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Journal Articles BMC Infectious Diseases Year : 2022

Clinical outcomes after treatment with direct antiviral agents: beyond the virological response in patients with previous HCV-related decompensated cirrhosis

1 CHRU Montpellier - Hôpital Saint Eloi
2 iPLESP - Institut Pierre Louis d'Epidémiologie et de Santé Publique
3 U1162 - Génomique Fonctionnelle des Tumeurs Solides
4 Physiopathogénèse et Traitement des Maladies du Foie
5 UNICANCER/CRCL - Centre de Recherche en Cancérologie de Lyon
6 ANRS - Agence Nationale de Recherches sur le Sida et les Hépatites Virales
7 IAB - Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble)
8 CRSA - Centre de Recherche Saint-Antoine
9 CRI (UMR_S_1149 / ERL_8252 / U1149) - Centre de recherche sur l'Inflammation
10 Physiopathologie des Maladies Inflammatoires de l'Intestin
11 INFINITE (Ex-Liric) - Institute for Translational Research in Inflammation - U 1286
12 IVH - Institut de Recherche sur les Maladies Virales et Hépatiques
13 IADI - Imagerie Adaptative Diagnostique et Interventionnelle
14 Service d'Hépato-gastro-entérologie [CHRU Nancy]
15 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Ponchaillou]
16 NuMeCan - Nutrition, Métabolismes et Cancer
17 CHI Créteil
18 BCR - Biomécanique cellulaire et respiratoire
19 CHU Saint-Antoine [AP-HP]
20 BaRITOn - Bordeaux Research In Translational Oncology [Bordeaux]
21 Hôpital Saint-Joseph [Marseille]
22 CHRO - Centre Hospitalier Régional d'Orléans
23 CHU Angers - Centre Hospitalier Universitaire d'Angers
24 UA - Université d'Angers
25 HIFIH - Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques
26 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
27 IPPRITT - Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation
28 ADEN - Nutrition, Inflammation et axe Microbiote-Intestin-Cerveau
29 IRIB - Institute for Research and Innovation in Biomedicine
30 UNIROUEN UFR Santé - UNIROUEN - UFR Santé
31 Service d'Hépato-Gastroentérologie [CHU Rouen]
32 PHARMA-DEV - Pharmacochimie et Biologie pour le Développement
33 Irset - Institut de recherche en santé, environnement et travail
34 LNC - Lipides - Nutrition - Cancer [Dijon - U1231]
35 Institut des Maladies de l'Appareil Digestif
36 CHR Metz-Thionville - Centre hospitalier régional Metz-Thionville
37 CHU Nice - Centre Hospitalier Universitaire de Nice
38 CHU Estaing [Clermont-Ferrand]
39 IP - Institut Pascal
40 TIMONE - Hôpital de la Timone [CHU - APHM]
41 CHU Trousseau [Tours]
42 CIC Nantes - Centre d’Investigation Clinique de Nantes
43 Hôpital Cochin [AP-HP]
44 Inserm U1223 - Physiopathologie du système immunitaire
Georges‐philippe Pageaux
  • Function : Correspondent author
Dominique Thabut
  • Function : Author
  • PersonId : 1081430
Isabelle Rosa
  • Function : Author
Armand Abergel
Hélène Fontaine
Stanislas Pol

Abstract

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.
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hal-03555553 , version 1 (03-02-2022)

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Georges‐philippe Pageaux, Clovis Lusivika Nzinga, Nathalie Ganne, Didier Samuel, Céline Dorival, et al.. Clinical outcomes after treatment with direct antiviral agents: beyond the virological response in patients with previous HCV-related decompensated cirrhosis. BMC Infectious Diseases, 2022, 22 (1), pp.94. ⟨10.1186/s12879-022-07076-0⟩. ⟨hal-03555553⟩
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