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Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma

Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma

Authors :
Caitlin C. Murphy
Andres Duarte-Rojo
Reena Salgia
Omobonike Oloruntoba
Annsa Huang
Sofia Kagan
Michael D. Leise
Jordan J. Feld
Parvez S. Mantry
Purva Gopal
Hrishikesh Samant
Neil Mehta
Renumathy Dhanasekaran
Adnan Said
Laura Kulik
Sheila Eswaran
Steven Scaglione
Jennifer Guy
Binu John
Anjana Pillai
Kalyan Ram Bhamidimarri
Michael L. Volk
Andrea D. Branch
Janice H. Jou
Prasun K. Jalal
Maarouf Hoteit
Catherine Frenette
Robert J. Wong
Mobolaji Odewole
Amit G. Singal
Amol S. Rangnekar
George N. Ioannou
Neehar D. Parikh
Nicole E. Rich
Avegail Flores
Tram Tran
Sanjaya K. Satapathy
Source :
Gastroenterology, vol 157, iss 5
Publication Year :
2019
Publisher :
Elsevier BV, 2019.

Abstract

Background & Aims There is controversy regarding the benefits of direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection for patients with a history of hepatocellular carcinoma (HCC). We performed a multicenter cohort study to compare overall survival between patients with HCV infection treated with DAAs and patients who did not receive DAA treatment for their HCV infection after complete response to prior HCC therapy. Methods We conducted a retrospective cohort study of patients with HCV-related HCC who achieved a complete response to resection, local ablation, transarterial chemo- or radioembolization, or radiation therapy, from January 2013 through December 2017 at 31 health care systems throughout the United States and Canada. We used Cox proportional hazards regression to determine the association between receipt of DAA therapy, modeled as a time-varying covariate, and all-cause mortality, accounting for informative censoring and confounding using inverse probability weighting. Results Of 797 patients with HCV-related HCC, 383 (48.1%) received DAA therapy and 414 (51.9%) did not receive treatment for their HCV infection after complete response to prior HCC therapy. Among DAA-treated patients, 43 deaths occurred during 941 person-years of follow-up, compared with 103 deaths during 526.6 person-years of follow-up among patients who did not receive DAA therapy (crude rate ratio, 0.23; 95% confidence interval [CI], 0.16–0.33). In inverse probability-weighted analyses, DAA therapy was associated with a significant reduction in risk of death (hazard ratio, 0.54; 95% CI, 0.33–0.90). This association differed by sustained virologic response to DAA therapy; risk of death was reduced in patients with sustained virologic response to DAA therapy (hazard ratio, 0.29; 95% CI, 0.18–0.47), but not in patients without a sustained virologic response (hazard ratio, 1.13; 95% CI, 0.55–2.33). Conclusions In an analysis of nearly 800 patients with complete response to HCC treatment, DAA therapy was associated with a significant reduction in risk of death.

Details

ISSN :
00165085
Volume :
157
Database :
OpenAIRE
Journal :
Gastroenterology
Accession number :
edsair.doi.dedup.....7e92a8d1859049dafc27bf1980bf7650
Full Text :
https://doi.org/10.1053/j.gastro.2019.07.040