A study published in the Journal of Hepatology has found that the survival benefit of patients with compensated hepatitis C virus (HCV) cirrhosis achieving sustained virologic response (SVR) by interferon (IFN) similar to that of the general population.
In Western countries, cirrhosis and liver disorders like decompensation or hepatocellular carcinoma still make up the main cause of death and liver transplantation in patients infected with HCV. International guidelines place highest priority for treatment with new direct antiviral agents to HCV-infected patients who have already developed cirrhosis. However, there have been questions raised about the robustness of the evidence for the recommendation.
Lead author, Savino Bruno, MD, Humanitas University and IRCCS Istituto Clinico Humanitas, Rozzano, Italy, and colleagues examined prospective surveillance data from three groups of Italian patients with compensated HCV cirrhosis who obtained SVR on an IFN-based regimen vs. observed non-SVR, untreated, and decompensated patients. Patients with non-cirrhotic advanced fibrosis were excluded from the analysis.
Overall survival was calculated from the start date of IFN treatment to death. The standardized mortality ratio (SMR) was calculated to understand the relative risk of death.
Of the 1,802 total patients, 795 patients with HCV-related cirrhosis in the three cohorts received IFN-based therapy. Twenty-eight patients of the 181 patients followed-up for a median 9.6 years died. For the whole series, the 10- and 20-year overall survival rates were 90.9% (95% CI: 84.3–94.8) and 62.9% (95% CI: 45.9–75.9), respectively.
For the corresponding age and sex matched general population, the number of expected deaths was 28.1, which corresponded to a SMR of 1.00 (95% CI: 0.72–1.35), with an SMR for non-SVR patients of 3.85 (95% CI: 3.43–4.30), and 3.01 for untreated patients (95% CI: 2.64–3.42) and for decompensated patients of 6.70 (95% CI: 5.39–8.22).
Study findings indicate that “patients who respond well to interferon-based therapies have a similar life expectancy to the general population, and [suggest] that treatment should be given as early as possible to patients with compensated HCV cirrhosis in order to achieve the highest benefit,” noted Dr. Bruno. More studies are needed to study the overall impact of SVR, he concluded.
For more information visit journal-of-hepatology.eu.