Population impact of direct-acting antiviral treatment on new presentations of hepatitis C-related decompensated cirrhosis: a national record-linkage study

Sharon J. Hutchinson, Heather Valerio, Scott A. McDonald, Alan Yeung, Kevin Pollock, Shanley Smith, Stephen Barclay, John F. Dillon, Raymond Fox, Peter Bramley, Andrew Fraser, Nicholas Kennedy, Rory N. Gunson, Kate Templeton, Hamish Innes, Allan McLeod, Amanda Weir, Peter C. Hayes, David Goldberg

Research output: Contribution to journalArticle

Abstract

Objective: Population-based studies demonstrating the clinical impact of interferon-free direct-acting antiviral (DAA) therapies are lacking. We examined the impact of the introduction of DAAs on HCV-related decompensated cirrhosis (DC) through analysis of population-based data from Scotland.

Design: Through analysis of national surveillance data (involving linkage of HCV diagnosis and clinical databases to hospital and deaths registers), we determined i) the scale-up in the number of patients treated and achieving a sustained viral response (SVR), and ii) the change in the trend of new presentations with HCV-related DC, with the introduction of DAAs.

Results: Approximately 11 000 patients had been treated in Scotland over the 8-year period 2010/11 to 2017/18. The scale-up in the number of patients achieving SVR between the pre-DAA and DAA eras was 2.3-fold overall and 5.9-fold among those with compensated cirrhosis (the group at immediate risk of developing DC). In the pre-DAA era, the annual number of HCV-related DC presentations increased 4.6-fold between 2000 (30) and 2014 (142). In the DAA era, presentations decreased by 51% to 69 in 2018 (and by 67% among those with chronic infection at presentation), representing a significant change in trend (rate ratio 0.88, 95% CI 0.85 to 0.90). With the introduction of DAAs, an estimated 330 DC cases had been averted during 2015-18.

Conclusions: National scale-up in interferon-free DAA treatment is associated with the rapid downturn in presentations of HCV-related DC at the population-level. Major progress in averting HCV-related DC in the short-term is feasible, and thus other countries should strive to achieve the same.

Original languageEnglish
Article number320007
Pages (from-to)1-9
Number of pages9
JournalGut
Early online date26 Mar 2020
DOIs
Publication statusE-pub ahead of print - 26 Mar 2020

Keywords

  • antiviral therapy
  • cirrhosis
  • hepatitis C
  • linkage analysis
  • surveillance

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    Hutchinson, S. J., Valerio, H., McDonald, S. A., Yeung, A., Pollock, K., Smith, S., Barclay, S., Dillon, J. F., Fox, R., Bramley, P., Fraser, A., Kennedy, N., Gunson, R. N., Templeton, K., Innes, H., McLeod, A., Weir, A., Hayes, P. C., & Goldberg, D. (2020). Population impact of direct-acting antiviral treatment on new presentations of hepatitis C-related decompensated cirrhosis: a national record-linkage study. Gut, 1-9. [320007]. https://doi.org/10.1136/gutjnl-2019-320007