DAA Therapy Associated With Higher Survival in HCV-Related Comorbidities

Patients with hepatitis C virus (HCV) and comorbidities, including hepatocellular carcinoma (HCC), clinically significant portal hypertension, and cirrhosis were shown to have significantly higher survival rates when treatment included directly acting antiviral agent (DAA) therapy, according to the results of several studies presented at the American Association for the Study of Liver Diseases’ The Liver Meeting, held November 8 to 12, 2019, in Boston, Massachusetts.

While the positive effect of DAA therapy for reducing mortality in HCV has been previously established, there is limited data on survival outcomes related to various HCV-related comorbidities in patients who received DAA therapy. The studies reported comparisons of survival rates between patients with HCV and HCV-related comorbidities who received DAA therapy vs counterparts who were not treated for comorbidities and/or did not receive DAA therapy.

In one study, researchers identified patients with HCV in the ERCHIVES database for whom the cause of death was a comorbid illness (HCC, clinically significant portal hypertension, or cirrhosis).¹ Patient response to various treatments were evaluated and compared with response to treatments that included DAA therapy. Researchers used this data to calculate survival rates of patients receiving DAA therapy compared with those who did not.

Results revealed that liver-related mortality in HCV was lower among those who received DAA therapy and achieved sustained virologic response as compared with those who received other treatments (0.31 per 100 person-years vs 0.76).¹ Further, stratification data demonstrated that differences in mortality between treatment regimens were significantly driven by attainment of sustained virologic response. In fact, compared with patients who did not receive treatment, those who developed sustained virologic response had a significantly higher 5-year overall survival (66.05% vs 87.78%).² In patients with HCV-related HCC, sustained virologic response with DAA therapy was independently associated with reduced mortality when compared with no HCV treatment, with hazard ratios ranging between 0.22 and 0.44 (P <.05).² 

Another study evaluating the effects of DAA in HCV-related HCC revealed that the median time from HCV-related HCC complete response to death in patients treated with DAA was 25.7 months (interquartile range [IQR], 19.4-33.9) vs 11.5 months (IQR, 7.1-20.2) in untreated patients.³ Results of this study also demonstrated a significantly reduced mortality associated with DAA therapy (HR, 0.39); again, this relationship was attributed to the achievement of sustained virologic response in patients receiving such treatment (HR, 0.55; 95% CI, 0.31-0.97).

In patients with HCV-related clinically significant portal hypertension, DAA therapy was found sufficient at reducing decompensation and liver-related deaths without the additional need for nonselective β-blockers.

The study researchers concluded that DAA therapy drives higher sustained virologic response rates in HCV and significantly reduces mortality rates associated with HCV-related comorbidities, and that DAA therapy should be considered for appropriate candidates.

References

1. Butt A, Yan P, Aslam S, Lo Re V, Shaikh OS. DAA regimens are associated with significant reduction in liver related mortality driven largely by higher SVR rates: results from the Erchives cohort. Presented at: American Association for the Study of Liver Diseases: The Liver Meeting; November 8-12, 2019; Boston, MA. Abstract 0039.

2. Dang H, Yeo YH, Yasuda S, et al. HCV cure by all oral DAA improves 5-year overall and liver-related survival in HCV-related HCC patients: a real-world, propensity score-matched study from both east and west. Presented at: American Association for the Study of Liver Diseases: The Liver Meeting; November 8-12, 2019; Boston, MA. Abstract 0040.

3. Singal AG, Rich NE, Mehta N, et al. Direct-acting antiviral therapy is associated with improved survival in patients with a history of hepato cellular carcinoma: a multicenter North American cohort study. Presented at: American Association for the Study of Liver Diseases: The Liver Meeting; November 8-12, 2019; Boston, MA. Abstract 0199.

4. Tosetti G, Degasperi E, Farina E, et al. Low risk of decompensation in HCV-related compensated cirrhotics with clinical significant portal hypertension followed up to 4 years after DAA induced SVR. Presented at: American Association for the Study of Liver Diseases: The Liver Meeting; November 8-12, 2019; Boston, MA. Abstract 0406.