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EClinicalMedicine. 2024;73:102671.

Effect of direct-acting antivirals on disease burden of hepatitis C virus infection in South Korea in 2007-2021: a nationwide, multicentre, retrospective cohort study.

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제1저자 손원, 박수영 · 교신저자 김원, 한승봉, 김승업

PMID 38881570 PMC11176940 DOI 10.1016/j.eclinm.2024.102671 IF 12.8 소화기내과
소속 (31)
  1. Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, South Korea.
  2. Kyungpook National University Hospital, Kyungpook National University, Daegu, South Korea.
  3. Konyang University College of Medicine, Daejeon, South Korea.
  4. CHA Bundang Medical Centre, CHA University, Seongnam, South Korea.
  5. Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, South Korea.
  6. Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, South Korea.
  7. Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, South Korea.
  8. Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine, Seoul, South Korea.
  9. Kyungpook National University Chilgok Hospital, Kyungpook National University, Daegu, South Korea.
  10. Liver Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
  11. Liver Centre, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea.
  12. Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, South Korea.
  13. Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea.
  14. Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea.
  15. Guro Hospital, Korea University College of Medicine, Seoul, South Korea.
  16. Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
  17. College of Medicine, Ewha Womans University, Seoul, South Korea.
  18. Chonnam National University Hospital, Chonnam National University, Hwasun, South Korea.
  19. Keimyung University School of Medicine, Daegu, South Korea.
  20. Yeungnam University College of Medicine, Daegu, South Korea.
  21. Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.
  22. Korea University Anam Hospital, Korea University College of Medicine, Seoul, South Korea.
  23. Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.
  24. St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea.
  25. Yonsei University Wonju College of Medicine, Wonju, South Korea.
  26. Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea.
  27. Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea.
  28. Yonsei University College of Medicine, Seoul, South Korea.
  29. Yonsei Liver Centre, Severance Hospital, Seoul, South Korea.
  30. Seoul Metropolitan Government Seoul National University Boramae Medical Centre, Seoul National University College of Medicine, Seoul, South Korea.
  31. Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea.

Abstract

BACKGROUND It is unclear whether direct-acting antivirals (DAAs) treatment improves the disease burden in hepatitis C virus (HCV) infection. This study aimed to investigate the effect of DAA treatment on the reduction of disease burden in patients with HCV infection using individual participant data.

METHODS This nationwide multicentre retrospective cohort study recruited patients with HCV infection from 29 tertiary institutions in South Korea. The data collection was done from medical records in each institution. The study included the untreated patients and the DAAs-treated patients and excluded those with a history of interferon-based treatments. Disease burden was the primary outcome, as represented by disability-adjusted life years (DALYs). Improvement in fibrosis after DAA treatment was assessed using APRI, FIB-4 index, and liver stiffness (LS) as assessed by transient elastography. Clinical outcomes were hepatocellular carcinoma (HCC), decompensation, and mortality.

FINDINGS Between January 1, 2007, and February 17, 2022, data from 11,725 patients with HCV infection, 8464 (72%) of whom were treated with DAAs, were analysed. DAA treatment significantly improved APRI- (median 0.64 [interquartile range (IQR), 0.35-1.31]-0.33 [0.23-0.52], p < 0.0001), FIB-4- (median 2.42 [IQR, 1.48-4.40]-1.93 [1.31-2.97], p < 0.0001), and liver LS-based fibrosis (median 7.4 [IQR, 5.3-12.3]-6.2 [4.6-10.2] kPa, p < 0.0001). During the median follow-up period of 27.5 months (IQR, 10.6-52.4), 469 patients died (4.0%), 586 (5.0%) developed HCC, and 580 (4.9%) developed decompensation. The APRI-based DALY estimate was significantly lower in the DAA group than in the untreated group (median 4.55 vs. 5.14 years, p < 0.0001), as was the FIB-4-based DALY estimate (median 5.43 [IQR, 3.00-6.44] vs. 5.79 [3.85-8.07] years, p < 0.0001). The differences between the untreated and DAA groups were greatest in patients aged 40-60 years. In multivariable analyses, the DAA group had a significantly reduced risk of HCC, decompensation, and mortality compared with the untreated group (hazard ratios: 0.41 [95% confidence interval (CI), 0.34-0.48], 0.31 [95% CI, 0.30-0.38], and 0.22 [95% CI, 0.17-0.27], respectively; p < 0.0001).

INTERPRETATION Our findings suggest that DAA treatment is associated with the improvement of liver-related outcomes and a reduction of liver fibrosis-based disease burden in patients with HCV infection. However, further studies using liver biopsy are needed to clarify the effect of DAA treatment on the reduction in the exact fibrosis-based disease burden beyond noninvasive tests.

FUNDING The Korea Disease Control and Prevention Agency.

© 2024 The Authors. Published by Elsevier Ltd.

Keywords

Direct-acting antiviralDisease burdenHepatitis C virusLiver fibrosis

Figures

Fig. 1
Fig. 1 Flow diagram of study patients.
Fig. 2
Fig. 2 Liver-related events according to the use of DAAs in patients with chronic hepatitis C: HCC development (A), decompensation development (B), mortality (C), and the composite outcome (D). “Decompensation” was defined as one of the following manifestations: ascites, variceal hemorrhage, hepatic encephalopathy, spontaneous bacterial peritonitis, or hepatorenal syndrome. The composite outcome was determined by the development of HCC or decompensation, the receipt of liver transplantation or hepatic resection, or all-cause mortality. Abbreviations: DAA, direct-acting antiviral; HCC, hepatocellular carcinoma.

그림 출처: PubMed Central 공개 논문 (PMC11176940)

Conflict of interest statement

All authors declare no financial or non-financial competing interests.

그 밖의 정보
출판 형태
Journal Article
저널
EClinicalMedicine · eISSN 2589-5370
전자 출판
2024-05-30
참고문헌
30편