Thursday, December 27, 2012

Hepatitis C Cirrhosis Patients with Sustained Treatment Response Have Lower Risk of Death

HCV Treatment
Hepatitis C Cirrhosis Patients with Sustained Treatment Response Have Lower Risk of Death

Published on Thursday, 27 December 2012 00:00
Written by Liz Highleyman

Hepatitis C patients with cirrhosis who achieve sustained virological response to interferon-based therapy have a reduced risk of all-cause mortality, liver-related death or transplantation, liver cancer, and liver failure compared with non-responders, according to a study described in the December 26, 2012, issue of JAMA
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HCV Therapy Response Tied to Survival (CME/CE) 12/26/2012 MedPage Today Gastroenterology
(MedPage Today) -- Response to hepatitis C (HCV) treatment is associated with improved survival in patients with advanced disease, researchers reported.
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SVR reduced all-cause mortality risk in patients with HCV, advanced fibrosis
Van der Meer AJ. JAMA. 2012;308:2584-2593.

  • December 26, 2012
Patients with chronic hepatitis C and advanced hepatic fibrosis were less likely to die from any cause or from liver-related issues after achieving sustained virologic response to interferon-based therapy in a recent study

In an international, multicenter study, researchers evaluated 530 patients with chronic HCV and cirrhosis or advanced fibrosis (defined as Ishak scores between 4 and 6), who received interferon-based treatment between 1990 and 2003. Incidence of all-cause or liver-related mortality, liver failure, hepatocellular carcinoma (HCC) and liver transplant was recorded over a median of 8.4 years of follow-up.

Sustained virologic response (SVR) occurred in 36% of cases, including 125 participants who achieved SVR with initial treatment and 67 who experienced SVR with retreatment after a median of 5.8 years.

During follow-up, 113 participants died, including 13 who achieved SVR. Investigators noted a significant difference in the 10-year cumulative all-cause mortality rates for the groups (8.9% for patients who achieved SVR vs. 26% for those who did not, P<.001).
Liver-related death occurred in three SVR cases and 70 non-SVR cases, and liver transplant was not required for patients who achieved SVR. Transplant was necessary for 46 patients without SVR (including 13 who subsequently died). Researchers calculated 10-year cumulative liver transplant or liver-related mortality incidence rates of 27.4% for patients who did not achieve SVR and 1.9% who did. HCC occurred in seven SVR cases and 76 non-SVR cases, for cumulative incidence rates of 5.1% and 21.8%, respectively. Four SVR patients experienced liver failure compared with 111 without SVR, with incidence rates of 2.1% and 29.9%, respectively (P<.001 for all comparisons).

Multivariate analysis indicated associations between SVR and reduced risk for all-cause (HR=0.26, 0.14-0.49) and liver-related mortality or liver transplant (HR=0.06, 0.02-0.19). Patients who achieved SVR also were less likely to develop HCC (aHR=0.19, 0.08-0.44) or liver failure (aHR=0.07, 0.03-0.20) (95% CI for all).

“Our study indicates that SVR was associated with improved overall survival in patients with chronic HCV infection and advanced hepatic fibrosis,” the researchers concluded. “In addition, we were able to further establish and quantify the risk reduction of HCC, liver failure and liver-related mortality or liver transplantation in patients with SVR.”

Disclosure: See the study for a full list of relevant disclosures

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