학술논문
Clinical outcomes after treatment with direct antiviral agents: beyond the virological response in patients with previous HCV-related decompensated cirrhosis
Document Type
Report
Author
Pageaux, Georges-Philippe; Nzinga, Clovis Lusivika; Ganne, Nathalie; Samuel, Didier; Dorival, Céline; Zoulim, Fabien; Cagnot, Carole; Decaens, Thomas; Thabut, Dominique; Asselah, Tarik; Mathurin, Philippe; Habersetzer, François; Bronowicki, Jean-Pierre; Guyader, Dominique; Rosa, Isabelle; Leroy, Vincent; Chazouilleres, Olivier; de Ledinghen, Victor; Bourliere, Marc; Causse, Xavier; Cales, Paul; Metivier, Sophie; Loustaud-Ratti, Véronique; Riachi, Ghassan; Alric, Laurent; Gelu-Simeon, Moana; Minello, Anne; Gournay, Jérôme; Geist, Claire; Tran, Albert; Abergel, Armand; Portal, Isabelle; d'Alteroche, Louis; Raffi, François; Fontaine, Hélène; Carrat, Fabrice; Pol, Stanislas; Bonnet, Delphine; Payssan-Sicart, Virginie; Pomes, Chloe; Bailly, François; Beaudoin, Marjolaine; Giboz, Dominique; Hartig-Lavie, Kerstin; Maynard, Marianne; Billaud, Eric; Boutoille, David; Cavellec, Morane; Chevalier, Caroline; Hubert, Isabelle; Goepfert, Pierre; Lannes, Adrien; Lunel, Françoise; Boursier, Jérôme; Boyer, Nathalie; Giuily, Nathalie; Castelnau, Corinne; Scoazec, Giovanna; Chibah, Aziza; Keser, Sylvie; Bonardi, Karim; Vallet-Pichard, Anaïs; Sogni, Philippe; Foucher, Juliette; Hiriart, Jean-Baptiste; Legendre, Amandine; Chermak, Faiza; Irlès-Depé, Marie; Ahmed, Si Nafa Si; Ansaldi, Christelle; Amara, Nisserine Ben; Oules, Valérie; Dunette, Jacqueline; Anty, Rodolphe; Gelsi, Eve; Truchi, Régine; Luckina, Elena; Messaoudi, Nadia; Moussali, Joseph; De Dieuleveult, Barbara; Goin, Héloïse; Labarrière, Damien; Potier, Pascal; Grando-Lemaire, Véronique; Nahon, Pierre; Brulé, Séverine; Monard, Rym; Jezequel, Caroline; Brener, Audrey; Laligant, Anne; Rabot, Aline; Renard, Isabelle; Baumert, Thomas F.; Dofföel, Michel; Mutter, Catherine; Simo-Noumbissie, Pauline; Razi, Esma; Barraud, Hélène; Bensenane, Mouni; Nani, Abdelbasset; Hassani-Nani, Sarah; Bernard, Marie-Albertine; Bismuth, Michael; Caillo, Ludovic; Faure, Stéphanie; Ripault, Marie Pierre; Bureau, Christophe; Launay, Sarah; Peron, Jean Marie; Robic, Marie Angèle; Tarallo, Léa; Faure, Marine; Froissart, Bruno; Hilleret, Marie-Noelle; Zarski, Jean-Pierre; Goria, Odile; Grard, Victorien; Montialoux, Hélène; François, Muriel; Ouedraogo, Christian; Pauleau, Christelle; Varault, Anne; Andreani, Tony; Angoulevant, Bénédicte; Chevance, Azeline; Serfaty, Lawrence; Antonini, Teresa; Coilly, Audrey; Vallée, Jean-Charles Duclos; Tateo, Mariagrazia; Bonny, Corinne; Brigitte, Chanteranne; Lamblin, Géraldine; Muti, Léon; Babouri, Abdenour; Filipe, Virginie; Barrault, Camille; Costes, Laurent; Hagège, Hervé; Merbah, Soraya; Carrier, Paul; Debette-Gratien, Maryline; Jacques, Jérémie; Lassailly, Guillaume; Artu, Florent; Canva, Valérie; Dharancy, Sébastien; Louvet, Alexandre; Latournerie, Marianne; Bardou, Marc; Mouillot, Thomas; Bacq, Yannick; Barbereau, Didier; Nicolas, Charlotte; Archambeaud, Isabelle; Habes, Sarah; Botta-Fridlund, Danièle; Saillard, Eric; Lafrance, Marie-Josée; Diallo, Alpha; Wadouachi, Lena; Petrov-Sanchez, Ventzi; Ammour, Douae; Ayour, Loubna; Benhida, Jaouad; Chau, Frederic; Gilibert, Audrey; Goderel, Isabelle; Hadi, Warda; Nzinga, Clovis Luzivika; Pannetier, Grégory; Pinot, François; Stahl, Odile; Téloulé, François
Source
BMC Infectious Diseases. January 27, 2022, Vol. 22 Issue 1
Subject
Language
English
ISSN
1471-2334
Abstract
Author(s): Georges-Philippe Pageaux[sup.1] , Clovis Lusivika Nzinga[sup.2] , Nathalie Ganne[sup.3,4] , Didier Samuel[sup.5,6,7] , Céline Dorival[sup.2] , Fabien Zoulim[sup.8] , Carole Cagnot[sup.9] , Thomas Decaens[sup.10,11,12] , Dominique Thabut[sup.13] , Tarik [...]
