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Observational Study
. 2021 Sep;28(9):1246-1255.
doi: 10.1111/jvh.13543. Epub 2021 Jul 8.

Uptake of interferon-free DAA therapy among HCV-infected decompensated cirrhosis patients and evidence for decreased mortality

Scott A McDonald  1 , Stephen T Barclay  2 , Hamish A Innes  1 , Andrew Fraser  3   4 , Peter C Hayes  5 , Andrew Bathgate  5 , John F Dillon  6 , April Went  7 , David J Goldberg  1 , Sharon J Hutchinson  1
Affiliations
Observational Study

Uptake of interferon-free DAA therapy among HCV-infected decompensated cirrhosis patients and evidence for decreased mortality

Scott A McDonald et al. J Viral Hepat. 2021 Sep.

Abstract

Interferon-free DAA therapies have recently been licensed for patients infected with hepatitis C virus (HCV) who have decompensated cirrhosis (DC). Our aim was to describe factors associated with uptake of IFN-free DAAs in DC patients and to compare mortality risk and hospital admission rates between pre-DAA and DAA eras. This observational study used record-linkage between Scotland's HCV Clinical Database and national inpatient hospitalization and mortality registers. For the DAA uptake analysis, the study population (n = 297) was restricted to patients alive on 1 November 2014, and Cox regression was used to estimate uptake associated with various covariates. For the Cox regression of mortality comparing pre-DAA and DAA eras, the study population (n = 624) comprised those diagnosed with DC in 2005-2018; follow-up was censored at two years. DAA uptake was 63% overall and was significantly higher for treatment-experienced patients (adjusted hazard ratio (aHR) = 1.64, 95% CI:1.14-2.34), genotype 1 vs. other genotypes (aHR = 1.55. 95% CI:1.15-2.10) and lower for persons diagnosed with DC pre-2014 (0.47, 95% CI:0.33-0.68) and in Greater Glasgow (0.64, 95% CI:0.47-0.88). The intention-to-treat SVR rate was 89% (95% CI:83-93%). All-cause and liver-related mortality risk were significantly reduced among patients diagnosed with DC in the DAA era (November 2014-December 2018) compared with the pre-DAA era (2005-October 2014) (aHRs of 0.68, 95% CI:0.49-0.93; 0.69, 95% CI:0.50-0.95, respectively); in contrast, hospital admission rates were higher in the DAA era (aRR = 1.14, 95% CI:1.04-1.26). The majority of HCV-infected DC patients engaged with specialist services can be treated with IFN-free DAAs. Improved survival among patients diagnosed with DC in the DAA era supports the beneficial impact of IFN-free therapies among those with advanced liver disease.

Keywords: Hepatitis C virus; Scotland; antiviral treatment; decompensated cirrhosis; mortality.

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References

REFERENCES

    1. McDonald SA, Innes HA, Aspinall E, et al. Prognosis of 1169 hepatitis C chronically infected patients with decompensated cirrhosis in the predirect-acting antiviral era. J Viral Hepat. 2017;24(4):295-303.
    1. Alavi M, Janjua NZ, Chong M, et al. The contribution of alcohol use disorder to decompensated cirrhosis among people with hepatitis C: an international study. J Hepatol. 2018;68(3):393-401.
    1. Aspinall EJ, Hutchinson SJ, Janjua NZ, et al. Trends in mortality after diagnosis of hepatitis C virus infection: an international comparison and implications for monitoring the population impact of treatment. J Hepatol. 2015;62(2):269-277.
    1. McDonald SA, Innes HA, Aspinall EJ, et al. Inpatient hospital burden of hepatitis C-diagnosed patients with decompensated cirrhosis. Liver International. 2018;38(8):1402-1410.
    1. Miller MH, Agarwal K, Austin A, et al. 2014 UK consensus guidelines-hepatitis C management and direct-acting antiviral therapy. Aliment Pharmacol Ther. 2014;39(12):1363-1375.

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