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SVR Leads to Survival Benefit Among HCV Patients

In a systematic review, researchers found that patients with hepatitis C virus infection who achieved a sustained virologic response after treatment had a survival benefit vs. patients who did not achieve a sustained virologic response, according to published findings.

“Despite the evidence for improved prognosis with SVR, there are some contradictory data suggesting that SVR-achievement does not provide a significant clinical benefit. …There is a need for definitive evidence evaluating the clinical benefit of achieving an SVR in a range of populations, especially given the high cost of interferon-free regimens,” the researchers wrote.

The researchers analyzed data from 31 studies found in the PubMed and Embase databases conducted between 1990 and November 2014. All studies that assessed the prognosis of HCV with treatment and any randomized controlled trial that evaluated the impact of SVR vs. non-SVR was eligible for inclusion in the analysis, according to the research, and the goal was to determine if SVR is a “prognostic factor” for all-cause mortality.

In the studies, 33,360 patients and SVR rates were examined, and the median follow-up time was 5.4 years. The patients in the included studies were predominantly male, had HCV genotype 1 and were between the ages of 40 and 50 years at baseline. All patients had been treated with interferon or pegylated-interferon monotherapy or in combination with ribavirin.

The adjusted hazard ratio of mortality among patients who did achieve SVR compared with patients who did not was 0.5 (95% CI, 0.37-0.67) among the general population, 0.26 (95% CI, 0.18-0.74) among patients with cirrhosis and 0.21 (95% CI, 0.1-0.45) among patients who were coinfected with HIV. SVR had the largest protective effect in the coinfected population, according to the research.

“After adjustment for potential confounding factors, an SVR was associated with approximately a 50%, 74% and 79% decreased risk of all-cause mortality compared with not achieving an SVR in the general, cirrhotic, and coinfected populations respectively,” the researchers wrote.

The researchers found that the pooled 5-year mortality rates in patients who achieved an SVR were lower compared with patients who did not achieve SVR across all three patient populations, with the most significant differences between SVR and non-SVR patients being among the coinfected patients and patients with cirrhosis.

The researchers concluded: “The results of this meta-analysis suggest that there is a significant survival benefit of achieving an SVR compared with unsuccessful treatment. … Although the expectation is that patients achieving SVR with interferon free treatment will have at least as much benefit from SVR as seen in historical studies, post-SVR patients cohorts do not yet have sufficient follow-up time to be helpful. Monitoring these outcomes has been built in to a number of registration trial programs, and further data collection over coming years will be important to build on the studies analyzed here.” – by Melinda Stevens

Disclosures: Simmons reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.