Impact of Sustained Virologic Response with Direct‐Acting Antiviral Treatment on Mortality in Patients with Advanced Liver Disease

• Published in: Hepatology (Baltimore, Md.) Vol. 69; no. 2; pp. 487 - 497
• Main Authors: Backus, Lisa I., Belperio, Pamela S., Shahoumian, Troy A., Mole, Larry A.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.02.2019
• Subjects: Adult; Aged; Aged, 80 and over; Antiviral Agents - therapeutic use; Cohort Studies; Confidence intervals; Demography; Female; Health risk assessment; Hepatitis C; Hepatitis C - drug therapy; Hepatitis C - mortality; Hepatitis C - virology; Hepatocellular carcinoma; Hepatology; Humans; Liver diseases; Male; Middle Aged; Mortality; Patients; Sustained Virologic Response; United States - epidemiology; United States
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.29408

The impact of sustained virologic response (SVR) on mortality after direct‐acting antiviral treatment is not well documented. This study evaluated the impact of direct‐acting antiviral–induced SVR on all‐cause mortality and on incident hepatocellular carcinoma (HCC) in 15,059 hepatitis C virus–infected patients with advanced liver disease defined by a FIB‐4 >3.25. Overall, 1,067 patients did not achieve SVR (no SVR) and 13,992 patients achieved SVR. In a mean follow‐up period of approximately 1.6 years, 195 no SVR patients and 598 SVR patients died. Mortality rates were 12.3 deaths/100 patient years of follow‐up for no SVR patients and 2.6 deaths/100 patient years for SVR patients, a 78.9% reduction (P < 0.001). Among patients without a prior diagnosis of HCC, 140 no SVR patients and 397 SVR patients were diagnosed with incident HCC. HCC rates were 11.5 HCCs/100 patient years for no SVR patients and 1.9 HCCs/100 patient years for SVR patients, an 83.5% reduction (P < 0.001). In multivariable Cox proportional hazard models controlling for baseline demographics, clinical characteristics, and comorbidities, SVR was independently associated with reduced risk of death compared to no SVR (hazard ratio, 0.26; 95% confidence interval, 0.22‐0.31; P < 0.001). A history of decompensated liver disease (hazard ratio, 1.57; 95% confidence interval, 1.34‐1.83; P < 0.001) and decreased albumin (hazard ratio, 2.70 per 1 g/dL decrease; 95% confidence interval, 2.38‐3.12; P < 0.001) were independently associated with increased risk of death. Conclusion: Those achieving SVR after direct‐acting antiviral treatment had significantly lower all‐cause mortality and lower incident HCC rates than those who did not achieve SVR.