility, just like the Italian elimination program. However, the age of Japanese patients has progressively increased ahead of other countries.”
In a multicenter, retrospective cohort study, Ogawa and colleagues investigated long-term liver-related outcomes and mortality among patients with chronic HCV who achieved SVR by all-oral DAA treatment from 2014 to 2023. Researchers enrolled 3,024 adults (mean age, 64.8 years) without decompensated cirrhosis, of whom 2,689 were HCC-naive and 333 were HCC-experienced.
Studied outcomes included the development or recurrence of HCC, survival rate and causes of death.
After a median follow-up of 6.5 years, the cumulative rate of de novo HCC incidence longitudinally increased at 3 years (4%), 5 years (5.6%) and 8 years (7%), although rates of recurrence plateaued in nearly 5 years (50.4%, 59.1% and 62%, respectively).
Of 377 patients aged younger than 50 years, none developed de novo HCC; however, the annual rate of HCC development was greater than 1.5% for patients aged 75 years and older.
Conversely, among 536 patients aged 50 years and older with cirrhosis, incidence rates of new HCC were elevated at 3 years (11.2%), 5 years (15.6%) and 8 years (18.9%). Among patients without cirrhosis, the 8-year cumulative incidence of HCC increased with age (50-59 years, 1.8%; 60 years and older, 5.5%; 75 years and older, 8.7%).
Additional factors related to HCC development included male sex (adjusted HR = 2.44; 95% CI, 1.45-4.11) and end-of-treatment alpha-fetoprotein of 7 ng/mL or greater (aHR = 5.59; 95% CI, 3.2-9.77).
Survival rates at 3, 5 and 8 years were 85.2%, 74.6% and 67.4%, respectively, in the HCC-experienced group, with 74% of deaths caused by liver-related complications, mainly HCC recurrence. In the HCC-naive group, 8-year survival was more than 90%, with non-liver-related complications causing 72% of deaths, of which 43% were non-liver cancer and 20% were cerebral/cardiovascular disease.
“In conclusion, DAA treatment longitudinally continues to improve liver-related morbidity and survival,” Ogawa said. “Noncirrhotic patients aged over 60 — at least over 75 — should be monitored regularly over a long period.”
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Ogawa E, et al. Long-term liver morbidity and mortality after HCV elimination by direct-acting antivirals in patients with chronic hepatitis C: Results from a large-scale, multicenter cohort study. Presented at: EASL Congress; June 5-8, 2024; Milan (hybrid).
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