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Clinical outcome after SVR: Veterans Affairs

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Presentation on theme: "Clinical outcome after SVR: Veterans Affairs"— Presentation transcript:

1 Clinical outcome after SVR: Veterans Affairs
Design Observational cohort (Veterans Affairs Registry) All patients treated with DAA, separated in 2 groups No advanced liver disease: FIB-4 ≤ 3.25 and absence of cirrhosis, liver decompensation, HCC or liver transplant Advanced liver disease: FIB-4 > 3.25 Overall all-cause mortality and incident HCC: rate per 100 patient-years of follow-up 1 year-mortality and incident HCC after end of treatment (censoring date May 31, 2016) Kaplan-Meier curves of survival and of HCC-free survival by SVR compared with log-rank tests Mortality and incident HCC rates compared with Exact Poisson test One-year mortality and HCC rates compared with proportion tests Cox proportional hazard models to identify predictors of mortality and the impact of SVR Veterans Affairs Backus L, AASLD 2017, Abs. 78

2 Clinical outcome after SVR: Veterans Affairs
Baseline characteristics Advanced liver disease No advanced liver disease No SVR N = 1 067 SVR N = N = 1 308 N = Mean age, years 62 63.2 * 60.3 61.2 * Female, % 2 3 4 African American / Caucasian, % 28 / 56 31 / 55 43 / 45 38 / 52 * History of decompensation, % 35 25 * - Alcohol abuse, % 30 21 * 27 Hard drug use, % 16 11 * 21 14 * Albumin (g/dL), mean 3.4 3.6 * 3.9 4.0 * Platelet count (x 109/L), mean 105 116 * 220 LDV/SOF regimen, % 58 60 64 65 Mean follow-up, days 542 595 * 458 499 * Death during follow-up, % 18.3 4.3 3.6 1.6 * p < vs no SVR Veterans Affairs Backus L, AASLD 2017, Abs. 78 2

3 Clinical outcome after SVR: Veterans Affairs
Survival curves for patients with advanced liver disease with and without SVR SVR No SVR All-cause mortality free survival HCC disease free survival 0.4 0.6 0.8 1.0 0.5 1 1.5 2 Log rank p-value < 0.001 0.7 0.8 0.9 1.0 0.5 1 1.5 2 Log rank p-value < 0.001 Years since end of DAA treatment Years since end of DAA treatment No SVR SVR 1 067 13 992 923 12 939 650 9 521 326 5 437 105 1 875 No SVR SVR 1 067 13 992 923 12 939 650 9 521 326 5 437 105 1 875 Veterans Affairs Backus L, AASLD 2017, Abs. 78

4 Clinical outcome after SVR: Veterans Affairs
All cause-mortality for patients with no advanced liver disease with and without SVR SVR No SVR Overall FIB-4 : FIB-4 < 1.45 0.5 1 1.5 2 Years since end of DAA treatment 0.9 0.925 0.95 0.975 p < 0.001 Years since end of DAA treatment 0.5 1 1.5 2 0.9 0.925 0.95 0.975 p < 0.001 0.5 1 1.5 2 Years since end of DAA treatment 0.9 0.925 0.95 0.975 p < 0.026 No SVR SVR 1 306 29 918 1 209 38 143 741 25 126 406 15 308 91 8 537 No SVR SVR 819 25 457 745 24 412 404 16 808 242 10 084 55 5 530 No SVR SVR 489 14 461 448 13 737 196 9 318 90 5 221 -inf 3 007 Veterans Affairs Backus L, AASLD 2017, Abs. 78

5 Clinical outcome after SVR: Veterans Affairs
Mortality and incident HCC rates in patients with advanced liver disease No SVR N = 1 067 SVR N = Reduction with SVR p Deaths/100 patient-years (95% CI) Total Genotype 1a Genotype 1b Genotype 2 Genotype 3 No HCC prior to DAA HCC prior to DAA 12.3 ( ) 12.8 ( ) 11.2 ( ) 9.9 ( ) 12.8 ( ) 10.1 ( ) 21 ( ) 2.6 ( ) 2.6 ( ) 2.5 ( ) 2.7 ( ) 3.3 ( ) 2.3 ( ) 7.5 ( ) 78.9% - 77.2% 64.3% < 0.001 1-year mortality rate (95% CI) 11.3 ( ) 2.3 ( ) 79.6% HCC/100 patient-years (95% CI) * 11.5 ( ) 1.9 ( ) 83.5% 1-year HCC rate (95% CI) 9.4 ( ) 1.9 ( ) 79.8% * Excludes patients with HCC prior to DAA initiation and HCC diagnosis while on DAA or ≤12 weeks after DAA completion Veterans Affairs Backus L, AASLD 2017, Abs. 78 5

6 Clinical outcome after SVR: Veterans Affairs
Mortality rates in patients with no advanced liver disease No SVR N = 1 308 SVR N = Reduction with SVR p Deaths/100 patient-years (95% CI) Total Genotype 1a Genotype 1b Genotype 2 Genotype 3 FIB-4 < 1.45 FIB 2.87 ( ) 2.21 ( ) 2.90 ( ) 6.44 ( ) 3.12 ( ) 2.08 ( ) 3.36 ( ) 1.18 ( ) 1.14 ( ) 1.27 ( ) 1.32 ( ) 0.91 ( ) 1.13 ( ) 1.21 ( ) 58.9% - 45.7% 64.0% < 0.001 0.04 Multivariate model of all-cause mortality after SVR, HR (95% CI) Advanced liver disease p No advanced liver disease 0.27 ( ) < 0.001 0.44 ( ) Variables selected a priori : age, gender, race/ethnicity, BMI, HIV, comorbidities, albumin, eGFR, genotype and SVR status Advanced liver disease model included history of liver decompensation Non-advanced liver disease model included FIB-4 strata and achievement of HCV RNA < LLOQ on treatment Veterans Affairs Backus L, AASLD 2017, Abs. 78 6

7 Clinical outcome after SVR: Veterans Affairs
Conclusions SVR after DAA was associated with Significant lower all-cause mortality, regardless of genotype Reduction of risk of 78.9% in patients with advanced chronic liver disease Reduction of risk of 58.9% in patients with non-advanced chronic liver disease Significant lower incidence of HCC Reduction of risk of 83.5% Veterans Affairs Backus L, AASLD 2017, Abs. 78


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