Backus LI, et al. - The impact of sustained virologic response (SVR) achieved with interferon-free direct-acting antiviral (DAA) treatment was evaluated on all-cause mortality in hepatitis C (HCV) infected patients without advanced liver disease. In patients without clinically apparent advanced liver disease, successfully treating HCV with DAAs manifested as a significant mortality benefit.

Methods

• The design of this study was an observational cohort analysis.
• The study comprised of 103,346 genotype 1, 2 and 3, HCV-monoinfected patients without advanced liver disease, defined by FIB-4 ≤3.25 and no diagnosis of cirrhosis, hepatic decompensation, hepatocellular carcinoma or history of liver transplantation, identified from the Veterans Affairs Hepatitis C Clinical Case Registry.

Results

• A total of 39,374 patients (96.8%) achieved SVR and 1,290 (3.2%) patients were No SVR among 40,664 patients treated with interferon-free DAA regimens.
• In this study, 62,682 patients constituted the untreated cohort.
• For SVR patients, the mortality rate was 1.18 deaths/100 patient years, which was significantly lower than the rate for No SVR patients (2.84 deaths/100 patient years)(p < 0.001) and untreated patients (3.84 deaths/100 patient years)(p < 0.001).
• Reduction in mortality rates in SVR patients with FIB-4 <1.45 and 1.45-3.25 was 46.0% (p=0.036) and 63.2% (p < 0.001), respectively, compared to No SVR patients which was a 66.7% (p < 0.001) and 70.6% (p < 0.001) reduction in mortality rates, respectively, compared to untreated patients.
• SVR was independently correlated with reduced risk of death compared to No SVR (hazard ratio (HR) 0.44, 95% confidence interval (CI) 0.32-0.59, p < 0.001) and compared to untreated patients (HR 0.32, 95%CI 0.29-0.36, p < 0.001), in multivariate Cox proportional hazard models controlling for baseline demographics, clinical characteristics and comorbidities.