Population impact of direct-acting antiviral treatment on new presentations of hepatitis C-related decompensated cirrhosis: a national record-linkage study

Abstract

ObjectivePopulation-based studies demonstrating the clinical impact of interferon-free direct-acting antiviral (DAA) therapies are lacking. We examined the impact of the introduction of DAAs on HCV-related decompensated cirrhosis (DC) through analysis of population-based data from Scotland.DesignThrough analysis of national surveillance data (involving linkage of HCV diagnosis and clinical databases to hospital and deaths registers), we determined i) the scale-up in the number of patients treated and achieving a sustained viral response (SVR), and ii) the change in the trend of new presentations with HCV-related DC, with the introduction of DAAs.ResultsApproximately 11 000 patients had been treated in Scotland over the 8-year period 2010/11 to 2017/18. The scale-up in the number of patients achieving SVR between the pre-DAA and DAA eras was 2.3-fold overall and 5.9-fold among those with compensated cirrhosis (the group at immediate risk of developing DC). In the pre-DAA era, the annual number of HCV-related DC presentations increased 4.6-fold between 2000 (30) and 2014 (142). In the DAA era, presentations decreased by 51% to 69 in 2018 (and by 67% among those with chronic infection at presentation), representing a significant change in trend (rate ratio 0.88, 95% CI 0.85 to 0.90). With the introduction of DAAs, an estimated 330 DC cases had been averted during 2015–18.ConclusionsNational scale-up in interferon-free DAA treatment is associated with the rapid downturn in presentations of HCV-related DC at the population-level. Major progress in averting HCV-related DC in the short-term is feasible, and thus other countries should strive to achieve the same.

Declining incidence of hepatitis C related hepatocellular carcinoma in the era of interferon‐free therapies: A population‐based cohort study

“…We also show that an HCV cure may be associated with improved survival after HCC, which has also been reported elsewhere 15,16 . This study also chimes with previous population‐based studies showing a reduction in all‐cause mortality, 23 incident decompensated cirrhosis 24 and HCC mortality 25 in the IFN‐free era. However, our finding of a reduced HCC incidence in the IFN‐free era is novel and to the best of our knowledge has not been shown before.…”

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

“…Paralleling the significant reduction in progression to DC that was reported among compensated cirrhosis patients using the same data sources, 24 we observed a significant decrease in both all‐cause and liver‐related mortality risk in the DAA compared with the pre‐DAA era among DC patients, with obtained adjusted HRs of 0.7. In their analysis of all‐cause mortality comparing DAA‐treated SVR‐attaining and untreated DC patients, Cheung et al did not observe any association between virological cure and mortality 16 .…”

The EASL–Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality

“…7,51 The incidence of HCV-related cirrhosis, hepatocellular carcinoma, and liver transplantation for end-stage liver disease due to HCV infection is declining due to the scale-up of treatment with highly effective direct-acting antiviral therapies. 52,53 Within 4 years of the introduction of direct-acting antivirals in Scotland, major reductions in new presentations of decompensated cirrhosis (-67%; ie, cirrhosis diagnosed after the development of complications), hepatocellular carcinoma (-69%), and associated deaths (-49%) were observed among those with chronic HCV infection. 52,54 The prevalence of chronic HCV infection is estimated to have declined, perhaps by as much as a third, in many western European countries (eg, France, Spain, Italy, and the UK) during the past 5 years, on the basis of estimates of available data and the size of at-risk populations.…”