January 11, 2013

Published in Journal Watch Gastroenterology January 11, 2013

Further justification for use of HCV therapies to achieve sustained virologic response

Previous studies suggest that achieving sustained virologic response (SVR) with interferon-based therapy reduces rates of liver failure and liver-related deaths in patients infected with hepatitis C virus (HCV) (JW Gastroenterol Jun 1 2007). To explore whether SVR might also lead to reduction in all-cause mortality — considered the most definitive clinical endpoint — investigators conducted a multinational, long-term cohort study involving 546 consecutive patients who were treated with an interferon-based regimen for advanced fibrosis or cirrhosis. Secondary outcomes were liver failure, liver-related mortality, liver cancer, and transplant. The median follow-up duration was 8.4 years.

Of 530 participants included in analyses (median age, 48; 70% men), 54% had cirrhosis. Thirty-six percent of patients achieved SVR. In comparison with patients who did not achieve SVR, these patients had significantly lower 10-year cumulative rates of all-cause mortality (8.9% vs. 26%) as well as liver-related mortality or transplantation (1.9% vs. 27.4%), liver failure (2.1% vs. 29.9%), and liver cancer incidence (5.1% vs. 21.8%). In multivariate analysis, SVR was independently associated with reduced risk for all-cause mortality (hazard ratio, 0.26; 95% confidence interval, 0.14–0.49) and reduced risk for liver-related mortality or transplantation (HR, 0.06; 95% CI, 0.02–0.19).

Comment: This study provides compelling evidence that successfully clearing HCV is associated with not only improved liver outcomes, but also lower all-cause mortality. Similar findings have been shown in patients coinfected with HIV and HCV (JAMA 2012; 308:370). Although the study population was limited to patients with advanced fibrosis or cirrhosis, this subset of patients with HCV infection is also the most difficult to treat. These findings demonstrate direct clinical benefits of HCV therapy and justify its use to achieve SVR. Moreover, these benefits were achieved with a low number needed to treat of only seven. With the development of more effective, safer regimens, the clinical benefits of SVR should only be greater in the near future.

Atif Zaman, MD, MPH

Citation(s):

van der Meer AJ et al. Association between sustained virological response and all-cause mortality among patients with chronic hepatitis C and advanced hepatic fibrosis. JAMA 2012 Dec 26; 308:2584. (http://jama.jamanetwork.com/article.aspx?articleid=1487498)

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