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Abstract Details
Population Impact of Direct-Acting Antiviral Treatment on New Presentations of Hepatitis C-related Decompensated Cirrhosis: A National Record-Linkage Study
Gut. 2020 Mar 26;gutjnl-2019-320007. doi: 10.1136/gutjnl-2019-320007. Online ahead of print.
Sharon J Hutchinson 1 2, Heather Valerio 3 2, Scott A McDonald 3 2, Alan Yeung 3 2, Kevin Pollock 3 2, Shanley Smith 3 2, Stephen Barclay 3 4, John F Dillon 5, Raymond Fox 6, Peter Bramley 7, Andrew Fraser 8 9, Nicholas Kennedy 10, Rory N Gunson 11, Kate Templeton 12, Hamish Innes 3 2, Allan McLeod 2, Amanda Weir 2, Peter C Hayes 13, David Goldberg 3 2
Author information
1Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK sharon.hutchinson2@nhs.net.
3Centre for Living, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.
4Glasgow Royal Infirmary, Glasgow, UK.
5Ninewells Hospital and Medical School, Dundee, UK.
6The Brownlee Centre, Glasgow, UK.
7Stirling Royal Infirmary, Stirling, UK.
8Aberdeen Royal Infirmary, Aberdeen, UK.
9Queen Elizabeth University Hospital, Glasgow, UK.
10University Hospital Monklands, Lanarkshire, UK.
11West of Scotland Specialist Virology Centre, Glasgow Royal Infirmary, Glasgow, UK.
12East of Scotland Specialist Virology Centre, Royal Infirmary of Edinburgh, Edinburgh, UK.
13Royal Infirmary of Edinburgh, Edinburgh, UK
Abstract
Objective: Population-based studies demonstrating the clinical impact of interferon-free direct-acting antiviral (DAA) therapies are lacking. We examined the impact of the introduction of DAAs on HCV-related decompensated cirrhosis (DC) through analysis of population-based data from Scotland.
Design:Through analysis of national surveillance data (involving linkage of HCV diagnosis and clinical databases to hospital and deaths registers), we determined i) the scale-up in the number of patients treated and achieving a sustained viral response (SVR), and ii) the change in the trend of new presentations with HCV-related DC, with the introduction of DAAs.
Results:Approximately 11 000 patients had been treated in Scotland over the 8-year period 2010/11 to 2017/18. The scale-up in the number of patients achieving SVR between the pre-DAA and DAA eras was 2.3-fold overall and 5.9-fold among those with compensated cirrhosis (the group at immediate risk of developing DC). In the pre-DAA era, the annual number of HCV-related DC presentations increased 4.6-fold between 2000 (30) and 2014 (142). In the DAA era, presentations decreased by 51% to 69 in 2018 (and by 67% among those with chronic infection at presentation), representing a significant change in trend (rate ratio 0.88, 95% CI 0.85 to 0.90). With the introduction of DAAs, an estimated 330 DC cases had been averted during 2015-18.
Conclusions:National scale-up in interferon-free DAA treatment is associated with the rapid downturn in presentations of HCV-related DC at the population-level. Major progress in averting HCV-related DC in the short-term is feasible, and thus other countries should strive to achieve the same.