Direct-acting antivirals reduce the risk of premature death and liver cancer among people with chronic hepatitis C, according to a major new analysis of treatment effectiveness published today.
The first prospective, longitudinal study investigating treatment of chronic hepatitis C with direct-acting antivirals has demonstrated the clinical effectiveness of the drugs on the disease.
The French research, published in The Lancet, concludes that antivirals should be considered for all patients with chronic hepatitis C, a virus that can lead to cirrhosis, liver disease and hepatocellular carcinoma.
The observational study, undertaken at the Sorbonne Université, involved 10,166 patients, all of whom were recruited from 32 centres in France.
At a median of 33 months, 9,895 patients had available follow-up information and were included in the analysis. Of those, 7,344 had been treated with direct-acting antivirals and 2,551 were untreated.
During follow-up, 218 patients died (129 treated, 89 untreated), 258 reported hepatocellular carcinoma (187 treated, 71 untreated), and 106 had decompensated cirrhosis (74 treated, 32 untreated).
The study found that direct-acting antiviral treatment was associated with reduced risk for global mortality and hepatocellular cancer, but not decompensation of cirrhosis.
Patients who were treated were 52% less likely to die prematurely than people who were not treated and 33% less likely to present with hepatocellular carcinoma.
And in a subgroup of 3,045 patients with cirrhosis at baseline, the same association was found for mortality and hepatocellular cancer, if the patients achieved an undetectable level of HCV in their blood.
The researchers believe this is because the treatment induces a sustained virological response, allowing the liver to regenerate which decreases risk.
Professor Fabrice Carrat, of the Sorbonne Université, said: “Taking a large cohort like this provides the opportunity to evaluate the effect of direct-acting antiviral therapy on the long-term outcomes of patients with hepatitis C. We saw a reduction of risk for complications related to the disease, and to mortality, and believe this treatment should be considered for all patients with chronic hepatitis C infection.”
Carrat F, Fontaine H, Dorival C et al. Clinical outcomes in patients with chronic hepatitis C after direct-acting antiviral treatment: a prospective cohort study. The Lancet 12 February 2019.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32111-1/fulltext
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