Background In HCV-infected patients with advanced liver disease, the direct antiviral agents-associated clinical benefits remain debated. We compared the clinical outcome of patients with a previous history of decompensated cirrhosis following treatment or not with direct antiviral agents from the French ANRS CO22 HEPATHER cohort. Methods We identified HCV patients who had experienced an episode of decompensated cirrhosis. Study outcomes were all-cause mortality, liver-related or non-liver-related deaths, hepatocellular carcinoma, liver transplantation. Secondary study outcomes were sustained virological response and its clinical benefits. Results 559 patients met the identification criteria, of which 483 received direct antiviral agents and 76 remained untreated after inclusion in the cohort. The median follow-up time was 39.7 (IQR: 22.7-51) months. After adjustment for multivariate analysis, exposure to direct antiviral agents was associated with a decrease in all-cause mortality (HR 0.45, 95% CI 0.24-0.84, p = 0.01) and non-liver-related death (HR 0.26, 95% CI 0.08-0.82, p = 0.02), and was not associated with liver-related death, decrease in hepatocellular carcinoma and need for liver transplantation. The sustained virological response was 88%. According to adjusted multivariable analysis, sustained virological response achievement was associated with a decrease in all-cause mortality (HR 0.29, 95% CI 0.15-0.54, p < 0.0001), liver-related mortality (HR 0.40, 95% CI 0.17-0.96, p = 0.04), non-liver-related mortality (HR 0.17, 95% CI 0.06-0.49, p = 0.001), liver transplantation (HR 0.17, 95% CI 0.05-0.54, p = 0.003), and hepatocellular carcinoma (HR 0.52, 95% CI 0.29-0.93, p = 0.03). Conclusion Treatment with direct antiviral agents is associated with reduced risk for mortality. The sustained virological response was 88%. Thus, direct antiviral agents treatment should be considered for any patient with HCV-related decompensated cirrhosis. Trial registration: ClinicalTrials.gov registry number: NCT01953458. Keywords: Hepatitis C virus, Decompensated cirrhosis, Direst-acting antiviral agents, Survival, Hepatocellular carcinoma, Sustained virological response
Background In HCV-infected patients with advanced liver disease, the direct antiviral agents-associated clinical benefits remain debated. We compared the clinical outcome of patients with a previous history of decompensated cirrhosis following treatment or not with direct antiviral agents from the French ANRS CO22 HEPATHER cohort. Methods We identified HCV patients who had experienced an episode of decompensated cirrhosis. Study outcomes were all-cause mortality, liver-related or non-liver-related deaths, hepatocellular carcinoma, liver transplantation. Secondary study outcomes were sustained virological response and its clinical benefits. Results 559 patients met the identification criteria, of which 483 received direct antiviral agents and 76 remained untreated after inclusion in the cohort. The median follow-up time was 39.7 (IQR: 22.7-51) months. After adjustment for multivariate analysis, exposure to direct antiviral agents was associated with a decrease in all-cause mortality (HR 0.45, 95% CI 0.24-0.84, p = 0.01) and non-liver-related death (HR 0.26, 95% CI 0.08-0.82, p = 0.02), and was not associated with liver-related death, decrease in hepatocellular carcinoma and need for liver transplantation. The sustained virological response was 88%. According to adjusted multivariable analysis, sustained virological response achievement was associated with a decrease in all-cause mortality (HR 0.29, 95% CI 0.15-0.54, p < 0.0001), liver-related mortality (HR 0.40, 95% CI 0.17-0.96, p = 0.04), non-liver-related mortality (HR 0.17, 95% CI 0.06-0.49, p = 0.001), liver transplantation (HR 0.17, 95% CI 0.05-0.54, p = 0.003), and hepatocellular carcinoma (HR 0.52, 95% CI 0.29-0.93, p = 0.03). Conclusion Treatment with direct antiviral agents is associated with reduced risk for mortality. The sustained virological response was 88%. Thus, direct antiviral agents treatment should be considered for any patient with HCV-related decompensated cirrhosis. Trial registration: ClinicalTrials.gov registry number: NCT01953458. Keywords: Hepatitis C virus, Decompensated cirrhosis, Direst-acting antiviral agents, Survival, Hepatocellular carcinoma, Sustained virological response