Direct-Acting Antiviral Therapy Lowers Mortality, Cancer Risk in Patients With Hepatitis C

According to a recent study, the use of direct-acting antivirals in patients with chronic hepatitis C (CHC) improves liver and nonliver outcomes and lowers the risk of hepatitis C-related mortality and cancer risk.

There is limited data on the effects of direct-acting antiviral treatment on morbidity and mortality rates in patients with CHC. In a retrospective cohort study, Ogawa and colleagues determined the association between hepatitis C elimination using direct-acting antiviral treatment and the risk of liver and nonliver morbidity and mortality.

The study included the data of 245,596 adult patients with CHC. Patients who were treated with one or more prescriptions of direct-acting antivirals (n = 40,654) were compared with patients who were left untreated (n = 204, 942). The researchers analyzed the incidence rates for liver outcomes (cirrhosis, liver decomposition, and hepatocellular carcinoma [HCC]), and nonliver outcomes (nonliver cancer, diabetes, chronic kidney disease [CKD], cardiovascular disease [CVD]).

The researchers found that the incidence rates of liver outcomes were lower in treated patients than in untreated patients. Additionally, the incidence rate for those with CKD and diabetes was lower in the direct-acting antiviral group. Further, in a multivariable regression analysis, direct-acting antiviral therapy was independently associated with a decrease in the risk for HCC, diabetes, chronic kidney disease, cardiovascular disease, nonliver cancer, and mortality. Indeed, the mortality rate in patients who were left untreated was twice as high as patients who were treated with direct-acting antivirals.

The researchers noted several limitations in their study, including the fact that the study only involved patients diagnosed with hepatitis C covered by private insurance. As a result, the findings may not be generalizable to patients who are underinsured or not insured. Despite the limitations, the researchers emphasize the overall importance of their findings.

“This retrospective cohort study provides nationwide, large-scale, clinical data results consistent with the improved outcomes of [direct-acting antivirals] therapy for insured patients with CHC—not just liver-related complications of HCC and liver decompensation but also for nonliver diseases,” the researchers concluded. “The study findings also highlight a substantial need to provide [direct-acting antivirals] therapy to all patients with HCV, regardless of disease stage or financial status.”

Reference:

Ogwa E, Chien N, Kam L, et al. Association of direct-acting antiviral therapy with liver and nonliver complications and long-term mortality in patients with chronic hepatitis C. JAMA Intern Med. Published online December 12, 2022. doi:10.1001/jamainternmed.2022.5699