1. Survival benefits of DAA in patients with decompensated cirrhosis
Objective
Incidence of deaths in DAA-treated patients with decompensated cirrhosis (Child-Pugh B or C) from LDV/SOF and SOF/VEL studies (SOLAR-1, SOLAR-2, ASTRAL-4, N = 463)
Comparison with the expected incidence in un-treated patients (survival model from liver transplant waitlist in the pre-DAA era: 2 cohorts, one for model development, one for model validation)
Survival Decompensated Cirrhosis
Kim WR, EASL 2018, Abs. PS-151

2. Observed versus expected deaths in DAA-treated patients
Survival benefits of DAA in patients with decompensated cirrhosis
Observed versus expected deaths in DAA-treated patients 50
100
150
200
250
300
350 10 20 30 40 60 70
p < 0.05
SMR = 0.46
Days from treatment initiation
Expected
Observed 54 25
54 deaths expected from survival mode
25 deaths observed over 1 year
Standardized mortality ratio
Survival Decompensated Cirrhosis
Kim WR, EASL 2018, Abs. PS-151

3. Observed versus expected deaths in DAA-treated patients
Survival benefits of DAA in patients with decompensated cirrhosis
Observed versus expected deaths in DAA-treated patients
Observed deaths from W12 vs expected re-calculated from W12 data update 50
100
150
200
250
300
350 10 20 30 40 60 70
p = NS
Days from treatment initiation
W12
Expected
Observed
Survival Decompensated Cirrhosis
Kim WR, EASL 2018, Abs. PS-151

4. Survival benefits of DAA in patients with decompensated cirrhosis
Conclusions
Decompensated HCV cirrhosis patients treated with LDV/SOF or SOF/VEL experienced significantly fewer deaths than predicted by the survival model
The difference became significant in less than 120 days
By the end of the first year, the risk was reduced by 54%
When the survival model was re-applied with week 12 updated data, observed and expected mortality matched, suggesting
Re-compensation following DAA therapy
SVR on DAA therapy translates in mortality benefit
A further validation of the survival model
Survival Decompensated Cirrhosis
Kim WR, EASL 2018, Abs. PS-151