TY - JOUR
T1 - Improved Survival Among all Interferon-α-Treated Patients in HCV-002, a Veterans Affairs Hepatitis C Cohort of 2211 Patients, Despite Increased Cirrhosis Among Nonresponders
AU - Cozen, Myrna L.
AU - Ryan, James C.
AU - Shen, Hui
AU - Cheung, Ramsey
AU - Kaplan, David E.
AU - Pocha, Christine
AU - Brau, Norbert
AU - Aytaman, Ayse
AU - Schmidt, Warren N.
AU - Pedrosa, Marcos
AU - Anand, Bhupinderjit S.
AU - Chang, Kyong Mi
AU - Morgan, Timothy
AU - Monto, Alexander
N1 - Publisher Copyright:
© 2016, Springer Science+Business Media New York (Outside the USA).
PY - 2016/6/1
Y1 - 2016/6/1
N2 - Background: As the era of interferon-alpha (IFN)-based therapy for hepatitis C ends, long-term treatment outcomes are now being evaluated. Aim: To more fully understand the natural history of hepatitis C infection by following a multisite cohort of patients. Methods: Patients with chronic HCV were prospectively enrolled in 1999–2000 from 11 VA medical centers and followed through retrospective medical record review. Results: A total of 2211 patients were followed for an average of 8.5 years after enrollment. Thirty-one percent of patients received HCV antiviral therapy, 15 % with standard IFN/ribavirin only, 16 % with pegylated IFN/ribavirin, and 26.7 % of treated patients achieved sustained virologic response (SVR). Cirrhosis developed in 25.8 % of patients. Treatment nonresponders had a greater than twofold increase in the hazard of cirrhosis and hepatocellular carcinoma, compared to untreated patients, whereas SVR patients were only marginally protected from cirrhosis. Nearly 6 % developed hepatocellular carcinoma, and 27.1 % died during the follow-up period. Treated patients, regardless of response, had a significant survival benefit compared to untreated patients (HR 0.58, CI 0.46–0.72). Improved survival was also associated with college education, younger age, lower levels of alcohol consumption, and longer duration of medical service follow-up—factors typically associated with treatment eligibility. Conclusions: As more hepatitis C patients are now being assessed for all-oral combination therapy, these results highlight that patient compliance and limiting harmful behaviors contribute a significant proportion of the survival benefit in treated patients and that the long-term clinical benefits of SVR may be less profound than previously reported.
AB - Background: As the era of interferon-alpha (IFN)-based therapy for hepatitis C ends, long-term treatment outcomes are now being evaluated. Aim: To more fully understand the natural history of hepatitis C infection by following a multisite cohort of patients. Methods: Patients with chronic HCV were prospectively enrolled in 1999–2000 from 11 VA medical centers and followed through retrospective medical record review. Results: A total of 2211 patients were followed for an average of 8.5 years after enrollment. Thirty-one percent of patients received HCV antiviral therapy, 15 % with standard IFN/ribavirin only, 16 % with pegylated IFN/ribavirin, and 26.7 % of treated patients achieved sustained virologic response (SVR). Cirrhosis developed in 25.8 % of patients. Treatment nonresponders had a greater than twofold increase in the hazard of cirrhosis and hepatocellular carcinoma, compared to untreated patients, whereas SVR patients were only marginally protected from cirrhosis. Nearly 6 % developed hepatocellular carcinoma, and 27.1 % died during the follow-up period. Treated patients, regardless of response, had a significant survival benefit compared to untreated patients (HR 0.58, CI 0.46–0.72). Improved survival was also associated with college education, younger age, lower levels of alcohol consumption, and longer duration of medical service follow-up—factors typically associated with treatment eligibility. Conclusions: As more hepatitis C patients are now being assessed for all-oral combination therapy, these results highlight that patient compliance and limiting harmful behaviors contribute a significant proportion of the survival benefit in treated patients and that the long-term clinical benefits of SVR may be less profound than previously reported.
KW - Cirrhosis
KW - Hepatitis C
KW - Hepatitis C therapy
KW - Hepatocellular carcinoma
KW - Survival
UR - http://www.scopus.com/inward/record.url?scp=84964076463&partnerID=8YFLogxK
U2 - 10.1007/s10620-016-4122-5
DO - 10.1007/s10620-016-4122-5
M3 - Article
C2 - 27059981
AN - SCOPUS:84964076463
SN - 0163-2116
VL - 61
SP - 1744
EP - 1756
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
IS - 6
ER -