12 Nov Improved Longevity of Hepatitis C Patients Who Respond To Therapy
Medical Research: What is the background for this study? What are the main findings?
Dr. van der Meer: This study was performed in order to assess the association between the virological response to antiviral therapy and the long-term clinical outcome among patients with advanced liver disease, who have the highest risk of cirrhosis-related complications and death due to their chronic viral infection. At the time this study was initiated there was scarce data on the relation between a sustained virological response (SVR; sustained elimination of hepatitis C RNA) and reduced all-cause mortality, the most definite clinical endpoint. With our large international multicenter cohort study we were able to show this association. After 10 years of follow-up the cumulative mortality rate was 9% among patients with SVR as compared to 26% among patients without SVR after antiviral therapy (p<0.001). The current JAMA research letter concerns a related analyses, in which we compared the survival among patients included in our cohort with that of an age- and sex-matched general population. Importantly, the survival among patients with SVR was comparable to the general population, despite the fact that all these patients had histological proof of advanced hepatic fibrosis. In contrast, the survival among patients without SVR was markedly lower as compared to the general population.
Medical Research: What should clinicians and patients take away from your report?
Dr. van der Meer: With this follow-up analyses, we further establish SVR as a relevant endpoint of antiviral therapy. Patients and physicians should take away from our report that antiviral therapy is needed in order to improve the clinical outcome of the population with chronic HCV infection. Even in case of advanced liver disease, patients should thus be referred for antiviral therapy. The result should stimulate a wide range of heatlh care workers to be alert for hepatitis C infection, as major clinical benefits may be achieved in adequate therapy. Currently, underdiagnosis of this disease remains one the most important reasons why only a small proportion of the hepatitis C-infected population is treated.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. van der Meer: As soon as the direct antivirals are widely implemented, SVR rates are expected to rise above 90% even for patients with cirrhosis. Future studies need to follow-up these patients to determine if the beneficial clinical outcome following SVR remains when interferon is no longer used. Also, these new antiviral treatment regimens are expected to cure patients with more advanced liver disease and may be applied in patients with comorbidities which contraindicated interferon-therapy. Current results thus need to reconfirmed in the nearby future. As only few patients will not attain SVR, and those who do fail interferon-free therapy are likely to be biased, comparisons between patients with SVR and general populations will continue to be relevant.