HCV: DAAs slash risk for early death, HCC in ANRS CO22

  • Lancet
  • 11 Feb 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • 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.

Study design

  • 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.    

Key results

  • 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.

Limitations

  • Biopsy rarely used to confirm cirrhosis.
  • Potentially underpowered to detect reduced DC.

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