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SVR for HCV with no advanced liver disease greatly reduces mortality risk
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Patients with hepatitis C without advanced liver disease who achieved sustained virologic response with direct-acting antiviral therapy had significantly reduced all-cause mortality rates compared with both treated patients who did not achieve SVR and untreated patients, according to a recently published data.
“Considering recent controversy surrounding the benefit of HCV direct-acting antiviral (DAA) therapy, there is a need for evidence demonstrating the mortality impact of DAAs with sustaining virologic response (SVR),” Lisa I. Backus, MD, PhD, from the Palo Alto Department of Veterans Affairs, California, told Healio Gastroenterology and Liver Disease. “A recent study by the Department of Veterans Affairs Population Health Services evaluated the impact of SVR achieved with all oral DAAs on all-cause mortality in more than 40,000 veterans without clinical evidence of advanced chronic liver disease.”
The study comprised 40,664 monoinfected patients with HCV genotype 1, 2 or 3 without advanced liver disease who received DAA therapy through Veterans Affairs. Harvoni (ledipasvir/sofosbuvir, Gilead Sciences) was the most commonly prescribed DAA (65%). At the end of treatment, 1,290 patients did not achieve SVR.
Backus and colleagues also included in the study 60,682 monoinfected patients with HCV and no advanced liver disease who did not receive treatment. Compared with those who received treatment, untreated patients had lower BMI, lower alanine aminotransferase and aspartate aminotransferase levels, higher platelet counts, higher estimated glomerular filtration rate and fewer comorbidities (P < .001 for all).
During follow-up, mortality rates were 1.6% among patients who achieved SVR with DAA treatment, 3.6% among those without SVR and 5% among the untreated patients.
SVR correlated with a 58.5% reduction in mortality vs. treatment without SVR (P < .001), and a 69.3% reduction in mortality vs. no treatment (P < .001).
Compared with treated patients without SVR, treated patients with SVR and a Fibrosis-4 index less than 1.45 had a 46% reduction in mortality (P = .036), and those with a FIB-4 index between 1.45 and 3.25 had a 63.2% reduction in mortality (P < .001). Similarly, those with SVR and FIB-4 index less than 1.45 had a 66.7% reduction in mortality (P < .001) compared with untreated patients, and those with FIB-4 index between 1.45 and 3.25 had a 70.6% reduction in mortality (P < .001) vs. untreated patients.
A multivariate analysis showed that SVR independently correlated with a significantly reduced risk for all-cause mortality, compared with both the untreated group (HR = 0.32; 95% CI, 0.29-0.36) and the treated patients without SVR (HR = 0.44; 95% CI, 0.32-0.59).
Additionally, treated patients without SVR also had a reduced risk for all-cause mortality compared with untreated patients (HR = 0.74; 95% CI, 0.55-0.99).
“Data from this study demonstrates that successfully treating HCV before the development of clinically apparent advanced liver disease translates into a significant mortality benefit,” Backus said. “Increasing access to DAAs for all HCV-infected individuals, regardless of stage of liver disease, should result in fewer deaths.” – by Talitha Bennett
Disclosure: The authors report no relevant financial disclosures.