Impact of treatment against hepatitis C virus on overall survival of naive patients with advanced liver disease.
The beneficial effect of achieving a sustained virological response (SVR) after antiviral treatment against hepatitis C virus is well established. However, it remains unclear whether unsuccessful treatment (non-SVR) also improves patient survival, especially in patients with advanced liver fibrosis. We retrospectively evaluated the incidence of death or liver transplantation in the 427 naive patients with a Child-Pugh score of A and advanced fibrosis newly admitted to the Hospital Beaujon between 2000 and 2010. Patients were followed for a median time of 5.5 years. The baseline characteristics of untreated (n=102) and treated (n=325) patients were largely similar, and there was no evidence of a bias of indication. Treated patients received a combination of interferon and ribavirin and had an SVR rate of 32%. The incidence of death or liver transplantation per 100 person-years was 1.00, 3.20, and 5.44 in SVR, non-SVR, and untreated patients, respectively. After adjusting for baseline characteristics, the risk of death or liver transplantation was significantly lower in SVR than in non-SVR patients and in non-SVR than in untreated patients (hazard ratios, 0.35 and 0.51, respectively; P=0.019 and 0.038, respectively). The effect of treatment in non-SVR patients was higher in patients who had a virological or a biochemical response than in those who did not have a virological or a biochemical response. The risk of death or liver transplantation was significantly lower in treated than in untreated patients. Moreover, there was a gradient of mortality between patients with SVRs, virological or biochemical responders, and untreated patients, suggesting that treatment, even in the absence of viral eradication, has a beneficial effect on survival.
IAME, UMR 1137, INSERM, Paris, France IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France blaise.kutala@bjn.aphp.fr.
Blaise K
BK
Kutala
IAME, UMR 1137, INSERM, Paris, France IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.
Jeremie
J
Guedj
AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France.
Tarik
T
Asselah
AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France.
Nathalie
N
Boyer
AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France.
Feryel
F
Mouri
AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France.
Michelle
M
Martinot-Peignoux
AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France.
Dominique
D
Valla
AP-HP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France.
Patrick
P
Marcellin
IAME, UMR 1137, INSERM, Paris, France IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France INSERM CIC-007, AP-HP, Hôpital Bichat, Paris, France.
Xavier
X
Duval
D000328:Adult; D000998:Antiviral Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D016174:Hepacivirus / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007372:Interferons / Q000494:pharmacology / Q000627:therapeutic use; D008107:Liver Diseases / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012254:Ribavirin / Q000494:pharmacology / Q000627:therapeutic use
D000998:Antiviral Agents; D012254:Ribavirin; D007372:Interferons