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Comparative Study
. 2019 Nov;157(5):1253-1263.e2.
doi: 10.1053/j.gastro.2019.07.040. Epub 2019 Jul 30.

Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma

Amit G Singal  1 , Nicole E Rich  2 , Neil Mehta  3 , Andrea D Branch  4 , Anjana Pillai  5 , Maarouf Hoteit  6 , Michael Volk  7 , Mobolaji Odewole  2 , Steven Scaglione  8 , Jennifer Guy  9 , Adnan Said  10 , Jordan J Feld  11 , Binu V John  12 , Catherine Frenette  13 , Parvez Mantry  14 , Amol S Rangnekar  15 , Omobonike Oloruntoba  16 , Michael Leise  17 , Janice H Jou  18 , Kalyan Ram Bhamidimarri  19 , Laura Kulik  20 , George N Ioannou  21 , Annsa Huang  3 , Tram Tran  22 , Hrishikesh Samant  23 , Renumathy Dhanasekaran  24 , Andres Duarte-Rojo  25 , Reena Salgia  26 , Sheila Eswaran  27 , Prasun Jalal  28 , Avegail Flores  29 , Sanjaya K Satapathy  30 , Sofia Kagan  2 , Purva Gopal  31 , Robert Wong  32 , Neehar D Parikh  33 , Caitlin C Murphy  2
Affiliations
Comparative Study

Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma

Amit G Singal et al. Gastroenterology. 2019 Nov.

Abstract

Background & aims: There is controversy regarding the benefits of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection for patients with a history of hepatocellular carcinoma (HCC). We performed a multicenter cohort study to compare overall survival between patients with HCV infection treated with DAAs and patients who did not receive DAA treatment for their HCV infection after complete response to prior HCC therapy.

Methods: We conducted a retrospective cohort study of patients with HCV-related HCC who achieved a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy, from January 2013 through December 2017 at 31 health care systems throughout the United States and Canada. We used Cox proportional hazards regression to determine the association between receipt of DAA therapy, modeled as a time-varying covariate, and all-cause mortality, accounting for informative censoring and confounding using inverse probability weighting.

Results: Of 797 patients with HCV-related HCC, 383 (48.1%) received DAA therapy and 414 (51.9%) did not receive treatment for their HCV infection after complete response to prior HCC therapy. Among DAA-treated patients, 43 deaths occurred during 941 person-years of follow-up, compared with 103 deaths during 526.6 person-years of follow-up among patients who did not receive DAA therapy (crude rate ratio, 0.23; 95% confidence interval [CI], 0.16-0.33). In inverse probability-weighted analyses, DAA therapy was associated with a significant reduction in risk of death (hazard ratio, 0.54; 95% CI, 0.33-0.90). This association differed by sustained virologic response to DAA therapy; risk of death was reduced in patients with sustained virologic response to DAA therapy (hazard ratio, 0.29; 95% CI, 0.18-0.47), but not in patients without a sustained virologic response (hazard ratio, 1.13; 95% CI, 0.55-2.33).

Conclusions: In an analysis of nearly 800 patients with complete response to HCC treatment, DAA therapy was associated with a significant reduction in risk of death.

Keywords: HCC; Hepatitis C; Liver Cancer; Survival.

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Figures

Figure 1.
Figure 1.
Study cohort inclusion and exclusion diagram
Figure 2.
Figure 2.
Overall survival, stratified by receipt of direct acting antiviral hepatitis C therapy
See this image and copyright information in PMC

Comment in

References

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