DAA use tied to fewer liver cancers, lower mortality in patients with HCV

Last Updated: 2019-02-18

By Anne Harding

NEW YORK (Reuters Health) - The use of direct acting antivirals (DAA) is associated with reduced mortality and hepatocellular-carcinoma risk in patients with chronic hepatitis C, according to a new study.

"This suggests that DAAs should be considered for all patients with chronic hepatitis C infection," Dr. Fabrice Carrat of the Institut Pierre Louis d'Epidemiologie et de Sante Publique in Paris told Reuters Health by email.

Observational studies have found that treating HCV with DAAs or interferon is linked to reduced risks of liver cancer, liver-disease complications and mortality if patients have a sustained virological response, Dr. Carrat and colleagues note in The Lancet, online February 11.

Concerns about hepatocellular carcinoma were raised after two studies suggested a higher risk of liver-cancer recurrence with DAAs, they add, but subsequent studies found no association.

In the new study, the researchers compared outcomes in HCV patients treated with DAAs and untreated patients in the ANRS CO22 Hepather cohort. Follow-up data was available for nearly 9,900 patients with no history of decompensated cirrhosis, liver cancer or liver transplant, including 7,344 who started taking DAAs and 2,551 untreated patients.

Patients who were on DAAs, on crude analysis, were at significantly increased risk of liver cancer (unadjusted hazard ratio, 2.77) and decompensated cirrhosis (HR, 3.83). After adjustment, however, DAAs were associated with significantly lower all-cause mortality (adjusted HR, 0.48) and hepatocellular carcinoma risk (aHR, 0.66).

The drugs were not significantly associated with decompensated cirrhosis (aHR, 1.14).

"As the most severe patients were those who were prioritized to receive treatment, a crude (unadjusted) comparison of treated versus untreated patients showed that treatment was associated with an increased risk of deaths or liver cancer," Dr. Carrat noted. "Taking into account the severity in the analysis, we showed an inverse association suggesting a protective effect of treatment."

He and his colleagues plan to assess the long-term effects of DAAs on decompensated cirrhosis in cirrhosis patients, residual liver cancer risk, regression of liver fibrosis and morbidity not related to the liver, especially cardiovascular events.

The study received funding from DAA manufacturers, and several of Dr. Carrat's co-authors reported ties to these companies.

SOURCE: https://bit.ly/2V0mTnL

Lancet 2019.