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- Title
Clinical outcomes after treatment with direct antiviral agents: beyond the virological response in patients with previous HCV-related decompensated cirrhosis.
- Authors
Pageaux, Georges-Philippe; Nzinga, Clovis Lusivika; Ganne, Nathalie; Samuel, Didier; Dorival, Céline; Zoulim, Fabien; Cagnot, Carole; Decaens, Thomas; Thabut, Dominique; Asselah, Tarik; Mathurin, Philippe; Habersetzer, François; Bronowicki, Jean-Pierre; Guyader, Dominique; Rosa, Isabelle; Leroy, Vincent; Chazouilleres, Olivier; de Ledinghen, Victor; Bourliere, Marc; Causse, Xavier
- Abstract
<bold>Background: </bold>In HCV-infected patients with advanced liver disease, the direct antiviral agents-associated clinical benefits remain debated. We compared the clinical outcome of patients with a previous history of decompensated cirrhosis following treatment or not with direct antiviral agents from the French ANRS CO22 HEPATHER cohort.<bold>Methods: </bold>We identified HCV patients who had experienced an episode of decompensated cirrhosis. Study outcomes were all-cause mortality, liver-related or non-liver-related deaths, hepatocellular carcinoma, liver transplantation. Secondary study outcomes were sustained virological response and its clinical benefits.<bold>Results: </bold>559 patients met the identification criteria, of which 483 received direct antiviral agents and 76 remained untreated after inclusion in the cohort. The median follow-up time was 39.7 (IQR: 22.7-51) months. After adjustment for multivariate analysis, exposure to direct antiviral agents was associated with a decrease in all-cause mortality (HR 0.45, 95% CI 0.24-0.84, p = 0.01) and non-liver-related death (HR 0.26, 95% CI 0.08-0.82, p = 0.02), and was not associated with liver-related death, decrease in hepatocellular carcinoma and need for liver transplantation. The sustained virological response was 88%. According to adjusted multivariable analysis, sustained virological response achievement was associated with a decrease in all-cause mortality (HR 0.29, 95% CI 0.15-0.54, p < 0.0001), liver-related mortality (HR 0.40, 95% CI 0.17-0.96, p = 0.04), non-liver-related mortality (HR 0.17, 95% CI 0.06-0.49, p = 0.001), liver transplantation (HR 0.17, 95% CI 0.05-0.54, p = 0.003), and hepatocellular carcinoma (HR 0.52, 95% CI 0.29-0.93, p = 0.03).<bold>Conclusion: </bold>Treatment with direct antiviral agents is associated with reduced risk for mortality. The sustained virological response was 88%. Thus, direct antiviral agents treatment should be considered for any patient with HCV-related decompensated cirrhosis.<bold>Trial Registration: </bold> ClinicalTrials.gov registry number: NCT01953458.
- Publication
BMC Infectious Diseases, 2022, Vol 22, Issue 1, p1
- ISSN
1471-2334
- Publication type
Article
- DOI
10.1186/s12879-022-07076-0