Direct-acting antiviral treatment, SVR attainment reduce mortality in HCV
Treatment with direct-acting antiviral regimens (paritaprevir/ritonavir, ombitasvir and dasabuvir [PrOD] or ledipasvir/sofosbuvir [LDV/SOF]) and attainment of sustained virologic response (SVR) are associated with a significant mortality benefit, which is evident within the first 18 months of treatment, in patients with hepatitis C virus (HCV) infection, a study has found.
Researchers examined a national cohort of HCV-infected veterans and identified 1,473 patients on PrOD and 5,497 on LDV/SOF. These patients were propensity score–matched to 6,970 untreated patients. Exclusion criteria were infection with human immunodeficiency virus, hepatitis B surface antigen positivity, hepatocellular carcinoma, or missing HCV RNA or FIB-4 scores.
The main study outcome was survival, assessed using frequency of events, Kaplan-Meier curves and Cox proportional hazards regression analyses.
Compared with untreated patients, those who were on PrOD or LDV/SOF were more likely to be obese and have cirrhosis, but less likely to have stage 3 to 5 chronic kidney disease (CKD), alcohol or drug abuse or dependence diagnosis, and anaemia.
Significantly more patients died in the untreated group than in either treatment group (0.3 percent in PrOD and 1.4 percent in LDV/SOF vs 2.5 percent; p<0.001). Treated patients were more likely to survive to 18 months of follow-up compared with untreated controls (p<0.001).
Multivariable Cox regression analysis found treatment with either regimen and attainment of SVR to be associated with a significant reduction in mortality. The respective hazard ratios were 0.43 (95 percent CI, 0.33 to 0.57) and 0.57 (0.33 to 0.99).
Management of patients with chronic HCV infection is said to have been revolutionized by the development of newer oral direct-acting antiviral agents. Numerous agents are now approved for use in various combinations, showing reliability in terms of achieving SVR rates of >90 percent. [Aliment Pharmacol Ther 2016;43:1276–92; http://www.fda.gov/forpatients/illness/hepatitisbc/ucm408658.htm]