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Liver cancer, mortality risks decrease with SVR after direct-acting antivirals

Patients who achieved sustained virologic response after direct-acting antiviral treatment also had significantly lower all-cause mortality and lower incident rates of hepatocellular carcinoma compared with patients who did not achieve SVR.

“In this evaluation, the high SVR rates attained with oral DAAs translated into an all-cause mortality benefit after adjusting for numerous baseline patient characteristics and comorbidities,” Lisa I. Backus, MD, PhD, from the Department of Veterans Affairs, Palo Alto, and colleagues wrote. “These findings strongly support a clinically significant benefit of DAA treatment in patients with advanced liver disease irrespective of HCV genotype. As more people are treated for HCV infection with DAAs, fewer deaths should result in this population.”

The study comprised 15,059 patients with HCV from the Veterans Affairs Clinical Case Registry who stopped DAA treatment by Sept. 30, 2016. Among those, 13,992 achieved SVR while 1,067 had virologic failure (n = 355) or a relapse of HCV infection (n = 712). Patients who did not achieve SVR had more severe liver disease compared with those with SVR.

Researchers observed a significant association between achieving SVR and reduced all-cause mortality (HR = 0.26; 95% CI, 0.22-0.31). They also found a link between SVR and a 78.9% reduction in deaths per 100 patient years of follow-up and a 79.6% reduction in one-year mortality for all genotypes combined.

In a multivariable model, data revealed a link between albumin levels below 3 g/dL (HR = 3.86; 95% CI, 3.21-4.65) and from 3 g/dL to 3.4 g/dL (HR = 2.01; 95% CI, 1.69-2.4) and with an increased risk for death vs. levels of 3.5 g/dL or higher. The data further showed an association between decreasing levels of estimated glomerular filtration rate and an increased risk for death.

During follow-up, SVR correlated with a delayed time until development of initial HCC (P < .001) and with an 83.5% reduction in HCC incident per 100 patient years. Among those with prior HCC who did not achieve SVR there were 21 deaths per 100 patient years (95% CI, 14.9-28.7) compared with 7.5 deaths per 100 patient years (95% CI, 5.9-9.5) among those with prior HCC who achieved SVR, representing a 64.3% reduction in rate of deaths (P < .001). Similarly, those with prior HCC and without SVR had a rate of 10.1 deaths per 100 patient years (95% CI, 8.4-11.9) compared with 2.3 deaths per 100 patient years (95% CI, 2.1-2.5) among those without prior HCC who achieved SVR (P < 0.001). – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.