Uptake of interferon-free DAA therapy among HCV-infected decompensated cirrhosis patients and evidence for decreased mortality

Scott A. McDonald (Lead / Corresponding author), Stephen T. Barclay, Hamish A. Innes, Andrew Fraser, Peter C. Hayes, Andrew Bathgate, John F. Dillon, April Went, David J. Goldberg, Sharon J. Hutchinson

Research output: Contribution to journalArticlepeer-review

Abstract

Interferon-free DAA therapies have recently been licensed for patients infected with hepatitis C virus (HCV) who have decompensated cirrhosis (DC). Our aim was to describe factors associated with uptake of IFN-free DAAs in DC patients and to compare mortality risk and hospital admission rates between pre-DAA and DAA eras. This observational study used record-linkage between Scotland's HCV Clinical Database and national inpatient hospitalisation and mortality registers. For the DAA uptake analysis, the study population (n=297) was restricted to patients alive on 1 November 2014, and Cox regression was used to estimate uptake associated with various covariates. For the Cox regression of mortality comparing pre-DAA and DAA eras, the study population (n=624) comprised those diagnosed with DC in 2005-2018; follow-up was censored at two years. DAA uptake was 63% overall, and was significantly higher for treatment-experienced patients (adjusted hazard ratio (aHR)=1.64, 95% CI:1.14-2.34), genotype 1 vs. other genotypes (aHR=1.55. 95% CI:1.15-2.10), and lower for persons diagnosed with DC pre-2014 (0.47, 95% CI:0.33-0.68) and in Greater Glasgow (0.64, 95% CI:0.47-0.88). The intention-to-treat SVR rate was 89% (95% CI:83-93%). All-cause and liver-related mortality risk were significantly reduced among patients diagnosed with DC in the DAA era (Nov 2014-Dec 2018) compared with the pre-DAA era (2005-Oct 2014) (aHRs of 0.68, 95% CI:0.49-0.93; 0.69, 95% CI:0.50-0.95, respectively); in contrast, hospital admission rates were higher in the DAA era (aRR=1.14, 95% CI:1.04-1.26). The majority of HCV-infected DC patients engaged with specialist services can be treated with IFN-free DAAs. Improved survival among patients diagnosed with DC in the DAA era supports the beneficial impact of IFN-free therapies among those with advanced liver disease.

Original languageEnglish
JournalJournal of Viral Hepatitis
DOIs
Publication statusE-pub ahead of print - 18 May 2021

Keywords

  • Hepatitis C virus
  • Decompensated cirrhosis
  • Mortality
  • Antiviral treatment
  • Scotland

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