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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
- 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.
- Subjects :
- Male
0301 basic medicine
Time Factors
Survival
medicine.medical_treatment
Rate ratio
Hepatitis
0302 clinical medicine
Risk Factors
HCC
Cancer
Liver Disease
Liver Neoplasms
Hazard ratio
Gastroenterology
Hepatitis C
Middle Aged
Treatment Outcome
Infectious Diseases
6.1 Pharmaceuticals
Hepatocellular carcinoma
Female
030211 gastroenterology & hepatology
Infection
Liver cancer
Cohort study
Liver Cancer
medicine.medical_specialty
Carcinoma, Hepatocellular
Chronic Liver Disease and Cirrhosis
Clinical Sciences
Antiviral Agents
Risk Assessment
Paediatrics and Reproductive Medicine
03 medical and health sciences
Rare Diseases
Hepatitis - C
Clinical Research
Internal medicine
medicine
Humans
Retrospective Studies
Aged
Gastroenterology & Hepatology
Hepatology
business.industry
Prevention
Carcinoma
Neurosciences
Evaluation of treatments and therapeutic interventions
Hepatocellular
Retrospective cohort study
Protective Factors
medicine.disease
Radiation therapy
Emerging Infectious Diseases
Good Health and Well Being
030104 developmental biology
North America
Digestive Diseases
business
Subjects
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