- HCV treatment with direct-acting antivirals (DAAs) reduces risks for early mortality and hepatocellular carcinoma (HCC), according to data from the large prospective French ANRS CO22 Hepather cohort study.
Why this matters
- “These findings firmly counter those of a Cochrane review of [DAA] treatment trials that could neither confirm nor reject if [DAAs] had an effect on long-term HCV-related morbidity and mortality,” writes Raymond T. Chung, MD, in an associated comment.
- Results support universal DAA treatment for HCV.
- Longitudinal multicenter study of 9895 HCV-infected patients (74.2% DAA-treated, 25.8% untreated), followed for 33.4 months (interquartile ratio, 24.0-40.7 months).
- Funding: INSERM-ANRS, ANR, DGS, MSD, Janssen, Gilead, AbbVie, Bristol-Myers Squibb, and Roche.
- 218 patients died, 258 were diagnosed with HCC, and 106 developed decompensated cirrhosis (DC).
- In unadjusted analysis, DAAs were tied to higher odds of HCC (HR=2.77) and DC (HR=3.83; both P<.0001>
- In adjusted analysis, DAAs yielded:
- 52% lower risk for early mortality (aHR=0.48; P=.0001; 40 vs 84 deaths per 10,000 patients), including liver-related (aHR=0.39; P=.0020) and non-liver-related deaths (aHR=0.60; P=.048).
- 34% lower risk for HCC (aHR=0.66, P=.018; 89 vs 129 cases per 10,000 patients).
- No effect on DC risk (P=.72).
- Benefits were consistent among cirrhotic patients (30.8%) with HCV clearance.
- Analysis adjusted for demographics/geography, BMI, infection route, fibrosis score, prior treatment experience, genotype, alcohol use, diabetes, hypertension, biological variables, and model for end-stage liver disease (MELD) score.
- Biopsy rarely used to confirm cirrhosis.
- Potentially underpowered to detect reduced DC.