Did you know that people who were treated with direct-acting antiviral (DAA) medications….
- Were significantly less likely to die than the people who were untreated.
- Had at least a 20% decrease in liver fibrosis after 24-weeks of the completion of DAA therapy
- Experienced a 71% reduction in liver cancer risk after being cured with a DAA medication.
The studies on this blog looked at treatment with DAAs to find out if curing hepatitis C (HCV) with DAAs improved HCV disease progression and reduced the risk of liver cancer.
These studies were published in journals to provide insight into the effectiveness and benefits of DAA therapy.
ARTICLE: Effect of Paritaprevir/Ritonavir/Ombitasvir/Dasabuvir and Ledipasvir/Sofosbuvir Regimens on Survival Compared With Untreated Hepatitis C Virus-Infected Persons: Results from ERCHIVES—A. A. Butt, et. al.
SOURCE: Clinical Infectious Diseases, Volume 65, Issue 6, 15 September 2017, Pages 1006–1011
Study Aims and Results: To determine the short-term outcome of treatment with Viekira Pak (paritaprevir/ritonavir/ombitasvir/dasabuvir or PROD) and Harvoni (ledipasvir plus sofosbuvir) compared to untreated patients. The study was conducted in the Veterans Medical Administration using ERCHIVES—Electronically Retrieved Cohort of HCV Infected Veterans. There were three groups:
- Viekira Group – 1,473 patients
- Harvoni Group – 5,497 patients
- Control Group – 6,970 patients who were HCV-positive but were not being treated
All of the persons were well-matched except the treated patients were more likely to be obese and have cirrhosis. The untreated people were more likely to have more serious kidney disease, alcohol or drug abuse or dependence, and anemia. The authors stated that the differences in the groups “were not associated with increased mortality”(death).
At the 18-month post-treatment follow-up period, the number of people who died was significantly higher in the untreated group compared to the treatment groups.
Conclusions: The PROD and Harvoni treatment groups had a considerably lower death rate than in the patients who were untreated.
Editorial Comments: It is remarkable that such a substantial benefit from treatment was reported in the group who were treated with DAAs only 18 months after the completion of therapy.
Article: Eradication Induced by Direct-Acting Antiviral Agents Reduces the Risk of Hepatocellular Carcinoma—G. N. Ioannou, et. al.
Source: Journal of Hepatology http://dx.doi.org/10.1016/j.jhep.2017.08.030
Study Aims and Results: The authors wanted to understand how being cured of hepatitis C (HCV) reduces the risk of developing liver cancer.
This was a retrospective study conducted at the VA National Healthcare System analyzing healthcare records of 62,354 veterans who received HCV treatment between 1/1/1999 to 12/31/2015. The medications and the number of patients treated included:
- 35,871 (58%) patients who received interferon only regimes,
- 4,535 (7.2%) patients who received interferon plus a direct-acting antiviral (DAA) therapy, and
- 21,948 (35%) patients who received direct-acting antiviral only therapy.
The authors continued to follow these patients through June 15, 2017. People cured with DAAs only or DAAs plus interferon treatment were not found to be at an increased risk of developing liver cancer. Furthermore, being cured with a DAA was associated with a 71% reduction in liver cancer risk compared to people who did not achieve a cure.
Conclusions: The risk of developing liver cancer was dramatically lower after being cured with a DAA therapy.
Editorial Comments: Hopefully, this study and the others listed in SnapShots will help to reduce some of the fear regarding the risk of liver cancer and DAA therapy. This study provides real-world information with a large patient population that should contribute to the positive data that treatment with DAAs decreases or eliminates the risk of liver cancer.
Unfortunately, the risk of developing liver cancer for those with severe fibrosis or cirrhosis is reduced but not eliminated. This is the reason that medical providers should continue to screen for liver cancer.
Article: Regression of Liver Fibrosis over a 24-Week Period After Completing Direct-Acting Antiviral Therapy in Patients with Chronic Hepatitis C Receiving Care Within The National Hepatitis C Elimination Program in Georgia: Results of Hepatology Clinic HEPA Experience–E. Dolmazashvili, et. al.
SOURCE: 2017 Aug 29. doi: 10.1097/MEG.0000000000000964
Study Aims and Results: The study was conducted to understand the effect of HCV treatment— specifically direct-acting antiviral medications (with and without interferon)—on the improvement of liver stiffness measurement. Liver stiffness measures the health of the liver including the amount of scarring of the liver. There were 304 patients enrolled in this prospective study. The technology used to measure liver scarring was Fibroscan. The majority of patients were men (88%) and the average age was 49 years old.
The genotypes treated were genotype 1 (47%); genotype 2 (17%) and genotype 3 (37%).
The treatment consisted of sofosbuvir-containing regimens—pegylated interferon, sofosbuvir plus ribavirin-153 patients (50%); sofosbuvir plus ribavirin-84 pts (28%); sofosbuvir, ledipasvir plus/minus ribavirin-67 pts (99%). The cure rate for all of the genotypes was 90%.
A total of 198 of patients had at least a 20% decrease in liver stiffness. Achieving a cure was predictive of a decrease in liver stiffness. Unfortunately, more than half of the people in the study who were cirrhotic remained so even after treatment.
Conclusions: There was a 20% decrease in liver stiffness after treatment ended.
Editorial Comments: These studies provide information that should contribute to the positive data that treatment with DAAs decreases or eliminates the risk of liver cancer.
The people with advanced fibrosis or cirrhosis will continue to have some form of disease progression even if cured. For this reason, it is vital that their medical providers assess their liver health on a regular basis.
Those who were cured with a DAA of course, there is a perfect solution to this problem about hepatitis C and liver cancer: Test, Treat & Cure Early!
Guidelines for people who are cured with severe fibrosis or cirrhosis:
American Gastroenterological Association Institute Clinical Practice Update—Expert Review: Care of Patients Who Have Achieved a Sustained Virologic Response After Antiviral Therapy for Chronic Hepatitis C Infection http://www.gastrojournal.org/article/S0016-5085(17)30327-X/fulltext
American Association for the Study of Liver Disease Guidelines (AASLD) HCV Guidelines
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