Effect of SVR on liver-related and all-cause hospitalization of patients with chronic HCV infection: The chronic hepatitis cohort study (CHECS), 2014-16.
Augustine R, Xing J, Spradling PR, Moorman AC, Rupp L, Gordon SC, Lu M, Boscarino JA, Schmidt MA, Daida Y, Holmberg SD, and Teshale EH. Effect of SVR on liver-related and all-cause hospitalization of patients with chronic HCV infection: The chronic hepatitis cohort study (CHECS), 2014-16. Hepatology 2018; 68:906A-907A.
Background: Chronic hepatitis C virus (HCV) infection can lead to increased hospitalization. Direct-acting antivirals (DAA) result in sustained virologic response (SVR) in >90% of treated patients and are associated with reductions in morbidity and mortality. The objective of this analysis was to determine the effect of SVR on hospitalization rates in patients treated with DAA. Methods: Pre-and post-SVR all-cause hospitalization rates per 100 person-years (PHPY) were calculated and compared overall and among certain subgroups of HCV mono-infected patients from four large US health systems with SVR during 2014-2016. Pre-SVR follow-up was defined as starting from 01/01/2013 or the time the patient entered the study to the start of their last treatment. Post-SVR follow-up started at the achievement of SVR, ending at earliest of last visit or 12/31/2016. Causes of hospitalization were sorted into three categories: liver-related; cardiovascular-, diabetes-, and renal-related (CDR-related); and all others. Liver transplant recipients during 2013-2016 were excluded. Results: Among 2384 patients treated with DAA who achieved SVR during 2014-2016, 936 (39.3%) were female, 1782 (74.7%) aged 46-65 years, 1187 (50.6%) had private insurance, and 361 (15.1%) had a mean Fib4 score >5.88 (indicative of cirrhosis) within one year prior to treatment. The overall post-SVR hospitalization rate was 11.7 (95% confidence interval [CI]: 10.3-13.2) PHPY, compared to 10.7 (95% CI: 9.6-12.0) PHPY pre-SVR, relative risk (RR) of 1.1 (p=0.33). Incidence of all non-liver and non-CDR-related hospitalization pre-vs. post-SVR were the only statistically significant increase (RR=1.2 [p=0.047]); there was a slight reduction in liver-related and CDR-related hospitalizations post-SVR (RR=0.6 [p=0.105] and RR=0.9 [p=0.720], respectively) (Table). In multivariable analysis, patients with the following clinical and demographic characteristics had a significantly higher incidence of allcause hospitalization post-vs. pre-SVR: one study site (15.8 vs. 12.4 PHPY); males (13.1 vs. 10.3 PHPY); those with 3.25≤FIB4≤5.88 (19.1 vs. 10.1 PHPY); those with Fib4≥5.88 (36.8 vs. 15.7 PHPY); and those with cancers other than hepatocellular carcinoma (54.1 vs. 17.5 PHPY) (Table). Conclusion: The overall hospitalization rate increased after SVR, mostly due to non-liver and non-CDR related causes. The highest increase was among persons in the highest FIB4 categories and those with cancers. This observation may be related to increasing age and comorbidities of the cohort. Treating everyone with chronic hepatitis C as early as possible will likely maximize the beneficial effect of SVR as a result of effective DAA treatment.