TY - JOUR
T1 - Direct-Acting Antiviral Therapy for Hepatitis C Virus Infection Is Associated With Increased Survival in Patients With a History of Hepatocellular Carcinoma
AU - Singal, Amit G.
AU - Rich, Nicole E.
AU - Mehta, Neil
AU - Branch, Andrea D.
AU - Pillai, Anjana
AU - Hoteit, Maarouf
AU - Volk, Michael
AU - Odewole, Mobolaji
AU - Scaglione, Steven
AU - Guy, Jennifer
AU - Said, Adnan
AU - Feld, Jordan J.
AU - John, Binu V.
AU - Frenette, Catherine
AU - Mantry, Parvez
AU - Rangnekar, Amol S.
AU - Oloruntoba, Omobonike
AU - Leise, Michael
AU - Jou, Janice H.
AU - Bhamidimarri, Kalyan Ram
AU - Kulik, Laura
AU - Ioannou, George N.
AU - Huang, Annsa
AU - Tran, Tram
AU - Samant, Hrishikesh
AU - Dhanasekaran, Renumathy
AU - Duarte-Rojo, Andres
AU - Salgia, Reena
AU - Eswaran, Sheila
AU - Jalal, Prasun
AU - Flores, Avegail
AU - Satapathy, Sanjaya K.
AU - Kagan, Sofia
AU - Gopal, Purva
AU - Wong, Robert
AU - Parikh, Neehar D.
AU - Murphy, Caitlin C.
N1 - Publisher Copyright:
© 2019 AGA Institute
PY - 2019/11
Y1 - 2019/11
N2 - 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.
AB - 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.
KW - HCC
KW - Hepatitis C
KW - Liver Cancer
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=85070813996&partnerID=8YFLogxK
U2 - 10.1053/j.gastro.2019.07.040
DO - 10.1053/j.gastro.2019.07.040
M3 - Article
C2 - 31374215
AN - SCOPUS:85070813996
SN - 0016-5085
VL - 157
SP - 1253-1263.e2
JO - Gastroenterology
JF - Gastroenterology
IS - 5
ER -