Direct-Acting Antivirals Cut Mortality in Chronic Hepatitis C
Mortality, hepatocellular carcinoma risk reduced after adjustment for potential confounders
TUESDAY, Feb. 12, 2019 (Pharmacist's Briefing) -- For adults with chronic hepatitis C virus (HCV) infection, direct-acting antivirals are associated with a reduced risk for mortality and hepatocellular carcinoma, according to a study published online Feb. 11 in The Lancet.
Fabrice Carrat, Ph.D., from the Sorbonne Université in Paris, and colleagues conducted a prospective study to compare the incidence of all-cause mortality, hepatocellular carcinoma, and decompensated cirrhosis for patients with chronic HCV treated with direct-acting antivirals and untreated patients. A total of 9,895 patients were included in the analyses and were followed for a median of 33.4 months.
During follow-up, 7,344 patients initiated treatment with direct-acting antivirals and 2,551 remained untreated at the final follow-up. The researchers found that exposure to direct-acting antivirals correlated with elevated risk for hepatocellular carcinoma (unadjusted hazard ratio, 2.77; 95 percent confidence interval, 2.07 to 3.71) and decompensated cirrhosis (unadjusted hazard ratio, 3.83; 95 percent confidence interval, 2.29 to 6.42). Exposure to direct-acting antivirals correlated with reduced all-cause mortality and hepatocellular carcinoma (adjusted hazard ratios, 0.48 [95 percent confidence interval, 0.33 to 0.70] and 0.66 [95 percent confidence interval, 0.46 to 0.93) but was not associated with decompensated cirrhosis (hazard ratio, 1.14; 95 percent confidence interval, 0.57 to 2.27) after adjustment for confounding variables.
"Because of the observational design of our study, we cannot formally conclude that inverse associations between direct-acting antiviral treatment and mortality or incidence of hepatocellular carcinoma reflect cause and effect relations," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry, including companies that provided study funding.