DAA Use in Hepatitis C Improves Survival for Patients with Previous Liver Cancer

Despite previous misconceptions that antiviral drugs used to treat hepatitis C virus (HCV) can be harmful to those with a history of liver cancer, a new study indicates that the drugs can actually reduce liver disease-related deaths by approximately half.

The study, published in Gastroenterology, dispels the idea that the use of direct-acting antivirals (DAAs) increases the risk of liver cancer recurrence. The findings build on a previous study led by the same researchers that confirmed the safety of DAAs in this patient population.

The researchers compared the overall survival between patients with HCV infection treated with DAAs versus patients who did not receive DAAs for the treatment of HCV. The study included a cohort of patients with HCV-related hepatocellular carcinoma (HCC) who achieved complete response to resection, local ablation, trans-arterial chemo- or radioembolization, or radiation therapy, from January 2013 through December 2017.

Of approximately 800 patients with HCV-related HCC, 48.1% received DAA therapy and 51.9% did not receive treatment. Overall, DAA therapy was associated with a significant reduction in risk of death (hazard ratio [HR], 0.54; 95% CI, 0.33-0.90), according to the study. Not only did the findings demonstrate the safety of DAAs, but the data also showed that they decreased death from cirrhosis and liver cancer by 46%, the researchers noted.

In addition, the findings demonstrated a variation in the association based on sustained virologic response (SVR) to DAA therapy, with a reduced risk of death in patients with SVR to DAA therapy (HR, 0.29; 95% CI, 0.18-0.47), but not in patients without an SVR (HR, 1.13; 85% CI, 0.55-2.33).

“Not only are these drugs safe in this patient population, but we have no demonstrated that they are helpful,” study author Amit Singal, MD, MS, associate professor of internal medicine, medical director of the UT Southwestern Liver Tumor Program, and clinical chief of hepatology, said in a press release. “Our study changes the paradigm from you could treat a patient’s hepatitis C to you should treat it.”

References

Singal A, Rich NE, Mehta N, et al. Direct-acting antiviral therapy for HCV infection is associated with increased survival in patients with a history of hepatocellular carcinoma. Gastroenterology. 2019. Doi: https://doi.org/10.1053/j.gastro.2019.07.040