Thursday, June 6, 2013

HCV treatment improves survival among anemic patients

HCV treatment improves survival among anemic patients

Mohanty A. Clin Gastroenterol Hepatol. 2013;11:741-747.

June 6, 2013
While anemia increased mortality rates among patients with hepatitis C, those who underwent treatment for the infection experienced significantly improved survival in a recent study.

Researchers performed a retrospective analysis of 200,139 veterans with chronic hepatitis C, including 29,510 with anemia, as well as 195,166 controls without HCV. Patients had been enrolled in the Electronically Retrieved Cohort of Hepatitis C-Infected Veterans between 2001 and 2008. HCV treatment was initiated in 1,820 patients with and 17,755 without anemia.

Anemia was more prevalent among patients with HCV than controls (14.7% vs. 12.5%; P<.001). Multivariate analysis indicated significant associations between pretreatment anemia and decompensated liver disease (OR=3.69; 95% CI, 3.53-3.86), chronic kidney disease (OR=3.36; 95% CI, 3.23-3.51) and black race (OR=2.03; 95% CI, 1.95-2.11).

Patients with anemia were significantly less likely to initiate HCV therapy (OR=0.56; 95% CI, 0.56-0.62), with the likelihood of treatment decreasing proportionally with anemia severity (P<.001 for trend).While mortality rates were higher among anemic patients (139.2 per 1,000 person-years vs. 35.9 per 1,000 person-years among those without anemia), treated anemic participants had lower all-cause mortality rates than untreated anemic patients (54.2 per 1,000 person-years vs. 146.8 per 1,000 person-years).

Investigators calculated an adjusted HR of 0.45 (95% CI, 0.39-0.51) for HCV treatment among anemic participants after adjustment for covariates. This risk reduction was similar to that observed among participants without anemia (aHR=0.44; 95% CI, 0.41-0.48), and was not impacted by anemia severity. Sensitivity analysis excluding those with major comorbidities (n=5,925, HCV patients with anemia; n=69,478, without anemia) yielded similar results, including a greater risk reduction among treated participants (HR=0.28; 95% CI, 0.22-0.37).

“Our study shows the importance of identifying and treating individuals with chronic HCV infection who have pretreatment anemia,” the researchers concluded. “Treatment for HCV infection in anemic individuals confers a significant survival advantage after adjusting for numerous comorbidities. A better understanding of pathways that lead to baseline anemia in chronic HCV-infected individuals and targeted therapies to treat this may allow HCV treatment for a higher proportion of individuals.”

Disclosure: The researchers report numerous financial disclosures.

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