Worse Outcomes for Patients Not Achieving Sustained Viral Remission After HCV Treatment

By Will Boggs MD

May 09, 2019

NEW YORK (Reuters Health) - Patients who do not achieve sustained viral remission (SVR) after completing direct-acting antiviral treatment for hepatitis C virus (HCV) infection experience worsening health-related quality of life (HRQoL), according to a registry study.

Earlier studies have demonstrated improvements in HRQoL and other patient-related outcomes during antiviral therapy for HCV and after achieving SVR. It has remained unclear how these outcomes change in patients who do not achieve SVR.

Dr. Zobair M. Younossi from Inova Fairfax Hospital, in Falls Church, Virginia, and colleagues used data from 242 patients with HCV who completed treatment in clinical trials and did not achieve SVR and who were enrolled in a long-term registry to assess long-term trends in HRQoL.

Before beginning treatment, these patients had HRQoL scores similar to those of the general U.S. population. By the end of treatment, mean scores had deteriorated by an average 3.4 to 6.2 points on a 0-100 scale (P<0.05) in five of the eight domains of SF-36, the instrument used to assess HRQoL, as had the mental component summary score.

At the time of registry enrollment, all but one domain score (general health) had returned to pretreatment baseline levels, the researchers report in Clinical Infectious Diseases, online April 5.

No HRQoL score improved relative to the pretreatment level or the registry baseline level during registry participation. By registry week 12, there were significant decreases in four domains and in both mental and physical component summary scores compared with pretreatment and in two domains compared with registry baseline levels.

There were similar decreases at weeks 24, 36, 48 and 96.

Decreases in HRQoL tended to be more pronounced in patients with cirrhosis, in patients with a pretreatment history of depression, and in patients who experienced disease progression or developed hepatocellular carcinoma while on registry.

"Retreatment of these patients will be important not only to improve their clinical outcomes but also their quality of life," the researchers conclude.

Dr. Mamta K. Jain from UT Southwestern Medical Center, in Dallas, who has studied hepatitis-C treatment, told Reuters Health by email, "It seems that those who receive one course of HCV treatment suffer emotionally and mentally if they fail to achieve SVR. We, as providers, know that there is risk of liver disease progression, but our patients may actually experience increased fear or anxiety if the treatment did not achieve a cure."

"Our patients have been told that achieving a cure is critical to preventing complications of their liver disease," she said. "This study provides additional impetus that we need to consider retreatment not just because of the clinical impact of having a cure has on the liver but because of the emotional impact of achieving a cure provides for the patient."

Dr. Jain, who was not involved in the work, added, "Insurance companies who deny retreatment for those with hepatitis C are causing both physical and emotional harm to those with HCV."

Dr. Younossi did not respond to a request for comments.

SOURCE: https://bit.ly/2VKIvWj

Clin Infect Dis 2019.