Access to Direct-Acting Antivirals Improves Outcomes for Hepatitis C Patients

Jasmine Yee, BSc, PhD

Access to direct-acting antivirals (DAA) for patients with chronic hepatitis C virus (HCV) helps improve outcomes, according to a new study.

A team, led by Jasmine Yee, BSc, PhD, The Kirby Institute, UNSW Australia, assessed real-world DAA treatment outcomes across a diverse range of Australian clinical services, while evaluating the factors linked to successful treatment and loss to follow-up.

Australia is 1 of the first countries with unrestricted access to government subsidized direct-acting antiviral therapies for adults with chronic HCV.

The Study

In the Real-world Effectiveness of Antiviral therapy in Chronic Hepatitis C (REACH-C), the investigators examined data from a national observational cohort of 96 clinical services, including specialist clinics and less traditional settings, including general practices.

The team gathered data on consecutive individuals who began DAA therapy between March 2016 and June 2019 and assessed the effectiveness of the treatment by sustained virological response at least 12 weeks following treatment using intention-to-treat and per-protocol analyses.

There were 10,843 patients who initiated DAA included in the study (male 69%; ≥50 years 52%; cirrhosis 22%), with SVR data available for 85% (n = 9174) of the patients.

SVR was 81% (n = 8750) by intention-to-treat and 95% (n = 8750) by per-protocol. There was greater than 92% sustained virologic response observed across all service types and participant characteristics.

The Factors

Various factors decreased the likelihood of achieving SVR, including male gender (aOR, 0.56; 95% CI, 0.43-0.72), cirrhosis (aOR, 0.52; 95% CI, 0.41-0.64), recent injecting drug use (aOR, 0.64; 95% CI, 0.46-0.91), and previous DAA treatment (aOR, 0.50; 95% CI, 0.28-0.90).

However, other factors modified the loss to follow-up, including IDU ± opioid agonist therapy (OAT; IDU only: aOR, 1.75; 95% CI, 1.44-2.11; IDU + OAT: aOR, 1.39; 95% CI, 1.11-1.74; OAT only, aOR, 1.36; 95% CI, 1.13-1.68) and age (aOR, 0.97; 95% CI 0.97-0.98).

“Treatment response was high in a diverse population and through a broad range of services following universal access to DAA therapy,” the authors wrote. “Loss to follow-up presents a real-world challenge. Younger people who inject drugs were more likely to disengage from care, requiring innovative strategies to retain them in follow-up.”

Direct-Acting Antivirals

Earlier this year, Investigators found DAA therapy following liver surgery for hepatocellular carcinoma (HCC) caused by hepatitis C virus infections extends post-surgery survival.

A team, led by Shogo Tanaka, Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, investigators the effect of DAA-induced sustained virological response following liver resection in patients with HCV-related hepatocellular carcinoma for postoperative recurrence and survival.

In the study, the investigators examined the outcomes in 18 patients with postoperative DAA-induced SVR, compared to 23 patients with postoperative DAA-induced SVR and 10 patients who did not receive DAA therapy as a control group between September 2014 and December 2019.

A year following surgery, serum concentrations of aminotransferases improved in both the HCC-DAA and DAA-HCC groups.

In addition, there were 15 HCC-AA patients with albumin-bilirubin grade 1, an increase from 11 at baseline.

One metric that did not differ between the 3 groups was the disease-free survival rate, which was 60% at year 3 for the HCC-DAA group, 92% for the DAA-HCC group and 60% for the control group.

However, the 3-year overall survival rates were highest in the 2 study groups in comparison with the control group. The rate was 84% in the DAA-HCC group and 100% in the HCC-DAA group, compared to just 46% in the control group (all P <0.05 according to Hohn’s test).

The study, “High Effectiveness of Broad Access Direct-Acting Antiviral Therapy for Hepatitis C in an Australian Real-World Cohort: The REACH-C Study,” was published online in Hepatology Communications.