Improved survival and high sustained virologic response with DAA therapy in patients with HCV‐related HCC: A call for expanded use

Ji, Fanpu; Li, T; Nguyen, Mindie H.

doi:10.1111/jgh.15420

Cited by 3 publications

(3 citation statements)

References 12 publications

(15 reference statements)

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“…We also noted some racial and ethnic disparities in survival where Black patients had an 18% higher risk of mortality compared to White patients and the shortest survival whether they received DAA treatment or not. This finding validates previous studies where Black patients were diagnosed with more advanced HCC when curative treatment was no longer an option 35–38 . Combining these results suggest that advocates for additional outreach efforts for early HCV diagnosis and linkage to care that is culturally appropriate for this community are needed 29–31 .…”

Section: Discussionsupporting

confidence: 87%

“…This finding validates previous studies where Black patients were diagnosed with more advanced HCC when curative treatment was no longer an option. [35][36][37][38] Combining these results suggest that advocates for additional outreach efforts for early HCV diagnosis and linkage to care that is culturally appropriate for this community are needed. [29][30][31] On the other hand, Asian patients had 44% reduced risk of mortality compared to White patients.…”

Section: F I G U R E 2 Survival Of Patients Withmentioning

confidence: 98%

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Treatment rates and factors associated with direct‐acting antiviral therapy for insured patients with hepatitis C‐related hepatocellular carcinoma – A real‐world nationwide study

Kam,

Yeo,

et al. 2023

Aliment Pharmacol Ther

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SummaryBackgroundSince the inception of the interferon‐free direct‐acting antiviral agents (DAAs) for hepatitis C virus (HCV) infection, guidelines as to who should receive this potentially curative treatment have evolved. Treatment with DAAs is now considered for all patients except for those considered moribund.AimTo determine the DAA treatment rate for patients with HCV‐related hepatocellular carcinoma (HCC).MethodsThis was a retrospective study from January 2015 to March 2021 of a national sample of privately insured patients with HCV‐related HCC using Optum's Clinformatics® Data Mart (CDM) Database – a large, de‐identified, adjudicated claims database.ResultsWe identified 3922 patients with HCV‐related HCC: 922 (23.5%) received DAA. Compared to untreated patients, DAA‐treated patients were younger (65.2 ± 7.5 vs. 66.4 ± 7.5 years, p < 0.001), more frequently saw a gastroenterology/infectious disease (GI/ID) physician (41.2% vs. 34.2%), and had decompensated cirrhosis (56% vs. 53%, p = 0.001). In multivariable analysis, younger age (HR: 0.98, 95% CI: 0.97–0.99, p < 0.001), GI/ID care (HR: 3.06, 95% CI: 2.13–4.51, p < 0.001), and having cirrhosis (compensated: HR: 1.60, 95% CI: 1.18–2.21, p = 0.003; decompensated: HR: 1.45, 95% CI: 1.07–1.98, p = 0.02) were associated with receiving DAA treatment, but not sex, race, or ethnicity. DAA‐treated patients had significantly higher 5‐year survival than untreated patients (47.2% vs. 35.2%, p < 0.001). Following adjustment for age, sex, race/ethnicity, Charlson Comorbidity Index, and HCC treatment, receiving DAA treatment was associated with lower mortality (aHR: 0.61, 95% CI: 0.53–0.69, p < 0.001).ConclusionDAA treatment remains underutilised in insured patients with HCV‐related HCC; fewer than one in four patients received treatment. Seeing a specialist and having decompensated cirrhosis were predictors for DAA treatment; additional efforts are needed to increase awareness of HCV treatment.

