Mortality rates among patients successfully treated for hepatitis C in the era of interferon-free antivirals: population based cohort study


Hamill, Victoria, Wong, Stanley, Benselin, Jennifer, Krajden, Mel, Hayes, Peter C, Mutimer, David, Yu, Amanda, Dillon, John F, Gelson, William, Garcia, Hector A Velasquez et al (show 21 more authors) (2023) Mortality rates among patients successfully treated for hepatitis C in the era of interferon-free antivirals: population based cohort study. BMJ-BRITISH MEDICAL JOURNAL, 382. e074001-.

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Abstract

<h4>Objectives</h4>To quantify mortality rates for patients successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals and compare these rates with those of the general population.<h4>Design</h4>Population based cohort study.<h4>Setting</h4>British Columbia, Scotland, and England (England cohort consists of patients with cirrhosis only).<h4>Participants</h4>21 790 people who were successfully treated for hepatitis C in the era of interferon-free antivirals (2014-19). Participants were divided into three liver disease severity groups: people without cirrhosis (pre-cirrhosis), those with compensated cirrhosis, and those with end stage liver disease. Follow-up started 12 weeks after antiviral treatment completion and ended on date of death or 31 December 2019.<h4>Main outcome measures</h4>Crude and age-sex standardised mortality rates, and standardised mortality ratio comparing the number of deaths with that of the general population, adjusting for age, sex, and year. Poisson regression was used to identify factors associated with all cause mortality rates.<h4>Results</h4>1572 (7%) participants died during follow-up. The leading causes of death were drug related mortality (n=383, 24%), liver failure (n=286, 18%), and liver cancer (n=250, 16%). Crude all cause mortality rates (deaths per 1000 person years) were 31.4 (95% confidence interval 29.3 to 33.7), 22.7 (20.7 to 25.0), and 39.6 (35.4 to 44.3) for cohorts from British Columbia, Scotland, and England, respectively. All cause mortality was considerably higher than the rate for the general population across all disease severity groups and settings; for example, all cause mortality was three times higher among people without cirrhosis in British Columbia (standardised mortality ratio 2.96, 95% confidence interval 2.71 to 3.23; P<0.001) and more than 10 times higher for patients with end stage liver disease in British Columbia (13.61, 11.94 to 15.49; P<0.001). In regression analyses, older age, recent substance misuse, alcohol misuse, and comorbidities were associated with higher mortality rates.<h4>Conclusion</h4>Mortality rates among people successfully treated for hepatitis C in the era of interferon-free, direct acting antivirals are high compared with the general population. Drug and liver related causes of death were the main drivers of excess mortality. These findings highlight the need for continued support and follow-up after successful treatment for hepatitis C to maximise the impact of direct acting antivirals.

Item Type: Article
Uncontrolled Keywords: Humans, Hepacivirus, Hepatitis C, Hepatitis C, Chronic, Liver Cirrhosis, Interferons, Antiviral Agents, Cohort Studies, End Stage Liver Disease
Divisions: Faculty of Health and Life Sciences
Faculty of Health and Life Sciences > Institute of Systems, Molecular and Integrative Biology
Depositing User: Symplectic Admin
Date Deposited: 21 Sep 2023 14:34
Last Modified: 19 Mar 2024 11:48
DOI: 10.1136/bmj-2022-074001
Open Access URL: https://www.bmj.com/content/bmj/382/bmj-2022-07400...
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URI: https://livrepository.liverpool.ac.uk/id/eprint/3172940
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