Clinical outcomes after treatment with direct antiviral agents: beyond the virological response in patients with previous HCV-related decompensated cirrhosis
- Type de publi. : Article dans une revue
- Date de publi. : 27/01/2022
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Auteurs :
Georges-Philippe PageauxClovis Lusivika NzingaNathalie GanneDidier SamuelCéline DorivalFabien ZoulimCarole CagnotThomas DecaensDominique ThabutTarik AsselahPhilippe MathurinFrançois HabersetzerJean-Pierre BronowickiDominique GuyaderIsabelle RosaVincent LeroyOlivier ChazouilleresVictor de LedinghenMarc BourliereXavier CaussePaul CalèsSophie MetivierVéronique Loustaud-RattiGhassan RiachiLaurent AlricMoana Gelu-SimeonAnne MinelloJérôme GournayClaire GeistAlbert TranArmand AbergelIsabelle PortalLouis D’alterocheFrançois RaffiHélène FontaineFabrice CarratStanislas Pol
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Organismes :
Hôpital Saint Eloi [CHU Montpellier]
Institut Pierre Louis d'Epidémiologie et de Santé Publique
Génomique Fonctionnelle des Tumeurs Solides
Physiopathogénèse et Traitement des Maladies du Foie
Institut Pierre Louis d'Epidémiologie et de Santé Publique
Centre de Recherche en Cancérologie de Lyon
Agence Nationale de Recherches sur le Sida et les Hépatites Virales
Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble)
Centre de Recherche Saint-Antoine
Centre de recherche sur l'Inflammation
Physiopathologie des Maladies Inflammatoires de l'Intestin
Institute for Translational Research in Inflammation - U 1286
Institut de Recherche sur les Maladies Virales et Hépatiques
Imagerie Adaptative Diagnostique et Interventionnelle
Service d'Hépato-gastro-entérologie [CHRU Nancy]
Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
Nutrition, Métabolismes et Cancer
CHI Créteil
Biomécanique cellulaire et respiratoire
CHU Saint-Antoine [AP-HP]
Bordeaux Research In Translational Oncology [Bordeaux]
Hôpital Saint-Joseph [Marseille]
Centre Hospitalier Regional d'Orléans
Centre Hospitalier Universitaire d'Angers
Université d'Angers
Hémodynamique, Interaction Fibrose et Invasivité tumorales Hépatiques
Centre Hospitalier Universitaire de Toulouse
Ciblage individuel et prévention des risques de traitements immunosupresseurs et de la transplantation
Nutrition, Inflammation et axe Microbiote-Intestin-Cerveau
Institute for Research and Innovation in Biomedicine
UNIROUEN - UFR Santé
Service d'Hépato-Gastroentérologie [CHU Rouen]
Pharmacochimie et Biologie pour le Développement
Centre Hospitalier Universitaire de Toulouse
Institut de recherche en santé, environnement et travail
Lipides - Nutrition - Cancer [Dijon - U1231]
Institut des Maladies de l'Appareil Digestif
Centre hospitalier régional de Metz-Thionville
Centre Hospitalier Universitaire de Nice
CHU Estaing [Clermont-Ferrand]
Institut Pascal
Hôpital de la Timone [CHU - APHM]
CHU Trousseau [Tours]
Centre d’Investigation Clinique de Nantes
Hôpital Cochin [AP-HP]
Institut Pierre Louis d'Epidémiologie et de Santé Publique
Physiopathologie du système immunitaire
- Publié dans BMC Infectious Diseases le 01/11/2020
Résumé : BACKGROUND: In HCV-infected patients with advanced liver disease, the direct antiviral agents-associated clinical benefits remain debated. We compared the clinical outcome of patients with a previous history of decompensated cirrhosis following treatment or not with direct antiviral agents from the French ANRS CO22 HEPATHER cohort. METHODS: We identified HCV patients who had experienced an episode of decompensated cirrhosis. Study outcomes were all-cause mortality, liver-related or non-liver-related deaths, hepatocellular carcinoma, liver transplantation. Secondary study outcomes were sustained virological response and its clinical benefits. RESULTS: 559 patients met the identification criteria, of which 483 received direct antiviral agents and 76 remained untreated after inclusion in the cohort. The median follow-up time was 39.7 (IQR: 22.7-51) months. After adjustment for multivariate analysis, exposure to direct antiviral agents was associated with a decrease in all-cause mortality (HR 0.45, 95% CI 0.24-0.84, p = 0.01) and non-liver-related death (HR 0.26, 95% CI 0.08-0.82, p = 0.02), and was not associated with liver-related death, decrease in hepatocellular carcinoma and need for liver transplantation. The sustained virological response was 88%. According to adjusted multivariable analysis, sustained virological response achievement was associated with a decrease in all-cause mortality (HR 0.29, 95% CI 0.15-0.54, p < 0.0001), liver-related mortality (HR 0.40, 95% CI 0.17-0.96, p = 0.04), non-liver-related mortality (HR 0.17, 95% CI 0.06-0.49, p = 0.001), liver transplantation (HR 0.17, 95% CI 0.05-0.54, p = 0.003), and hepatocellular carcinoma (HR 0.52, 95% CI 0.29-0.93, p = 0.03). CONCLUSION: Treatment with direct antiviral agents is associated with reduced risk for mortality. The sustained virological response was 88%. Thus, direct antiviral agents treatment should be considered for any patient with HCV-related decompensated cirrhosis. TRIAL REGISTRATION: ClinicalTrials.gov registry number: NCT01953458.
Fichiers liés :
s12879-022-07076-0
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