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Section: Discussionsupporting

confidence: 87%

Section: F I G U R E 2 Survival Of Patients Withmentioning

confidence: 98%

Treatment rates and factors associated with direct‐acting antiviral therapy for insured patients with hepatitis C‐related hepatocellular carcinoma – A real‐world nationwide study

Kam,

Yeo,

et al. 2023

Aliment Pharmacol Ther

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“… 24 It should also be noted that the SVR12 for active HCC in our study was still fairly high at 91.5% ( Fig.1 ), supporting prior suggestions that HCV-related HCC should be treated with DAAs based on a risk-benefit evaluation. 25 , 26 However, DAA-based treatment recommendations for patients with HCV-related HCC have not been well-established across guidelines, 16 , 17 despite increasing evidence that HCV-cured HCC patients have significantly improved overall and liver-related survival compared to those without SVR12. 27 , 28 Therefore, additional patient and provider education and clearer guideline recommendations are needed.…”

Section: Discussionmentioning

confidence: 99%

Real-world Effectiveness and Tolerability of Interferon-free Direct-acting Antiviral for 15,849 Patients with Chronic Hepatitis C: A Multinational Cohort Study

Ji,

Tran,

Ogawa

et al. 2024

J Clin Transl Hepatol

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Background and Aims As practice patterns and hepatitis C virus (HCV) genotypes (GT) vary geographically, a global real-world study from both East and West covering all GTs can help inform practice policy toward the 2030 HCV elimination goal. This study aimed to assess the effectiveness and tolerability of DAA treatment in routine clinical practice in a multinational cohort for patients infected with all HCV GTs, focusing on GT3 and GT6. Methods We analyzed the sustained virological response (SVR12) of 15,849 chronic hepatitis C patients from 39 Real-World Evidence from the Asia Liver Consortium for HCV clinical sites in Asia Pacific, North America, and Europe between 07/01/2014–07/01/2021. Results The mean age was 62±13 years, with 49.6% male. The demographic breakdown was 91.1% Asian (52.9% Japanese, 25.7% Chinese/Taiwanese, 5.4% Korean, 3.3% Malaysian, and 2.9% Vietnamese), 6.4% White, 1.3% Hispanic/Latino, and 1% Black/African-American. Additionally, 34.8% had cirrhosis, 8.6% had hepatocellular carcinoma (HCC), and 24.9% were treatment-experienced (20.7% with interferon, 4.3% with direct-acting antivirals). The largest group was GT1 (10,246 [64.6%]), followed by GT2 (3,686 [23.2%]), GT3 (1,151 [7.2%]), GT6 (457 [2.8%]), GT4 (47 [0.3%]), GT5 (1 [0.006%]), and untyped GTs (261 [1.6%]). The overall SVR12 was 96.9%, with rates over 95% for GT1/2/3/6 but 91.5% for GT4. SVR12 for GT3 was 95.1% overall, 98.2% for GT3a, and 94.0% for GT3b. SVR12 was 98.3% overall for GT6, lower for patients with cirrhosis and treatment-experienced (TE) (93.8%) but ≥97.5% for treatment-naive patients regardless of cirrhosis status. On multivariable analysis, advanced age, prior treatment failure, cirrhosis, active HCC, and GT3/4 were independent predictors of lower SVR12, while being Asian was a significant predictor of achieving SVR12. Conclusions In this diverse multinational real-world cohort of patients with various GTs, the overall cure rate was 96.9%, despite large numbers of patients with cirrhosis, HCC, TE, and GT3/6. SVR12 for GT3/6 with cirrhosis and TE was lower but still excellent (>91%).

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Antiviral Therapy for Hepatitis C Virus Infection in Cirrhosis

2022

Pharmacotherapy for Liver Cirrhosis and Its Complications

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Improved survival and high sustained virologic response with DAA therapy in patients with HCV‐related HCC: A call for expanded use

Cited by 3 publications

References 12 publications

Treatment rates and factors associated with direct‐acting antiviral therapy for insured patients with hepatitis C‐related hepatocellular carcinoma – A real‐world nationwide study

Treatment rates and factors associated with direct‐acting antiviral therapy for insured patients with hepatitis C‐related hepatocellular carcinoma – A real‐world nationwide study

Real-world Effectiveness and Tolerability of Interferon-free Direct-acting Antiviral for 15,849 Patients with Chronic Hepatitis C: A Multinational Cohort Study

Antiviral Therapy for Hepatitis C Virus Infection in Cirrhosis

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