Direct-Acting Antiviral Lowers Mortality Rate Among HCV Patients

Direct-acting antivirals (DAA) could be the answer in treating patients with hepatitis C viral (HCV) infections, regardless of whether they also suffer from cirrhosis, according to a JAMA Network Open study. 

Specifically, adjusted hazard ratio of dying patients with DAA treatment and those without DAA treatment in the cirrhosis group was 0.51. Meanwhile, the adjusted HA ratio of dying patients with DAA treatment and those without DAA treatment among patients without cirrhosis was 0.54. 

These findings suggest that increasing access to DAA drugs for all patients with HCV infection, regardless of disease progression, could improve population health.

The main objective of the study was to uncover the association of DAA treatment with mortality among Medicare beneficiaries with hepatitis C.

DAA drugs are highly effective, with a cure rate of 90 percent, which is much higher than the 50 percent cure rate for the earlier interferon-based HCV therapy, researchers said.

Additionally, DAA drugs have few adverse effects and improved tolerability, which are factors in patients completing the therapy.

Overall, DAA treatment appeared to be associated with a decrease in mortality among Medicare beneficiaries with or without cirrhosis. 

“Direct-acting antiviral treatment was statistically significantly associated with a decrease in mortality among patients with and those without cirrhosis,” researchers said.

“The association of direct-acting antiviral treatment with mortality was similar for male and female beneficiaries, regardless of the presence of cirrhosis, and it was slightly smaller among patients without cirrhosis who have dual-eligibility status compared with patients with Medicare coverage only.”

The cohort study used Medicare claims data of 51,478 beneficiaries who sought hepatitis C care for the first time between January 1, 2014, and December 31, 2016. 

Researchers also used Medicare Part D files to identify DAA therapy initiation and completion, as well as death dates, demographic data, and indicators of health risks from the Master Beneficiary Summary Files.

Beneficiaries with hepatitis C were considered patients with DAA treatment if they initiated DAA therapy during the study period. Beneficiaries with hepatitis C who did not initiate DAA therapy during the study period were considered as patients without DAA treatment.

Data was analyzed between September 2019 and March 2020. 

Hepatitis C is the most common blood-borne illness in the US, researchers said. Specifically, nearly 2.4 million people in the US were estimated to have hepatitis C between 2013 and 2016.

If chronic hepatitis C is untreated, serious health problems, such as hepatocellular cancer, cirrhosis, and liver damage, can occur. 

Individuals living with hepatitis C also experience increased mortality compared with the general population. About 20,000 individuals in the US die each year from hepatitis C–related conditions.

Researchers noted three previous studies that examined the association of DAA treatment with mortality.

One study enrolled patients with a history of hepatocellular carcinoma from 31 health systems across the US and Canada. Researchers reported that DAA therapy was associated with a 71 percent reduction in mortality compared with patients who did not receive DAA drugs.

But the study sample was not representative of the population with hepatitis C because only one to five percent of patients with hepatitis C have hepatocellular carcinoma.

The other studies used a sample of patients with hepatitis C in the US Department of Veterans Affairs health system and reported that DAA treatment was associated with a decrease in mortality. 

However, 97 percent of the patients in these VA studies were men and also did not match patients with DAA treatment to those without treatment.